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Diagnosing menopause (DRAFT)

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Definitions

Menopause is characterised by the loss of ovarian reproductive function and is defined as amenorrhoea (without exogenous hormonal cause) for 12months. Menopause usually occurs between 45-55years and the average age in the UK is 51.

Perimenopause is the period preceding menopause and ending 1 year after the last menstrual period (LMP), during which time ovarian function starts to decrease, period cycles become irregular and menstruation pattern changes. It typically starts in a woman’s mid-to-late-40s and lasts 4–5 years. This is often associated with menopausal symptoms for which women can access treatment.

Diagnosis

In otherwise healthy women, >45y with menopause symptoms, diagnose:

Perimenopause based on symptoms and irregular periods
Menopause in women who have been amenorrhoeic for 12months and are not using hormonal contraception
Menopause based on symptoms in women without a uterus

In those under 45y, please see relevant sections – <40y , <45y

Menopausal symptoms

There are many symptoms of menopause, including (but not limited to) vasomotor symptoms, sleep disturbances, musculoskeletal symptoms, mood symptoms, impaired memory and cognition, genitourinary symptoms and sexual difficulties.

A Menopause Symptoms Questionnaire has been developed in BNSSG based on the Greene Climacteric scale. Patients can complete the questionnaire prior to a menopause appointment to guide treatment discussions.

80-90% of women will have some symptoms and 25% of women describe their menopause symptoms as severe and debilitating. Menopause symptoms last on average 7 years but may continue beyond this.

Cultural differences exist (including biological, hormonal, perceptions, expectations and attitudes) and additional considerations are required when caring for people in ethnic minorities. The BMS has produced a tool to help 20-BMS-TfC-Menopause-in-ethnic-minority-women-JUNE2023-A.pdf (thebms.org.uk)

Use of FSH

Do not use FSH to diagnose menopause in women over 45y old with menopausal symptoms.

Do not measure FSH in women using HRT, combined hormonal contraception, depo/Sayana press, high dose progestogens or tamoxifen.

In women under 45y, consider using FSH to diagnose menopause. Please see the Early Menopause page

For women under 40y, please see the Premature Ovarian Insufficiency page.

Measuring FSH can be considered in women who are over 50 and amenorrhoeic due to progestogen only contraception to assess whether contraception can be stopped. See Contraception section.

Resources

Resources for Patients:

Menopause and later life | RCOG

BMS TV - British Menopause Society (thebms.org.uk)

https://www.nice.org.uk/guidance/ng23/resources/menopausepdf-718895758021

https://www.womens-health-concern.org/

www.menopausematters.co.uk/

www.managemymenopause.co.uk

https://www.daisynetwork.org/

Rock My Menopause - Menopause Information

Find a BMS-recognised Menopause Specialist - British Menopause Society (thebms.org.uk)

References and Resources:

17-BMS-TfC-What-is-the-menopause-AUGUST2023-A.pdf (thebms.org.uk)

Overview | Menopause: diagnosis and management | Guidance | NICE

BMS-Menopause-Practice-Standards-JULY2022-01D.pdf (thebms.org.uk)

20-BMS-TfC-Menopause-in-ethnic-minority-women-JUNE2023-A.pdf (thebms.org.uk)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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