How to Tell If You've Reached Menopause

And Why You Won't Know For Sure Right Away

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Diagnosing menopause, the end of your reproductive years can be challenging: Most women won't know for sure that they've reached this milestone—the point at which the ovaries no longer produce estrogen and progesterone—until at least a year after they get there. Here's why.

What the Word "Menopause" Means

The terminology around menopause is one of the things that makes understanding the timing so confusing.

Often you'll hear someone say she's "in menopause," or she's "going through menopause," or she's "menopausal." But this rarely means she's actually reached menopause. Most likely, she's experiencing perimenopause—the period of time leading up to menopause. Perimenopause symptoms include hot flashes, night sweats, irregular periods, changes in menstrual flow (heavier or lighter, for example), and so forth.

Strictly speaking, a woman has reached menopause when she has gone an entire year without having a period. Here's where it gets tricky: Unless you have a surgical procedure that will cause your periods to stop immediately, such as a hysterectomy (which, incidentally is often referred to as "surgical menopause"), there's no way to know ahead of time when you'll reach menopause. In fact, you'll only know for sure if you note each time you menstruate on a calendar or in some other way, and then notice when a year or more goes by that you haven't had a period.

Lab Tests for Menopause

In cases in which it's not clear if a woman has reached menopause, there are lab tests that can confirm the diagnosis. These measure amounts of certain reproductive hormones in the body that fluctuate during the menstrual cycle. These are the specific hormones and what they do:

  • Follicle-stimulating hormone (FSH). This hormone is released by the pituitary gland. After menopause, the levels of FSH in the blood rise dramatically, making it a good indicator of having reached menopause.
  • Estradiol. This is one of three types of estrogen and is the type most often evaluated when testing for menopause.
  • Thyroid stimulating hormone (TSH). Sometimes a thyroid problem can cause symptoms that mimic menopause. Especially in the case of someone who seems to have reached premature menopause, meaning she's under age 40 when symptoms begin to appear, it may be important to test levels of TSH to rule out a condition other than menopause.

There are home lab kits to measure FSH in urine that usually is consistent with lab tests that measure FSH in the blood. Even so, using an FSH home test won't be a guarantee that you've reached menopause. Even if you've gone several months without menstruating until an entire year goes by there's always a chance you'll have another period. In that case, you'll have to start the countdown all over again. This is because FSH levels can vary during menopause, and while it may be high on the day you measure it, it is not a guarantee that you have stopped menstruating completely.​​

Sources:

American College of Obstetrics and Gynecology. "Frequently Asked Questions: The Menopause Years." 2015.

National Institutes of Health. Medline Plus. "Health Topics: Menopause." 

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