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Menopause Investigation and laboratory testing – Information for GPs

Women aged over 45 years

The menopause can be diagnosed in women who have not had a period for at least 12 months and are not using hormonal contraception.

Laboratory testing (FSH and oestradiol) should not be routinely used in the investigation of the menopause. FSH levels fluctuate prior to the menopause and an FSH result is not required for the diagnosis.

In women aged 40-45 years with menopausal symptoms, including a change to their menstrual cycle

FSH >40 IU/L is suggestive of the perimenopause. Menopause can only be confirmed clinically in women who have not had a period for at least 12 months.

In women aged under 40 years where premature ovarian insufficiency is suspected

If the first FSH result is increased (>40 IU/L), suggest repeat FSH in 4-6 weeks to confirm.

Note that FSH should not be requested in women using combined oestrogen and progestogen contraception or high dose progestogen.

Summary

In women >45 years, the perimenopause and menopause should be diagnosed clinically. FSH measurement is not required.

FSH measurements may be indicated in women ≤45 years with menopausal symptoms. Patients with high FSH levels suggestive of premature ovarian failure should have repeat testing within 4-6 weeks

For further information on the diagnosis and management of the menopause, please refer to NICE NG23.

Reference

NICE NG23 Menopause: diagnosis and management (https://www.nice.org.uk/guidance/ng23)

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