Diagnosing Menopause: Signs and Symptoms

Diagnosing menopause involves assessing symptoms you are experiencing, which may include hot flashes, vaginal dryness, mood swings, menstrual irregularity, and more. Menopause is not diagnosed until it has been one full year since your last menstrual period.

Menopause doesn't happen overnight. For most women, it is a gradual process that occurs over several years. These years are referred to as the menopause transition or perimenopause. Most of your worst symptoms will probably occur during these years and may get better once you reach menopause.

What Is Menopause?

Menopause is a normal part of the aging process in women. Over time your ovaries will continue to lose follicles and oocytes (eggs). The rate at which this happens is not the same for every woman. This is why your age is not a good predictor of whether or not you are in menopause.

Although the average age of menopause is 51, the recognized age range is from 40-58 years old. The rate at which your ovaries age and eventually bring you into menopause is influenced by both your genetics and environmental exposures.

Diagnosing Menopause

Diagnosing menopause involves the assessment of several factors, such as:

• Menstrual history
• Symptoms
• Blood tests (although not always necessary) may include hormone and thyroid function tests
• Other considerations, such as age, family history, and medical conditions

Signs and Symptoms

Your symptoms are first and foremost when it comes to diagnosing and managing the menopause transition. It is important to recognize the changes in your body and to discuss these with your healthcare provider. Depending on the severity of the symptoms, you may want to consider treatment options.

Hot Flashes and Night Sweats

Hot flashes and night sweats fall under the broader category of vasomotor symptoms. A hot flash is a sudden feeling of heat, most often in the upper body and face. Your face and neck may become flushed and sometimes red blotches appear on the chest, back, and/or arms. Night sweats are hot flashes that occur during the night and may disrupt sleep.

Abnormal Menstrual Pattern

Due to the changing hormone levels caused by the decline in the function of your ovaries, your menstrual cycle will become irregular. Changes may include the following:

• Your period is shorter or lasts longer.
• Bleeding is heavier or less than usual.
• Bleeding is more frequent.

Although this type of change in your bleeding pattern is completely normal, it is important to discuss menstrual changes with your healthcare provider.

Due to the hormonal imbalances of the menopausal transition, certain uterine conditions like fibroids and uterine polyps can become more symptomatic. Also, depending on your other risk factors or medical conditions, your practitioner may suggest additional testing to evaluate irregular bleeding.

Vaginal Dryness

Vaginal dryness is usually caused by low estrogen levels and may start months to years before the menopause transition. Vaginal dryness may be especially noticeable during sex and can cause itching, often causing irritation and discomfort.

Mood Swings

This can be one of the most troubling symptoms of the menopause transition. You may never have had any significant mood issues in the past but suddenly you feel tremendously anxious or depressed.

Or perhaps you have struggled with mood symptoms in the past and are noticing a worsening of the symptoms. This can be especially true for women who have had a prior hormone-mediated or reproductive mood disorder like postpartum depression or premenstrual dysphoric disorder (PMDD).

It also doesn't help that the menopause transition may coincide with many other social stressors such as work, raising kids, and dealing with aging parents.

Discuss any mood symptoms with your healthcare provider. Do not suffer in silence or feel ashamed of what you're experiencing.

Sleep Disturbances

Changes in sleep may include having trouble falling asleep, being wide awake in the middle of the night, or waking up multiple times during the night. Night sweats or a need to urinate during the night can contribute to sleep disturbances and make it difficult to get back to sleep.

Headaches

For some women, migraine headaches may first appear during the menopause transition. This is not surprising as many of the factors that are thought to act as triggers are common in the menopause transition including:

• Sleep disturbances
• Mood changes
• Decreasing estrogen levels

Although it's not surprising that normal types of headaches may develop during the menopause transition, it is important to discuss any new headaches or any changes in your typical headaches with your healthcare provider.

Acne

Even if you didn't have acne when you were a teen, the hormonal changes and increased oil production associated with the menopause transition can bring on acne. Along with hormonal changes, other factors that may contribute to acne include genetics, stress, dietary changes, and lack of sleep or exercise.

Urinary Problems

Many women develop bladder or urinary problems during perimenopause and menopause, such as:

• Urinary incontinence: You have difficulty holding your urine long enough to get to the bathroom.
• Urinary stress incontinence: Urine leaks out when you cough, sneeze, or laugh.

Urinary problems during or after menopause are not a normal part of aging and can be treated.

Skin Changes

When hormone levels diminish, your skin may become drier and thinner. You may also notice more hair on your face, and dark spots may appear on your face, hands, neck, arms, or chest.

Dry Eyes

Dry eye is very common as women get older, with about 80.5% of postmenopausal women having dry eye disease. Symptoms may include itching, burning, redness, blurry vision, sensitivity to light, and a feeling of something being stuck in the eye.

Cognitive Changes

Some people experience cognitive changes, such as difficulties with memory, attention, and processing speed, that may be linked to hormonal fluctuations and sleep disruption. This is sometimes referred to as "brain fog." 

Hormone Tests

The hormone level considered potentially helpful to diagnose menopause is FSH or follicle-stimulating hormone. FSH is produced by your pituitary gland and it plays an important role in your menstrual cycle. FSH stimulates your ovaries to produce estrogen, and when sufficient estrogen is produced, it feeds back and decreases your FSH. This is partially the basis of your regular menstrual cycle.

When the menopause transition hits and your ovaries decrease estrogen production, your FSH levels begin to rise, trying to stimulate your ovaries to make enough estrogen to keep the cycle going.

Rising FSH levels do indicate decreasing ovarian function. But this happens over time, and your FSH and estrogen levels will continue to fluctuate. In the menopause transition years, your FSH level may be high one day and significantly lower the next, yet you may not have any symptoms.

It is also possible that you may be having very unpleasant symptoms with hormone levels that are still within the normal value ranges. Ultimately, checking FSH and other ovarian hormone levels in most women can be very misleading.

Perhaps the only clinical situation when an FSH level is helpful is if you have had a prior hysterectomy or endometrial ablation. Because you have stopped getting your period due to surgery, you can't correctly determine when it has been one year without your period.

Summary

Diagnosing menopause involves assessing your menstrual history, symptoms, and other considerations to determine whether you are going through the menopause transition. This is one situation when your symptoms are much more reliable for establishing a diagnosis and monitoring your response to treatment options.

Listen to your body and find a healthcare provider who will listen to you and help you manage the menopause transition and beyond.