In otherwise healthy women, trans men, and non-binary people registered female at birth aged 45 or over with menopause-associated symptoms, perimenopause and menopause can be identified without laboratory tests NICE NG23. Perimenopause is identified if there are recently started vasomotor symptoms and any changes in menstrual cycle NICE NG23. Menopause is identified if there has been no period for at least 12 months and hormonal contraception is not being used NICE NG23. In individuals who have had a hysterectomy, menopause is identified based on symptom type and combination, such as vasomotor symptoms NICE NG23.
For individuals aged 40 to 45 with menopause-associated symptoms, including a change in their menstrual cycle, a serum FSH level can be considered to confirm menopause NICE NG23. For individuals under 40 where menopause is suspected, a serum FSH level can also be considered NICE NG23. However, a single blood test is not sufficient for diagnosing premature ovarian insufficiency NICE NG23. Premature ovarian insufficiency in individuals under 40 is diagnosed based on menopause-associated symptoms, including absent or infrequent periods, and elevated FSH levels on two blood samples taken 4 to 6 weeks apart NICE NG23. Anti-Müllerian hormone testing is not routinely used to diagnose premature ovarian insufficiency NICE NG23.
Laboratory and imaging tests such as anti-Müllerian hormone, inhibin A, inhibin B, oestradiol, antral follicle count, and ovarian volume are not used to identify perimenopause or menopause in individuals aged 45 or over NICE NG23. A follicle-stimulating hormone (FSH) blood test should not be used to identify menopause in individuals using combined oestrogen and progestogen contraception or high-dose progestogen NICE NG23.
For women concerned about fertility with regular monthly menstrual cycles, they are likely to be ovulating NICE CG156. For women undergoing infertility investigations with regular menstrual cycles, a blood test to measure serum progesterone in the mid-luteal phase (day 21 of a 28-day cycle) should be offered to confirm ovulation NICE CG156. Women with prolonged irregular menstrual cycles should be offered a blood test to measure serum progesterone, potentially repeated weekly until the next menstrual cycle starts NICE CKS. Serum gonadotrophins (FSH and LH) measurements are valuable in women with anovulation or oligo-ovulation and can identify ovulation disorders NICE CKS. Thyroid function tests should be confined to women with symptoms of thyroid disease NICE CKS. Prolactin measurement should only be offered to women with an ovulatory disorder, galactorrhoea, or a suspected pituitary tumour NICE CKS.