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Menopause - general diagnostic advice for professionals and patients

The Menopause

The menopause is when a woman stops having periods and is no longer able to get pregnant naturally.

Periods usually start to become less frequent over a few months or years before they stop altogether; in some patients they can stop suddenly.

The menopause is a natural part of ageing that usually occurs between 45 and 55 years of age, as a woman's oestrogen levels decline. In the UK, the average age for a woman to reach the menopause is 51, this means that half of women will have their menopause before 51 and half after.

Around 1 in 100 women experience the menopause before 40 years of age. This is known as premature menopause or premature ovarian insufficiency.

Symptoms of the menopause

Most women will experience symptoms at the menopause. Some of these can be quite severe and have a significant impact on your everyday activities.

Common symptoms include:

  • hot flushes

  • night sweats

  • vaginal dryness and discomfort during sex

  • difficulty sleeping

  • low mood or anxiety

  • reduced sex drive (libido)

  • problems with memory and concentration

Menopausal symptoms can begin months or even years before the periods stop and last around four years after the last period, although some women experience them for much longer.

When should the patient consult their GP?

If the symptoms are very troublesome the patient should consult their doctor. If menopause occurs younger than 40 years of age the doctor may do tests to diagnose the menopause as well as determine the cause. If the patient has symptoms between the age of 40 and 45 it is often worth discussing them with their GP.

National Institute for Clinical Excellence (NICE) advice on diagnosing menopause.

NICE provide guidance on diagnosing menopause and perimenopause (NG23 November 2015). This is a brief note on what you may expect from the consultation whether you are the patient or doctor. Most people do not need a consultation but if necessary it will very often be a general practitioner who is consulted.

1. In otherwise healthy women over 45 years of age with menopausal symptoms the following can be diagnosed without the use of laboratory tests:

  • Perimenopause - base this on vasomotor symptoms and irregular periods.

  • Menopause - in women who have not had a period for at least 12 months and are not using hormonal contraception

  • Menopause - in women without a uterus this should be based on symptoms

2. It can be difficult to diagnose menopause in women who are taking hormonal treatment, eg for the treatment of heavy periods.

3. In women over 45 years of age the following tests should not be used to diagnose perimenopause or menopause:

  • anti-Müllerian hormone

  • inhibin A

  • inhibin B

  • oestradiol

  • antral follicle count

  • ovarian volume.

4. Your doctor should not use a serum follicle-stimulating hormone (FSH) test to diagnose menopause in women using combined oestrogen and progestogen contraception or high-dose progestogen.

An FSH test should only be considered to diagnose menopause:

  • in women aged 40 to 45 years with menopausal symptoms, including a change in their menstrual cycle

  • in women aged under 40 years in whom menopause is suspected.

Every effort is made to ensure that this health and medication advice is accurate and up to date. It is for information only and supports your consultation it does not obviate the need for that consultation and should not replace a visit to your doctor or health care professional.

The written advice is general in nature and in is not specific to individual patients and Dr Philip Kelly cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages contained in any external link.

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