You and your health professional 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 health professional suspects another medical condition, or if you have a medical condition that makes a diagnosis difficult, your health professional 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 any unexpected vaginal bleeding to your health professional.

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 health professional 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 normal 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

All women age 65 and older should have a routine bone mineral density test to screen for osteoporosis. If you are at increased risk for osteoporosis, your routine screening should begin earlier, at age 60. If you have stopped hormone therapy, it is very important to discuss osteoporosis screening with your health professional. This is because you no longer have the extra bone protection from extra estrogen.

Most experts say that the decision to screen women age 60 and younger 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.