Perimenopause, the transitional phase leading up to menopause, often brings a variety of symptoms due to fluctuating hormone levels. Diagnosing this phase can be challenging, as many symptoms overlap with other conditions.
In this guide, we’ll explore how perimenopause is diagnosed following NICE (National Institute for Health and Care Excellence) and BMS (British Menopause Society) guidance, including the role of symptoms, the necessity of blood tests, and specific hormone checks, including testosterone.
Understanding Perimenopause diagnosis and symptoms
Perimenopause typically begins in a woman’s early to mid-40s, though timing varies. This phase can last from a few months to several years, ending when a woman has not experienced a menstrual period for 12 consecutive months. Common symptoms during perimenopause include:
Menstrual cycle changes - heavier, lighter or changing in duration
Vasomotor symptoms - Hot flushes & Night sweats
Mood swings and irritability
Musculoskeletal symptoms such as joint and muscle aches and pains
Genitourinary syndrome of the menopause (GSM) which can include increased urination, recurrent UTI's, vaginal dryness and discomfort and itchiness
Reduced libido and sexual arousal
Due to fluctuating hormone levels, symptoms can vary in intensity and frequency. It’s important to assess whether these symptoms stem from perimenopause or other health conditions.
NICE Guidelines on Diagnosing Perimenopause
NICE guidelines recommend a symptom-focused approach for diagnosing perimenopause, particularly in women over the age of 45. For women in this age group, routine blood tests are not required; diagnosis is typically based on clinical assessment of symptoms and changes in menstrual cycles.
Key NICE Guidance Points:
For Women Aged 45 and Over: In women over 45, the presence of menopausal symptoms is generally enough to diagnose perimenopause without blood tests.
For Women Aged Under 45: In younger women, where premature menopause or early menopause may be a concern, blood tests can assist in confirming the diagnosis. Follicle-stimulating hormone (FSH) levels may be measured to support diagnosis. Although these blood tests can return at normal level and you can still be diagnosed as perimenopausal based upon your symptoms.
BMS Guidance on Diagnosing Perimenopause
The British Menopause Society also supports a symptom-based approach, especially in women over 45. BMS recommends a thorough clinical assessment, including family history, lifestyle factors, and any potential risk factors for other conditions that could mimic perimenopausal symptoms.
When Blood Tests Are Useful According to BMS:
In Women Under 45 with Symptoms: In cases suggesting early menopause or premature ovarian insufficiency, blood tests, including FSH levels on two occasions (4–6 weeks apart), can support diagnosis.
Rule Out Other Conditions: BMS advises that blood tests can sometimes help to rule out other causes of symptoms, such as thyroid disorders or low iron levels, which may present similarly.
When deemed necessary, blood tests can measure various hormone levels to provide insights into the underlying causes of symptoms. The following hormones and markers may be tested:
Follicle-Stimulating Hormone (FSH): As ovarian function declines, FSH levels generally rise. Elevated FSH levels in women under 45 with symptoms may support a perimenopause diagnosis, although FSH levels can fluctuate significantly.
Estradiol (Oestrogen): Oestrogen levels gradually decline during perimenopause. Testing oestrogen levels can sometimes help indicate a woman’s stage in the menopausal transition, although results may vary.
Testosterone: While less commonly discussed, testosterone levels also decline in perimenopause, which can impact libido, energy, and muscle strength. Low testosterone may contribute to symptoms such as fatigue, mood changes, and reduced libido. Assessing testosterone levels may help identify hormonal imbalances contributing to these symptoms, especially in cases where symptoms persist despite treatment.
Thyroid Function Tests: Since hypothyroidism and hyperthyroidism can cause similar symptoms, thyroid function tests are sometimes recommended to ensure symptoms are not caused by thyroid dysfunction.
Full Blood Count (FBC) and Ferritin: Fatigue, a common perimenopausal symptom, can also result from anaemia. Checking iron levels through ferritin and FBC tests can determine whether low iron is contributing to symptoms.
Key Takeaways
Symptom-based Diagnosis: For women over 45, both NICE and BMS agree that perimenopause can often be diagnosed based on symptoms alone, without blood tests.
Role of Blood Tests: Blood tests are not routinely required for perimenopause diagnosis, especially in women over 45. However, in younger women or cases where symptoms are unclear, testing levels of FSH, oestrogen, and testosterone may assist in understanding hormonal status. However bloods results which are normal does not always mean you are not perimenopausal.
Testosterone and Symptom Management: Although less routinely assessed, testosterone levels can provide insights into symptoms like reduced libido and energy. Where clinically appropriate, testosterone testing may support a more comprehensive understanding of hormone changes during perimenopause.
Ruling Out Other Conditions: Blood tests can also be used to exclude other conditions, such as thyroid dysfunction or iron deficiency, which may present with similar symptoms.
We support women to achieve an accurate diagnosis of the perimenopausal through our comprehensive assessment in our menopause consultations.
By following NICE and BMS guidelines, we can support women in managing the transition through perimenopause with clarity and personalised care options based on individual needs.
We recommend our TMS 1 blood test to assess your hormone levels or our TMS 4 blood test to include a complete wellness screen.
Treatment Options
NICE and BMS guidelines recommend that hormone replacement therapy is first line treatment of perimenopausal symptoms. There are non-hormonal options or lifestyle and supplement support for women wishing to choose an alternative option or for those who are unable to use HRT.
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