investigations for menopause?

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 ². Perimenopause is identified if there are recently started vasomotor symptoms and any changes in menstrual cycle ². Menopause is identified if there has been no period for at least 12 months and hormonal contraception is not being used ². In individuals who have had a hysterectomy, menopause is identified based on symptom type and combination, such as vasomotor symptoms ².

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 ². For individuals under 40 where menopause is suspected, a serum FSH level can also be considered ². However, a single blood test is not sufficient for diagnosing premature ovarian insufficiency ². 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 ². Anti-Müllerian hormone testing is not routinely used to diagnose premature ovarian insufficiency ².

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 ². 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 ².

For women concerned about fertility with regular monthly menstrual cycles, they are likely to be ovulating ⁴. 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 ⁴. 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 ³. Serum gonadotrophins (FSH and LH) measurements are valuable in women with anovulation or oligo-ovulation and can identify ovulation disorders ³. Thyroid function tests should be confined to women with symptoms of thyroid disease ³. Prolactin measurement should only be offered to women with an ovulatory disorder, galactorrhoea, or a suspected pituitary tumour ³.