How will you know that you are in menopause? This was a million-dollar question that an acquaintance asked me the other day. It isn’t unknown that when your periods have stopped for twelve consecutive months, that’s an indication the transition phase is over and you have entered menopause. Adding to this are other things like your age, 51 being the average menopausal age in the United States. But is that all?
Aren’t there any tests that would officially confirm menopause? A friend of mine, a medical practitioner, once said that in most cases, laboratory tests aren’t needed to diagnose menopause. Your symptoms are the biggest indication. She even said that when patients below 40 come with menopause-like symptoms, it’s then that we prescribe bloodwork to confirm if the symptoms are due to menopause or any underlying condition.
For me, my symptoms were enough to confirm that I had crossed the menopausal stage. Yet, the doctor suggested a few bloodwork to confirm the diagnosis.
So, are you worried about how to confirm your menopause? Have you been advised of blood tests, the names of which sound like jargon to you? This article will be of help. Here, I will discuss the ways to understand that you are experiencing menopause. I have mentioned some of the probable tests that could indicate if you have reached menopause or not. So, stay hooked on my write-up to know more.
How to Tell You Are Transitioning into Menopause?
Well, even before you head to the doctor, your bodily changes and symptoms will give you a hint that things are not the way they should be. I understood something was wrong when my periods started getting irregular, followed by hot flashes.
The theory is that as you enter your 40s and go through the perimenopause phase, your estrogen levels will act a little weird. There’s a decline in its levels. However, the fluctuations do not happen regularly or consistently.
You may feel the effect on your menstrual cycle. It will be inconsistent. In some months, you’ll bleed heavily. While in some cycles, the bleeding could be scanty. You might even go without periods for a couple of cycles. That’s exactly my story. One month, I would bleed so heavily that it would drain me completely. The next month, I would barely have much flow during my menses.
If your menstrual cycle is preponed or postponed by about seven days, you could be in your early perimenopause. Whereas, if the gap between your periods is 60 days or greater than that, then late perimenopause has set in.
You may even start experiencing hot flashes marked by a feeling of warmth on the chest, face, and neck. The reason for the same is the reduced estrogen levels as well. It’s the most common symptom of menopause, seen in over 75 – 80 % of women; on average, -8 of 10 women, to be more specific.
You could even find yourself more prone to vaginal infections and urinary incontinence. Blame it again on the low estrogen levels. Did you know around 60% of menopausal women go through urogenital symptoms?
You’ll eventually begin experiencing low fertility levels. So planning a family then could be pretty challenging, not impossible, though. You may even experience bone loss, skin changes, hair thinning, low mood, lack of sleep, weight gain, etc.
Before you stress, you may not experience all of these symptoms together. The intensity and occurrences vary from one woman to the other. For instance, some women may struggle to deal with urinary problems, while a few may be troubled with irregular menses. I had more sleep issues and hot flashes. My friend was tormented with vaginal dryness and mood swings.
As you start getting close to the menopause phase, the frequency of your periods lessens. You could go for months without periods. When you have not had your periods continuously for twelve whole months, that means menopause has started.
Now that is the way you can detect that you have entered into the menopause phase. But that isn’t enough. You need to know whether all the changes you have encountered are because of menopause or if there is any other reason behind the same. In the following section, let us take a look at the ways or tests that may help in determining or confirming menopause.
Tests to Determine Menopause: Are They Any?
In most cases, menopause may be diagnosed through the symptoms themselves without any formal tests. However, if you are going through bothersome symptoms that come in the way of your daily living, it is always advisable to speak to a healthcare provider. He will ask you several questions to conclude. These will include:
- Your age
- Your symptoms
- Details about your menstrual cycle (the flow, the irregularity of your periods)
- Any underlying health conditions
- The supplements or medications you take (if any)
Based on your answers, your doctor will evaluate your condition. He may even advise some bloodwork. This is to rule out the fact that the symptoms are because of menopause and not other medical conditions.
1. Vaginal Swab
Your healthcare provider may do a swab test of your vagina to check the pH levels. In the reproductive years, the pH level of your vagina is between 4.0 and 4.5. As you near menopause, the levels may rise to 6.0 or as much as 7.5.
However, it is important to know that there are other reasons for an elevated vaginal pH level. Bacterial vaginosis is one of them. It happens when there is an increased bacterial infestation in the vagina. If that’s the case, then you may experience other symptoms also. These include burning, vaginal pain, itching, white discharge, etc.
If a bacterial infection isn’t the reason, it could be due to menopause, especially if you have reached menopausal age.
2. FSH (Follicle Stimulating Hormone)Test
This is one of the significant ways to determine menopause. My doctor suggested this bloodwork. Follicle-stimulating hormones play a significant role in a woman’s menstrual cycle. It even helps in stimulating the egg’s growth in the ovary. FSH plays a significant role in men as well. It helps in controlling sperm production. Here is a detailed analysis of the FSH levels in women in different stages of their life.
| Stages | FSH levels |
|---|---|
| Before puberty | 0 - 4.0 mIU/mL |
| During puberty | 0.3 - 10.0 mIU/mL |
| After puberty (in menstruating women) | 4.7 - 21.5 mIU/mL |
| In menopause | 25.8 - 134.8 mIU/mL |
So from this table, it is quite clear that menopause leads to high levels of FSH. So, if you have not had your periods for 12 months, you can get your FSH checked if the doctor advises of the same. When the hormone levels are consistently high, and there are no periods, it could mean that menopause has set in. That’s how it was for me. However, the results of FSH could be misleading in perimenopause. This is because of the fluctuating hormone levels, transitioning from high to low.
3. Estradiol Tests
If your menses have paused, and you experience other menopausal symptoms, then your doctor might also advise you to take a test to check the estradiol levels (E2). If you are in the menopause transition phase or already in menopause, then under such circumstances, your body will have low estradiol levels.
This test even helps in understanding how well your ovaries are working. So if you are below 40, and your periods have stopped, an estradiol test might help determine if you have a tumor in your ovaries or not. It could even be a case of premature menopause, which happens before the age of 40.
For women who are still menstruating, their estimated estradiol levels are 15-350 pg/mL. For women who have already had menopause and are in the postmenopause phase, the levels could be as low as 10 pg/m.
4. AMH (Anti-Müllerian Hormone) Test
One of the basic purposes of the AMH test is to check the number of eggs the ovaries have. If you are in the menopause transition (perimenopause) stage or have already hit the menopause phase, then the egg supply declines. A reduction in eggs in your ovaries means a dip in the AMH levels.
If you are less than 40 or 45 and aren’t having your periods anymore, then AMH may help detect if you are having premature or early menopause. Based on this test, your doctor may even prescribe other tests to check for any underlying conditions.
5. Luteinizing Hormone (LH) Test
The pituitary gland produces the luteinizing hormones. They play a significant role in maintaining the reproductive system of the body. When LH levels are excessively high, it could indicate that you are in the menopause phase.
If you are above 45 and have all the symptoms of menopause alongside stopped periods, then the LH levels test, alongside other tests, could mean that menopause has begun. Let’s take a look at how the LH hormones in women should be in different stages.
| Stages | LH levels |
|---|---|
| Menstrual cycle (Follicular phase) | 1.68 - 15 IU/mL |
| Menstrual cycle (Mid-cycle phase) | 21.9 - 56.6 IU/mL |
| Menstrual cycle (Luteal phase) | 0.61- 16.3 IU/mL |
| Postmenopause stage | 14.2 - 52.3 IU/mL |
High LH levels also indicate other conditions, like polycystic ovary syndrome or pituitary disorder.
6. Progesterone Levels Test
Besides estrogen, progesterone is another significant hormone responsible for reproduction and menopause as well. In the menopause transition phase, the estrogen and progesterone go through a rise-and-fall cycle.
As menopause means that you aren’t ovulating anymore, it will lead to a drop in your progesterone levels. In menopausal women, the progesterone levels are around 0.20 ng/mL. It could be even less than this.
7. Thyroid Stimulating Hormone (TSH) Test
No, this isn’t a test for menopause. Rather, it helps to determine if the symptoms you are experiencing are because of menopause or thyroid problems. Certain symptoms of hypothyroidism can mimic the signs of menopause, including hot flashes, insomnia, palpitations, weight gain, concentration problems, sleep problems, etc. That’s what happened to a friend. She felt it was menopause due to the hot flashes and night sweats she frequently had. However, it was an underactive thyroid gland that was causing the trouble.
So to rule out that your irregular periods and the associated symptoms aren’t because of thyroid problems, your doctor may ask you to test the TSH levels.
FAQs
For the estradiol levels, a urine or blood sample is needed if doing it at the doctor’s place. But, if doing it at home, a saliva sample is needed. To test the FSH levels in a laboratory blood sample is required. For a home test a urine sample would suffice. The AMH and LH levels test also needs a blood sample. You would only need a urine sample when testing the LH levels at home.
Suppose you are being bothered by the symptoms and also haven’t had periods for quite long, close to a year. Then, doing a test at home would give you an insight into the status of your hormone levels.
You could check your FSH, LH, and estradiol levels at home. However, the home tests may not determine if you are in the menopause transition phase or the menopause stage. To get confirmation about the same, you will have to visit the doctor. Also, the healthcare provider will be able to determine if the symptoms you are facing are due to menopause or any underlying health issues. Even if you do tests at home, it is essential to go to the doctor to get a confirmation.
Yes, the tests to detect premature or early menopause are the same as the ones to identify perimenopause and menopause. Your doctor will advise bloodwork to test your FSH levels, estradiol, and LH hormones. He may even advise a test to check your sugar and thyroid levels. This is to ensure that the symptoms aren’t happening due to other underlying conditions.
Yearly screenings are a mandate for menopausal women since they are at risk of uterine, breast, and ovarian cancers alongside other conditions. Some of the screening tests that are mandated to be done include:
• Mammogram (to detect breast tumors)
• Bone density test
• Pap smear (to determine cervical cancer)
• Colonoscopy (for colon cancer)
• Tests for blood sugar and cholesterol
• Blood pressure monitoring
This has been my doctor’s advice as well. She advised me to have a mammogram screening every two years or earlier if I spotted anything unusual. I follow her advice to the tee. I even take care of getting checked regularly for my other parameters.
Conclusion
Blood tests are mostly done to validate the fact that the bodily changes you are undergoing, alongside the irregular periods, are pointing towards menopause. However, the tests would yield better results when your periods have stopped completely for a year. If you are in the perimenopause stage, where your hormones keep fluctuating every other day, you may not get accurate results.
If your body condition and the tests confirm that you are in menopause, then you must take extra care of yourself. Follow a proper diet, exercise regularly, and take care of your emotional well-being.
Menopause doesn’t have a treatment. Lifestyle changes and regular exercise helped me immensely. You could consult the doctor to manage symptoms like anxiety, hot flashes, sleep problems, etc. He may also prescribe medications if you find it troublesome to deal with them.
References:
- https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
- https://www.nia.nih.gov/health/what-menopause
- https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/premature-and-early-menopause
- https://medlineplus.gov/lab-tests/anti-mullerian-hormone-test/
- https://medlineplus.gov/lab-tests/follicle-stimulating-hormone-fsh-levels-test/#:~:text=What%20happens%20during%20an%20FSH,a%20test%20tube%20or%20vial.
