How to diagnose Menopause

A key question many women have is when they will start (peri) menopause and/or if the symptoms they’re experiencing are due to the hormonal changes that come with the Menopause transition. Both are very valid questions and we’ll do our best to answer them.

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How do I know if I have started Menopause?

The word Menopause comes from the Greek words 'menos', meaning month, and 'pause', meaning to cease. It refers to the cessation of your monthly ovulation cycle. It’s a single point in time when a woman has not had her period for 12 consecutive months and therefore it’s a (easy!) self-diagnosis made in hindsight. 

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However, often times when speaking about “menopause” what is really meant is the phase leading up to it when symptoms emerge and are often at its worst. This phase, Perimenopause, in simple terms, means around menopause (peri- around). This is when your ovaries gradually stop working,  estrogen production decreases and your hormones start to fluctuate causing up to 34 symptoms. 

Diagnosing peri-menopause is usually done by a medical professional based on a combination of your age and the symptom(s) you are experiencing. The onset of peri-menopause is typically in your mid forties and for most women the first symptom they will notice is an irregular menstrual cycle (read more on that here).  

You are not required to speak to a doctor when going through the menopause transition but at this point it is a good idea to speak to one if any of the following apply to you:

• you want or need treatment for your symptoms, 
• you are trying to get pregnant or still want to have children, or 
• you have a complex medical history, atypical symptoms, or are much younger/ older than the average onset (before 42 or after 52). 
• you have questions or concerns or want to know how to prepare yourself best for what is to come. 

So how are symptoms diagnosed?

A logical next question is how the individual symptoms are diagnosed, what type of (lab) testing is required and which doctor should you go see?

The 34 symptoms that you may experience at some point during the Menopause transition can be divided into two buckets: 

• Physical symptoms:  like Hot flashes, Bloating, Hair thinning, Skin Issues, Vaginal and Urinary symptoms, Osteoporosis and Joint & Muscle Pain. 
• Mental and emotional symptoms such as Brain Fog, Depression, Anxiety, Irritability and Panic attacks. 

All of these symptoms, including the vast majority of the physical symptoms, are diagnosed based on “patient self-reporting”. Your doctor may ask you specific additional questions to better understand the severity and make a diagnosis. If you want to have a better understanding of how specific symptoms are diagnosed, have a look at the section “diagnosis” on each of our symptom fact sheets. 

 There are few exceptions where laboratory tests are required:

• UTIs - routine laboratory tests using your urine
• Osteoporosis - may require DEXA scans and/or routine blood tests
• Heart palpitations - may require tests like wearing a heart monitor for a few days

Lastly, depending on your symptoms and medical history your doctor may ask for laboratory tests to exclude other potential underlying factors such as a thyroid disease. 

Wait, a doctor doesn't need to test my hormone levels?‍

The answer is simple: No.  Hormone testing is not required to determine if a woman is in peri-menopause nor is it required for treatment. Even when prescribing Hormone Replacement Therapy (read more on that here) it is not required to know exact levels of estrogen or other hormones. 

This may seem counterintuitive as it would seem logical to try and replace the exact amount of hormones that your body is no longer naturally producing in order to avoid symptoms. However, when it comes to our hormone levels an optimal level where your body functions best hasn’t been defined and is probably going to be different for everyone.  

What we do know is that:

• Hormone levels vary day-to-day, and even throughout the day. Making it difficult to get an accurate measuring, especially during menopause. Have a look at figure 1 for an example of hormonal levels over a 6 month period for a woman going through peri-menopause. 
• Hormone levels do not determine how mild or severe an individual’s menopausal symptoms will be, nor which symptoms she will be experiencing. 

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