New Blood Test For The Menopause
Am I going through the menopause? Its something many women ask themselves when certain symptoms start bothering them. A new test can now answer that question with greater certainty.
Many GPs wont bother testing women for the menopause. It is simply accepted that the perimenopause begins in a womens mid 40s, with the average age of the menopause being 52. If women want to check their hormone level, they usually have to go to a private gynaecologist.
A new test, called MenoCheck which tests anti-Mullerian hormone, wont give the precise date, but for women in their late 40s it will be able to predict if periods will be ceasing in the next 12 months.
Up until now, the best biochemical indicator was FSH levels.
Dr Caje Moniz, Consultant Clinical Biochemist and Head of Biochemistry at Kings College Hospital commented: The menopause is a result of a loss of ovarian function. When approaching the menopause, periods become irregular, FSH levels increase in an attempt to stimulate the ovaries and overcome the negative inhibition that they normally exert.
He added: Measuring FSH in the blood can give an indication of ovarian status and whereas levels fluctuate during normal periods , this fluctuation increases 4-5 fold at the climecteric .
Medically, the menopause is regarded as a period of 12 months since periods fail altogether and eventually remain elevated signalling cessation of ovarian function and the menopause.
Nice Guidance On Menopause
In November 2015, NICE Guideline 23 on Menopause: diagnosis and management was published, providing recommendations for healthcare professionals who care for women in menopause.1 NICE NG23 also includes a section with information for the public, which provides women with information about what to expect from a healthcare professional if they have menopausal symptoms.
NICE Quality Standard 143,4 published in February 2017, distils the key points from NICE NG23 into measurable statements that can be used to assess the quality of care provided and quantify potential improvements to clinical practice. The five quality statements that make up NICE QS143 are listed in Table 1 and discussed in detail below.
Can Blood Test For Menopause Be Wrong
Are hormone levels or other blood tests helpful in detecting menopause? Because hormone levels may fluctuate greatly in an individual woman, even from one day to the next, they are not a reliable indicator for diagnosing menopause. Even if levels are low one day, they may be high the next day in the same woman.
When To Seek Help For The Menopause
If you can manage your symptoms yourself, you may not need to see a doctor. But you may wish to see one if youre finding your symptoms hard to deal with or if you get symptoms before 40. You might find it difficult to talk about some of the symptoms youre having. But remember, your GP is there to help and will have helped many other women in your situation before.
If youre under 45 and have symptoms of the menopause, your GP may suggest that you have a blood test. This is to measure the level of follicle stimulating hormone in your blood. The blood level of this hormone increases as you approach the menopause. By measuring your blood level of FSH, its possible to tell if your symptoms might be caused by the menopause.
Types Of Perimenopause Tests
Because each woman experiences perimenopause symptoms differently, doctors will take many factors into consideration when determining if a woman has entered perimenopause, including perimenopause test results, menopause symptoms, age, and menstrual history, among others.
The following hormones can be checked via saliva, urine, or blood tests to determine perimenopause. Speak with your healthcare professional about which would be best for you.
Are Hormone Levels Or Other Blood Tests Helpful In Detecting Menopause
Because hormone levels may fluctuate greatly in an individual woman, even from one day to the next, they are not a reliable indicator for diagnosing menopause. Even if levels are low one day, they may be high the next day in the same woman. There is no single blood test that reliably predicts when a woman is going through menopause, or menopausal transition. Therefore, there is currently no proven role for blood testing regarding menopause except for tests to exclude medical causes of erratic menstrual periods other than menopause. Menopause is diagnosed based on the lack of menstrual periods for 12 months. The average age women in the U.S. stopÂ having their periods is 51.
Diagnosing Perimenopause And Menopausestatement 1
The single greatest change in clinical practice is that clinicians now have the green light to make a positive diagnosis of menopause in healthy women aged over 45 years based on symptoms alone, without the use of laboratory tests; diagnosis can be confirmed in women presenting with:1,4
- perimenopause based on vasomotor symptoms and irregular periods
- menopause in women who have not had a period for 12 months and are not using hormonal contraception
- menopause based on symptoms in women without a uterus.
The most commonly used laboratory test is follicle-stimulating hormone ; however, evidence suggests that FSH testing does not reliably aid a diagnosis of menopause in women aged over 45 years because levels of this endocrine marker fluctuate considerably in the years leading up to menopause.1
Approximately 70% of FSH tests are currently received by women over the age of 45 years, but with implementation of Quality Statement 1 it is expected that this will fall to around 15%.5 This recommendation also has the potential to bring significant cost savings to the NHS.5 At approximately £15 per test, an estimated national saving of £9.6 million is predicted by reducing unnecessary FSH testing.5
Audit is recommended to measure the proportion of women aged over 45 years for whom a diagnosis of perimenopause or menopause is made based on symptoms alone, without the use of laboratory tests.
Menopause Blood Test Results How To Read
After you took a blood sample for the perimenopause test, the results are ready within a few seconds or one minute only. Some doctors recommend repeating a test for perimenopause in one to two months, because the hormones may fluctuate a lot. The first screening may show the following results:
- Overranged thyroid hormones. They lead to irregular menstrual bleeding, extreme tiredness, changes in weight primary symptoms of climax. Thus, perimenopause test will help to figure out the presence of problems with thyroid;
- Level of FSH. If it is abnormal, it is the strongest sign of the approximating perimenopausal stage. If a hormone test for menopause clearly shows the changes in level and you experience poor periods, most likely the process of maturing started;
- Dropped estrogen. A perimenopause testindicates how much it is dropped and when is the nearest possibility of your hitting a perimenopause stage;
- Increased luteinizing hormone. A true indicator of climax is the raised level of LH. A perimenopause test will confirm your condition if again there are also irregular periods and tiredness.
For the top results, it is highly recommended to address the results of the menopause test to the health care provider or gynecologist. They can offer the best guidance and prescribe the solutions to welcome womens health conditions decently.
Diagnosis Of Of Perimenopause
Perimenopause is a natural part of life, and also represents a point of transition that can last several years. For these reasons, perimenopause is not typically diagnosed unless its symptoms cause significant discomfort or inconvenience.
If your doctor suspects that another condition, such as a thyroid issue or hormonal imbalance, may be causing your symptoms , he or she may recommend hormone testing. Hormone testing is done through a hormone panel to test your levels of estrogen and other sex-linked hormones. This kind of testing can often show whether you are nearing or in menopause.
Symptom Assessment And Diagnosis
The time when most women are trying to understand what is happening to them is during the peri- menopause. During this time of hormonal fluctuation women may experience some, but not all of the symptoms listed in the table. For instance, she may come with severe joint aches and tiredness, which may be suggestive of a rheumatological disease. Checking a symptom score will often reveal many more unreported menopausal symptoms.
In most cases, recording a symptom score helps to make the diagnosis, at the same time educates the woman and is a basis for assessing efficacy of treatment. Checking FSH or AMH levels or serum oestradiol and progesterone are unnecessary tests in diagnosing menopause for most women. AMH may in the future become a useful test to predict the age of menopause but at this stage routine use is not recommended . Checking an androgen profile as a routine on all peri-menopausal women is also unnecessary and costly. Many women come to the consultation expecting a blood test to diagnose menopause, and it is important to explain to them why we use the symptom score rather than a blood test in establishing a diagnosis. It is important to explain to women that the blood tests of FSH/oestradiol can fluctuate on a daily basis and therefore are not useful or necessary. It is especially unhelpful to do hormone blood tests while women are on MHT/OCP symptoms, not blood levels, guide your therapy. Respond to the symptoms, not the biochemistry.
Box 1: Menopause Symptoms
- lack of interest in sex
- joint and muscle stiffness.
National Institute for Health and Care Excellence. Menopause. Quality Standard 143. NICE, 2017. Available from: www. nice.org.uk/qs143
NICE has not checked the use of its content in this article to confirm that it accurately reflects the NICE publication from which it is taken
If You’re Over 45 And Having Menopausal Symptoms
Firstly, your doctor will take a full medical history – including family history and current symptoms. This information, combined with age will inform whether symptoms are considered menopausal or not.
Expect the medical history to cover:
- Current symptoms; there are 34 symptoms which you may experience during your menopause
- Family history of major disease
- Discussion of changes to periods
- Gynaecological history
- Health behaviours that can impact health risks
- Blood pressure
- Risk factors for long term diseases .
- They’ll only do a physical exam of the breasts and abdomen if it’s needed because of your specific symptoms.
If you have typical menopausal symptoms, and the doctor does not suspect other causes, then they’ll most likely conclude that your menopausal. No blood tests are needed for official ‘diagnosis’.
If you’re between 40 and 45 and having menopausal symptoms…
Have a read of our article ‘Menopause between 40 and 45’ if you think you may be entering your menopause during this time.
If you are under 40 and having menopausal symptoms…
The doctor will run a blood test for FSH check for premature ovarian insufficiency . They’ll run this twice over a 6-8 week period to confirm your levels – this is because your hormones will fluctuate a lot during the lead up to menopause. Uncharacteristically high FSH results will suggest that your symptoms are due to hormonal changes that typically arise as you approach menopause.
Want to check where you are at with your menopause?
Premature And Early Menopause
If you reach the menopause before 40, it’s called premature menopause. When the menopause happens between 40 and 45, its called an early menopause.
Get the personalised support you need from a specially trained Bupa GP, including an individual care plan. Find out more about the Bupa Menopause Plan >
Blood Tests For Hormone Levels Q&a
Here at the Marion Gluck Clinic, we place a focus on giving you the very best experience and precise, personalised care. We are often asked questions about the blood tests that are required for treatment at the clinic. We sat down with Dr Ghazala Aziz-Scott, one of our hormone doctors, to help answer your most frequently asked questions about blood tests for hormone levels and hormone balancing therapy.
Causes Of The Menopause
The menopause is a natural part of ageing. It happens when your ovaries run out of or stop producing eggs. Your ovaries also make the hormone oestrogen, so when they stop working, theres a drop in your blood level of this hormone. This change disrupts your periods and causes the symptoms of the menopause.
Some things can cause the menopause to happen early. These include the following.
- surgery to remove your ovaries , which may be done during a hysterectomy.
- Some types of medicine, including chemotherapy.
- Radiotherapy to your pelvic area.
- Premature ovarian failure when your ovaries stop working early. Doctors dont know why this happens but it can run in families. And it may not always be permanent.
Causes Of Early Menopause
Early menopause can happen if your ovaries stop making enough hormones, particularly oestrogen.
This is sometimes called premature ovarian failure or primary ovarian insufficiency.
The cause is often unknown, but can include:
- chromosome abnormalities, such as Turner syndrome
- autoimmune diseases, where the immune system starts attacking body tissues
- certain infections, such as tuberculosis, malaria and mumps in rare cases
Premature ovarian failure can sometimes run in families. This may be the case if a relative went through the menopause in their 20s or 30s.
Bleeding After The Menopause
If you start to have bleeding after youve reached the menopause , see your GP. Many women get this, and there may be a simple explanation. For instance, the normal changes that happen to your vagina after menopause can cause bleeding. But bleeding after the menopause can also be a symptom of certain cancers, including womb cancer, so your GP will want to rule this out.
Symptoms Of The Menopause
Most women will experience menopausal symptoms. Some of these can be quite severe and have a significant impact on your everyday activities.
Common symptoms include:
- reduced sex drive
- problems with memory and concentration
Menopausal symptoms can begin months or even years before your periods stop and last around 4 years after your last period, although some women experience them for much longer.
Testing + Symptoms = Diagnosis
Both lab tests and symptom charting are not necessarily 100% accurate.
This time is a period of great fluctuation, both in terms of your symptoms and in terms of your lab tests and hormones.
Your hormones and prohormones may fluctuate wildly during this time which means that checking just one time may not necessarily be accurate.
As a woman is going through the menopause transition it’s not uncommon for her body to attempt to menstruate.
This attempted menstruation may cause small to large rises in hormone levels which may alter your symptoms.
Because of this, you don’t want to rely heavily on one form of diagnostic tool over another.
Instead, it’s best to combine both your symptoms and use them in conjunction with your lab tests .
This is especially important if you are suffering from early menopause.
Women who suffer from early menopause may be pushed aside as having depression as opposed to true ovarian failure/menopause.
The good news is that it is easily testable and that you can be sure what is happening in your body with a couple of lab tests.
During menopause, we know that your estradiol levels and progesterone levels WILL fall dramatically.
When in doubt, make sure to ask your doctor for the lab tests listed above as they may help to explain what is happening in your body.
Why Would I Need This Test
Your doctor might suggest a blood test for oestrogen if:
- your menstrual cycle is abnormal, or you have heavy bleeding
- you can’t get pregnant
- you have symptoms of menopause, like hot flushes
- you have symptoms that might mean your hormones are unbalanced
If you are pregnant, you might have a blood test for oestrogen:
- as part of screening for Down syndrome in your unborn child
- to check that your placenta is working properly
Young girls occasionally have blood tests for oestrogen if they are developing sex organs when very young. Young boys occasionally have blood tests for oestrogen if they are developing breasts.
Making A Menopause Diagnosis
As it stands, there are several ways that a doctor can gauge whether or not a woman is in menopause. A vaginal swab can be used to evaluate pH levels. Blood tests to measure follicle-stimulating hormone and estrogen have also been used.
Dr. Mary Ellen Pavone, associate professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, explained that AMH is the first value to drop as women approach menopause. Menopause is always a retrospective clinical diagnosis that is defined as not having a period for at least one year. Its not a lab diagnosis, she added.
Although this test may suggest menopause or that someone may be entering menopause soon, it cannot substitute for a clinical diagnosis, Pavone said.
Periods can become irregular leading up to menopause, so the test may give doctors a better idea of a womans menopause status.
Final Menstrual Period Blood Tests
Can blood tests tell you when your final period is going to happen?
In About Menopause: Diagnosis of Menopause Is There A Test To Diagnose Perimenopause or Menopause? the Jean Hailes for Womens Health explain:
Blood tests wont tell you when your final period is going to happen and wont help you manage your perimenopause, or what follows. During the perimenopause, hormone levels vary widely and can be low one day and within the normal range the next.3
Blood Tests And The Menopause
I regularly see women in my clinic asking for a menopause test. Or, even worse, women who have had a test and told they cant possibly be menopausal because their blood tests are normal.
For most women, menopause occurs after the age of 45, with the average age being 51. Blood tests in this group of women are not required to diagnose menopause or menopausal symptoms. In fact, during the perimenopausal phase, blood tests can often vary significantly from one day to the next, and as a result can often be falsely interpreted.
The FSH test is what is usually being performed to diagnose menopause. It starts to rise during the perimenopause as ovarian function starts to decline, in a bid to keep the ovaries ovulating. However, this rise does not follow a nice gradual pattern there are often significant peaks and troughs, which means blood test results can often vary. One high reading does not necessarily mean you are post menopause, and, likewise, a low reading does not mean things are not changing.
As the results can be so difficult to interpret, the NICE guidelines do not recommend its use in the diagnosis of menopause in women over 45 years. The test may have a role in some situations , and it is still an important test for women who may be going through premature menopause. However, for the majority of women, diagnosing menopause should be based on their symptoms.
How To Prepare For The Test
Before you take a menopause test, you may undertake certain steps. They will help to save precious time. They are:
- Remember all the uncommon feelings youve felt.
- How long did they last?
- Were they severe?
- Note the last time you had a period.
- Report on any irregularities over the past few months.
- Enlist all the pills youve been taking.
After you make this list, youll quickly answer the standard questions of your doctor. Dont be shy to discuss them even if some symptoms are very delicate. He/she is a professional and can help you. Additionally, you may have to take a lipid profile test, as well as tests for liver and kidney function.
Emotional Effects Of The Menopause
The changes that happen in your body as you approach and reach the menopause can affect how you feel. You may find you get anxious or irritable or have mood swings. These symptoms can be worse if youre not sleeping enough because of night sweats. You may also have difficulty concentrating, and have a poor memory.
If you make some changes to your lifestyle, it may help to ease these effects. Your pharmacist or GP may also be able to recommend treatments that can help.
Women going through the menopause may have an increased chance of developing depression, which is more serious than mood swings. If you find your mood stays low for two weeks or more, contact your GP.
Tips For Using Hormone Test For Perimenopause
If you plan to use a hormone test for menopause, it is worth reading the instructions or general recommendations from the doctor. For instance, it concerns the events when a lady takes oral contraceptives or receives hormone replacement therapy. In both cases, it is a must to consult a gynecologist, and in some cases even to postpone taking perimenopause blood test within 6 weeks because the results may be distorted, and a doctor wont see a full picture of the hormone level.
The second concern relates to the discontinuation of taking supplements or drugs. Note, if you are prescribed to take them, do not stop their application to proceed with a blood test for perimenopause without a previous doctors consent. Other tips are:
Note, do not diagnose yourself only with doing a home test for perimenopause. It is a must to consult a doctor.
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Reviewing Treatments For Menopausal Symptomsstatement 4
Most women find that their menopausal symptoms respond well to treatment; however, some women find that their symptoms do not improve or they experience unpleasant side-effects. A review should take place 3 months after starting each treatment, and annually thereafter unless there are clinical indications for an earlier review .1,4 This review mechanism gives the opportunity for referral to a specialist if necessary.1
In the authors opinion, it is important to assess the following factors at review:
- tolerability and treatment compliance
- suitability of the regimen
- change in medical or sexual history
- change in venous thromboembolic risk.
At annual review the importance of keeping up to date with national screening programmes should also be discussed.1
Bleeding If You’re On The Pill
If you’re taking the combined pill, you’ll have monthly period-type bleeds for as long as you keep taking the pill.
If you’re taking the progestogen-only pill, your bleeds may be irregular or stop altogether for as long as you keep taking the pill.
The combined pill may also mask or control menopausal symptoms, such as hot flushes and night sweats.
These factors can make it hard to know when you’re no longer ovulating and therefore no longer fertile.
When To Do A Menopause Blood Test
The menopause is a completely natural part of ageing and many women self-diagnose themselves as their periods become irregular.
However, you might like to see a GP or specialist if:
- your symptoms are bad
- your periods become irregular early
Your periods being absent for a year combined with your age are the main clinical indicators of menopause so a blood test wont always be offered But in some cases, you will be offered one for example, if youre under the age of 45. You can also do a finger-prick blood test at home to check if you might be menopausal.
Keep in mind that not all blood tests are diagnostic. Some tests are used to build a picture of whats going on inside your body. Checking in on your female hormones at this point can help do that.