Diagnosis of menopause should be based on the woman’s symptoms and age. Healthy women over 45 years with menopausal symptoms, diagnose without laboratory tests if the woman has:
- vasomotor symptoms and irregular periods.
- not had a period for at least 12 months.
- had a hysterectomy and has symptoms
- had a bilateral salpingo-oopherectomy (BSO) at any age
FSH level over 30 units/L is diagnostic of ovarian decline. Fluctuations of FSH in perimenopause limit its value. FSH should not be done if taking combined oestrogen and progestogen contraception.
Consider checking FSH if the woman is:
- between 40 to45 years with menopausal symptoms, including a change in menstrual cycle.
- younger than 40 years in whom premature ovarian insufficiency (POI) is suspected.
Consider HRT to manage menopause symptoms including vasomotor symptoms, psychological symptoms (including low mood that arises as result of menopause), altered sexual function and urogenital atrophy.
For most women with disruptive symptoms, the benefits of HRT are likely to outweigh the risks if they are below the age of 60 years or within 10 years of menopause. There is no arbitrary limit for as long as it is felt that benefits of symptom control and improvement in quality of life continue to outweigh any risks.
In women with POI or BSO, systemic HRT is strongly recommended, if there are no contraindications, until at least the average age of natural menopause (51 years in the UK) to prevent the early onset of osteoporosis, CVD, cognitive decline and to maintain sexual function.
HRT may be appropriate for prevention of osteoporosis related fractures in women below the age of 60 years or within 10 years of menopause in symptomatic women or for the prevention of osteoporosis in women who are at higher risk.
HRT is 1st line treatment for menopause related mood disorders. There is no clear evidence that SSRIs or SNRIs ease low mood in menopausal women who have not been diagnosed with depression.