How is menopause diagnosed?
How does it start?
The onset of menopause can manifest itself through various symptoms. Sometimes it starts with cycle irregularities, but also other symptoms such as hot flushes or sleep disorders can predominate. Some women don’t note any changes in their menstruation while already experiencing one or various other menopausal symptoms. It is important to keep track of menstrual cycles and any other changes or irregularities.
Other common symptoms are mood swings, vaginal dryness and decreased interest in sex. If a woman experiences these symptoms, it may indicate the beginning of menopause. Many women with menopausal symptoms do not need treatment. However, this is an excellent time for a medical examination and consult with a healthcare professional who can provide appropriate support and information about menopause and effective therapy options.
What is Menopause Rating Scale?
It is important that physicians understand which menopausal symptoms have the biggest impact on women´s daily life but some women may struggle to describe the severity of their symptoms. Different women tolerate the discomfort to various extent, and many can tolerate quite severe symptoms before considering medication.
In Switzerland, the questionnaire “Menopause Rating Scale” is often used to evaluate symptoms and the woman can complete it by herself. She will judge the severity of her own symptoms by scores starting with 0 (no symptoms), 1 (mild), 2 (moderate), 3 (severe) and 4 (extremely severe). These symptoms include flushes and sweating, heart troubles, sleep disorders, depressive mood, irritability, anxiety, physical and mental exhaustion, sexual and urinary problems, vaginal dryness, and joint and muscle complaints. The women can also rate the severity of weight and skin changes and headaches.
The physician may also use this questionnaire at subsequent follow-up visits to decide whether the symptoms alleviated or worsened. Based on this, they can adapt therapy or advise some changes in a woman´s lifestyle.
If it is not menopause, what could it be?
Sometimes women experience symptoms that resemble menopause, but it might be something else. While hot flushes and night sweats are common symptoms of menopause, they can also be signs of other health issues, some of them even serious. The most common conditions that may be mistaken for menopause are thyroid disease, depression, anemia, diabetes, cancer, sleep apnea or systemic inflammatory disorders such as rheumatoid arthritis. Medication, for example some anti-depressants, may also cause hot flushes.
How can a woman know if the symptoms are menopause or something else? The first step is talking to the physician and explaining the symptoms. If a woman feels a low mood or anxiety, the physician will evaluate whether this is related to depression or anxiety itself or caused by the lack of estrogen. Factors such as a history of depression or elevated FSH levels can aid in finding the reason. Hair loss, another symptom of menopause, could be a sign of iron deficiency or hypothyroidism.
What kind of assessments are needed for diagnosis?
During a medical evaluation, a healthcare professional will inquire about a woman's medical history and relevant health conditions, in addition to the present menopause symptoms. In some cases, the physician will perform a pelvic exam to check for any signs of reproductive health issues. They may also evaluate other symptoms, such as changes in the breasts or skin.
Laboratory tests are not necessarily essential to confirm menopause and symptom scoring is mainly used for diagnosis, for example with the “Menopause Rating Scale”. However, in certain situations, the doctor might suggest blood tests to measure hormone levels, such as follicle-stimulating hormone (FSH) and estradiol. These tests can help determine if a woman is going through menopause.
When are hormone tests helpful?
For most women who have symptoms at the typical age of menopause (over 45 years), a measurement of hormone levels is not necessary to confirm menopause. In the perimenopause, a single measurement of oestradiol and FSH is not sufficient for diagnosis, as hormone levels can fluctuate widely. Even if a woman experiences hot flushes and changes in period rhythm, a low FSH level does not necessarily mean that she has not yet entered the menopause.
For women who experience menopausal symptoms at a younger age (before 40), the doctor may perform additional medical tests to determine the underlying cause. To diagnose premature ovarian failure (early menopause), FSH levels need to be measured at two different time points 4-6 weeks apart.
What is follicle-stimulating hormone or FSH?
FSH is a hormone that is released by the pituitary gland into the bloodstream and stimulates the ovaries to produce estrogen. During menopause, the ovaries stop working and the FSH levels increase, and estrogen levels decrease.
What about home hormone tests?
Over-the-counter tests, such as salivary hormone level tests or urine tests that measure FSH levels, are expensive and not accurate or recommended for confirming menopause. Consultation with a healthcare professional is necessary for an accurate assessment and appropriate management of menopause symptoms.
