Menopause Health Center

You and your doctor can tell whether you are in perimenopause based on your age, your history of menstrual periods, your symptoms, and the results of your pelvic exam. If possible, bring a calendar or journal of your menstrual period and symptoms.

If you have severe symptoms before or after menopause, if your doctor suspects another medical condition, or if you have a medical condition that makes a diagnosis difficult, your doctor may do one or more of the following tests:

• A pregnancy test is done if there is a chance that you are pregnant.
• A follicle-stimulating hormone (FSH) test can be used to confirm whether you have reached menopause. FSH levels increase during perimenopause and are high after menopause.
• An estrogen test is sometimes done to see how low estrogen has dropped after menopause.
• A thyroid-stimulating hormone test is used to see whether irregular menstrual periods or perimenopause-like symptoms are being caused by a thyroid problem.

If you have had no menstrual periods for 1 year, you have reached menopause and are in postmenopause. This is a good time to have a full physical exam, with particular focus on your heart health and risk factors for osteoporosis. Be sure to report to your doctor any unexpected vaginal bleeding.

Unexpected vaginal or menstrual bleeding

If you have irregular bleeding during perimenopause or you are taking continuous hormone therapy and have vaginal bleeding after 6 to 12 months of treatment, your doctor may use one or more additional tests to rule out serious causes of the bleeding. These tests may include:

• Transvaginal ultrasound to look for growths or structural abnormalities of the uterus.
• Endometrial biopsy to see whether the uterine lining (endometrium) is acting normally during the menstrual cycle and to check for signs of cancer.

For more information, see the topics Abnormal Vaginal Bleeding and Dysfunctional Uterine Bleeding.

Bone mineral density screening for osteoporosis

The United States Preventive Services Task Force (USPSTF) recommends that all women age 65 and older routinely have a bone mineral density test to screen for osteoporosis. If you are at increased risk for fractures caused by osteoporosis, routine screening should start sooner.⁴ If you have stopped hormone therapy, it is very important to discuss osteoporosis screening with your doctor. This is because you no longer have the extra bone protection from extra estrogen. USPSTF recommends that you and your doctor check your fracture risk using a tool such as FRAX to help decide whether you should be screened for osteoporosis. Talk to your doctor about your risk factors and when to start bone mineral density screening.

The FRAX tool was developed by the World Health Organization to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone mineral density test (BMD) on your hip, you can type in your score. If you have not had that test, you can leave the score blank.

Most experts say that the decision to screen younger women should be made on an individual basis. This decision depends on your risk for developing osteoporosis and whether the test results could help with treatment decisions. For more information, see the topic Osteoporosis.