Diagnosis: menopause

Is there such a thing as a menopause diagnosis?

One of the questions I’m most often asked is ‘Can I get a blood test to diagnose if I’m in menopause?’ Some women are surprised when I tell them we only do this under certain circumstances. The NICE guidelines say that women over  45 who are otherwise presenting as healthy don’t need a blood test for diagnosis.

In this case, a GP can usually diagnose menopause based on any symptoms a woman has. If you’re visiting your doctor to find out if you’re menopausal, it’s a good idea to keep a note of any symptoms you’ve noticed. These could be hot flushes, problems remembering things, mood swings, irregular periods… anything which is unusual for you.

Here are some other questions I’m frequently asked about menopause:

When is a blood test needed?

Your GP will carry out a blood test if they think your symptoms are a result of underlying conditions. Not everything a menopausal woman experiences is due to the menopause. These won’t be to diagnose menopause, but rather to rule out any other conditions. If you’re under 45, it’s important that Premature Ovarian Insufficiency (POI) is diagnosed quickly, as this can put you at greater risk of some long-term health conditions that need supporting.

I’m on the pill, how can I track my periods?

If you’re taking a contraceptive pill you might not know if you’ve gone through menopause. To find out, you can stop taking it for a month and then have a blood test to find out if you’re postmenopausal. A word of caution here though. You can still get pregnant while you’re menopausal or on HRT so please use another form of contraceptive if you don’t want to become pregnant. We recommend you continue using contraception for two years after your last period if you’re under 50 and one year if you’re over 50.

I have a Mirena coil fitted so don’t have periods. Do I need to have it removed to find out if I’m menopausal?

No, you don’t need to, because it will not mask other menopausal symptoms other than a change in your periods. A Mirena coil can help if you have heavy periods, as it can reduce or even stop the bleeding completely. It works by releasing progesterone – some women use the coil as the progesterone element of their HRT. Remember, HRT itself is not a contraception, but the Mirena coil is, so don’t have it removed if you don’t want to become pregnant. If it’s been in place for more than five years you may need to have it changed as it may not provide sufficient progesterone (although will still serve to avoid pregnancy).

If my periods haven’t changed does that mean I’m not menopausal?

No. Remember, menopause is unique to every woman and the menopause transition is different for us all. While some women do experience heavier, lighter or more irregular periods, some don’t notice any changes until they stop completely. Changes in periods is only one of the symptoms of menopause – there are other physical and psychological symptoms that can indicate you are menopausal.

I don’t have hot flushes, does that mean I’m not going through menopause yet?

Again, no. Hot flushes have become the poster symptom for menopause and it’s true that many women do experience them. However, some women never do. Also, some don’t realise they have hot flushes, as they happen at night and manifest as night sweats. There are a range of symptoms that women can experience during menopause, both physical and psychological, and these can change and vary over time.

Is HRT the same as contraception?

No. The levels of hormones in HRT aren’t high enough to act as contraception. Unless you’re actively trying for a baby then you’ll need to continue with your usual contraception. While irregular periods can be a sign of menopause, don’t forget a missed period can also be a sign of pregnancy! And if you’ve missed a few periods that doesn’t mean you’re not still ovulating, so don’t take any chances. If you miss a period and are sexually active, you should do a pregnancy test.

How can I get the best from my doctor’s appointment?

It’s a good idea to do some preparation to get the most from your GP appointment, as these can often be quite short. Try to find out as much as possible beforehand about the types of treatments available, both medical and natural, and which approaches you think might work best for you. Make a list of symptoms, or keep a diary of when you experience them. You can then discuss these at your appointment.

The big thing to remember with menopause is there really isn’t a one-size-fits-all answer. Learning as much as you can about the possible symptoms can help you understand the best way for you to manage them.


Joanne Hobson

About Joanne Hobson

I've worked in Nottingham as a GP for over 30 years and have always had an interest in women's sexual health and psychosexual medicine. Although I am now retired as a partner in general practice I still undertake locum surgeries in primary care. I am a menopause specialist and have run a menopause clinic with a colleague for the last 15 years in Nottingham. I work in a Nottingham community gynaecology clinic and see all aspects of gynaecology, including patients with psychosexual problems. I have Membership of the Institute of Psychosexual Medicine and regularly give talks to local groups. I contribute to local radio programmes on general health as well as menopausal topics. Please visit my website to find out more, or do get in touch. I also have a private practice at Spire Hospital.