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How To Get Tested For Early Menopause

What Causes The Menopause

EARLY MENOPAUSE | BusbeeStyle

The menopause is caused by a change in the balance of the body’s sex hormones, which occurs as you get older.

It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month.

Premature or early menopause can occur at any age, and in many cases there’s no clear cause.

Sometimes it’s caused by a treatment such as surgery to remove the ovaries , some breast cancer treatments, chemotherapy or radiotherapy, or it can be brought on by an underlying condition, such as Down’s syndrome or Addison’s disease.

Page last reviewed: 29 August 2018 Next review due: 29 August 2021

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.

Table : Nice Quality Standard For Menopauselist Of Quality Statements4

No.

Women with premature ovarian insufficiency are offered HRT or a combined hormonal contraceptive.

Women having treatment for menopausal symptoms have a review 3 months after starting each treatment and then at least annually.

Women who are likely to go through menopause as a result of medical or surgical treatment are given information about menopause and fertility before they have their treatment.

FSH=follicle stimulating hormone HRT=hormone replacement therapy

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

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Risks Of Premature & Early Menopause

The risks of developing osteoporosis and cardiovascular disease are higher for women with premature or early menopause than for women reaching menopause at the expected age. For this reason, it is important that you seek advice and treatment from your doctor.

According to community studies, women who go through premature or early menopause without hormone treatment have a reduced life expectancy by about two years.

The advice below is based on current expert opinion, as there are no studies on women with premature or early menopause that establish which prevention strategies are effective.

Nice Guidance On Menopause

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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.

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Consequences Of Premature Menopause

The consequences of premature menopause can be divided into short and long term consequences.

Short term consequences include vasomotor symptoms such as hot flushes, night sweats, palpitations and headaches, weight gain, vaginal dryness and dyspareunia, urgency and stress incontinence with psychological problems including irritability, forgetfulness, insomnia and poor concentration.

The long term consequences of premature menopause include infertility, osteoporosis and an increased risk of premature death, cardiovascular diseases and stroke.

Infertility

It is true that some authors have reported pregnancies in women with premature menopause, but the reality is that it is rare. With recent advancement in oocyte donation, women with premature menopause now have hoped to mother a child. Currently, oocyte donation is widely used and it is a successful option in management of infertility due to ovarian failure. The possible theoretical reasons for high pregnancy rates in ovum donation programmes are:

  • Absence of the state of hypoestrogenism,

  • Absence of other causes of infertility,

  • Lack of endometrial hyperstimulation,

  • Absence of episodes of premature lutenization,

  • Better control of the window of receptivity.

  • Osteoporosis

    Cardiovascular consequences

    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.

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    What Are Premature Menopause Early Menopause And Primary Ovarian Insufficiency

    Premature menopause and early menopause are conditions where a woman goes through menopause at an earlier age than is typically expected. Both conditions can result in women being unable to become pregnant. If there is no obvious medical or surgical cause for the premature menopause, this is called primary ovarian insufficiency . Primary ovarian insufficiency is also referred to as premature ovarian insufficiency.

    The name premature ovarian failure is no longer used because women who are told they have early menopause can have intermittent ovulation, menstrual bleeding or even pregnancy after being told they have ovarian failure.

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    Unless the ovaries have been surgically removed, it can be difficult to diagnose a woman younger than age 45 with menopause as opposed to primary ovarian insufficiency . Women with POI can have intermittent ovulation, which may or may not be accompanied by a menstrual bleed. Other women may be able to get pregnant through in vitro fertilization with egg donation. It is important to work with a fertility specialist to explore options.

    Options available to you will vary depending on whether you have interest in having children in the future. In some cases, fertility may be restored and pregnancy could be possible. Assisted reproductive technology , including in vitro fertilization might be considered.

    If you do not want to get pregnant while on hormone-replacement therapy, your doctor will talk to you about contraceptive options.

    Talk to your healthcare provider about possible causes of premature or early menopause and your questions regarding fertility.

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    Symptoms Of Early Menopause

    The main symptom of early menopause is periods becoming infrequent or stopping altogether without any other reason .

    Some women may also get other typical menopausal symptoms, including:

    Read more about the symptoms of the menopause.

    Women who go through early menopause also have an increased risk of osteoporosis and cardiovascular disease because of their lowered oestrogen hormone levels.

    Testing For Menopause & Early Menopause

    Is it possible to test for and diagnose if you are in menopause?

    The answer is yes.

    The changes in your hormones cause several changes to other hormones in your body which can be picked up with routine blood tests.

    What you need to realize is that all of the systems in your body are connected in some way.

    If you drop your estrogen, for instance, then that will alter other hormones that are normally produced by your brain to stimulate the release of estrogen.

    These hormones and prohormones can be picked up and used to help draw a picture of what is happening in your body.

    So which blood tests do you need to diagnose menopause?

    I’ve included a list below that every woman who is going through menopause should ask their doctor for:

    It’s also helpful to understand what happens to these values during menopause so that you can understand where you are at in your transition.

    I’ve included some of the general ranges to look for with these lab tests below:

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    Box : Potential Improvements Following Implementation Of A Local Menopause Specialist Service

    Implementation of a local menopause specialist service could lead to improvements in:

    • diagnosis of perimenopause and menopause through
    • a reduction in FSH testing for diagnosis of menopause in women over 45 years
    • use of electronic prompts for FSH laboratory requests
    • liaison with local pathology optimisation groups
  • diagnosis of premature ovarian insufficiency through
  • encouraging GPs to consider POI in women aged under 40 years
  • providing a referral pathway for a specialist service, if there is doubt
  • recording positive diagnoses through
  • creating adequate Read codes for menopause, perimenopause, and premature ovarian insufficiency
  • constructing disease registers
  • promoting the use of HRT promptly and up to natural age of menopause, unless contraindicated
  • review of treatments for menopausal symptoms through
  • initiating medication reviews 3 months after starting treatment, annually thereafter
  • providing information for women having treatment likely to cause menopause through
  • working with secondary care to ensure access to and understanding of appropriate information prior to treatment.
  • FSH=follicle-stimulating hormone POI=premature ovarian insufficiency HRT=hormone replacement therapy

    Information For Women Having Treatment Likely To Cause Menopausestatement 5

    Menopause Home Screening Test kit Information

    Certain medical or surgical treatments, such as cancer treatments and gynaecological surgery, can affect fertility and induce menopause.1,4 It is important that women who require treatment of this kind are provided with information about menopause and fertility before they have their treatment, as they may be younger than women experiencing natural menopause and therefore less likely to be aware of menopausal symptoms.

    Left untreated, menopause symptoms can lead to long-term poor health outcomes and potential psychological trauma.6 Promoting awareness of menopausal symptoms increases the likelihood that women will access treatment and services as soon as they need them, and empowers women to make an informed choice about their ongoing hormonal status.

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    Possible Signs Of Early Menopause

    So if I had had any clue what I was going through, what would have been the signs of early menopause for me to look out for? The first thing may be quite obvious like a hot flush that you cant explain. Or maybe youre more anxious and irritable than usual.

    Ive learnt over the last decade that hormonal fluctuations during the perimenopause years are very normal and can be pretty extreme. Perimenopause is the years leading up to menopause. Menopause is defined as two years after your last period if you are under 50, and one year if you are over.

    Some doctors are reluctant to test hormones for menopause when a woman is in her 40s because of these day-to-day hormonal fluctuations. But it would appear my doctor didnt know any of that when he told me definitively I had gone through menopause.

    But when your hormones start to fluctuate there may be several things to watch out for. Maybe you start forgetting things and not knowing that even that can be hormone related, you think you have early onset Alzheimers. You likely dont, so stop worrying about that.

    Infertility can be another of the signs of early menopause. I wish it was more well known that perimenopause can start so early and that for many of us, our fertility starts to drop at an alarming rate from our mid 30s. So if you want to have kids, dont leave it too long. Older women giving birth may get lots of publicity but they are still relatively unusual.

    What Can I Do About Hot Flashes

    Hot flashes occur from a decrease in estrogen levels. In response to this, your glands release higher amounts of other hormones that affect the brain’s thermostat, causing your body temperature to fluctuate. Hormone therapy has been shown to relieve some of the discomfort of hot flashes for many women. However, the decision to start using these hormones should be made only after you and your healthcare provider have evaluated your risk versus benefit ratio.

    To learn more about women’s health, and specifically hormone therapy, the National Heart, Lung, and Blood Institute of the National Institutes of Health launched the Women’s Health Initiative in 1991. The hormone trial had 2 studies: the estrogen-plus-progestin study of women with a uterus and the estrogen-alone study of women without a uterus. Both studies ended early when the research showed that hormone therapy did not help prevent heart disease and it increased risk for some medical problems. Follow-up studies found an increased risk of heart disease in women who took estrogen-plus-progestin therapy, especially those who started hormone therapy more than 10 years after menopause.

    The WHI recommends that women follow the FDA advice on hormone therapy. It states that hormone therapy should not be taken to prevent heart disease.

    Practical suggestions for coping with hot flashes include:

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    The Role Of Menopause Tests

    Menopause testing is used to determine if a patients symptoms are part of menopause or related to another condition. Symptoms related to menopause include:

    • Irregular menstrual periods
    • Vaginal dryness, irritation, or discharge
    • Mood swings
    • Trouble concentrating

    In evaluating the cause of these symptoms, a doctor may ask about a patients age, symptoms, and family history. In around 75% of women, symptoms of perimenopause begin during the expected age range and doctors can diagnose menopause without laboratory testing. Menopause is confirmed after a woman has had no menstrual period for 12 months.

    However, menopause testing is often ordered when the cause of symptoms is not clear. For example, menopause testing may be used for women who have had a hysterectomy, women who begin to have symptoms of menopause several years before age 50, or when a woman experiences abnormal symptoms suggestive of menopause.

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    Management of the condition can vary depending on why menopause started earlier than normal. Given the health risks associated with early menopause, hormone replacement therapy is routinely recommended to all women with premature menopause or primary ovarian insufficiency, unless there is a compelling reason it cant be used. There is a lot of confusion about the safety of hormone therapies. Many of the risks of hormone therapy used after natural menopause are not thought to apply to women who have premature menopause. It is important to discuss the pros and cons of hormone therapy with your doctor. Some healthcare providers have additional certification in the management of menopause, and these providers will be a valuable resource when receiving conflicting information about the safety of hormone therapy.

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    How Do You Confirm Menopause

    The definition of menopause is the time 12 months after you have your last period. Perimenopause is the transition time leading up to this point.

    Usually, if you have classic menopause symptoms and you havent had your period in 12 months, there is probably no need for a test odds are, you have gone through menopause. If you want scientific confirmation, though, the only relatively reliable methods of testing are menopause blood tests.

    In 2018, the FDA approved a blood test that tests the levels of AMH in your blood. This hormone is produced by your ovaries and helps out with growing and releasing your eggs. Its one of the hormones that take a dip when you hit menopause, so knowing its levels can be useful in figuring out if this is where youre at.

    But this test shouldnt be done in isolation. You will also need to have a full health check-up that includes talking to your doctor about the symptoms you are experiencing.

    Before your appointment, its not a bad idea to keep a journal so that youre able to chat with your doctor about whats going on. Youll want to keep a record of your periods and any symptoms youre experiencing. Heres a list of some of the signs and symptoms of menopause to look out for.

    At your appointment, the doctor will likely ask you questions like:

    • When was your last period?
    • How regular are your periods?
    • What symptoms do you have?
    • How bad are your symptoms?
    • Does anything make your symptoms better/worse?

    When Does Menopause Occur

    Although the average age of menopause is 51, menopause can actually happen any time from the 30s to the mid-50s or later. Women who smoke and are underweight tend to have an earlier menopause, while women who are overweight often have a later menopause. Generally, a woman tends to have menopause at about the same age as her mother did.

    Menopause can also happen for reasons other than natural reasons. These include:

    • Premature menopause. Premature menopause may happen when there is ovarian failure before the age of 40. It may be associated with smoking, radiation exposure, chemotherapeutic drugs, or surgery that impairs the ovarian blood supply. Premature ovarian failure is also called primary ovarian insufficiency.

    • Surgical menopause. Surgical menopause may follow the removal of one or both ovaries, or radiation of the pelvis, including the ovaries, in premenopausal women. This results in an abrupt menopause. These women often have more severe menopausal symptoms than if they were to have menopause naturally.

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