How Is Menopause Diagnosed?

The simple cases

For most women over 45 who have not had a period for 12 or more months and who have classic symptoms, the diagnosis is clinical — meaning it is based on your history and symptoms, without needing blood tests. Your doctor does not need a test result to diagnose menopause in this situation.

When blood tests are helpful

Hormone testing is NOT routinely recommended for diagnosing menopause in women over 45 with typical symptoms. FSH and estradiol levels fluctuate so significantly during perimenopause that a single result can be misleading.

Blood tests are useful for:

• Women under 45 with possible menopause symptoms
• Women with amenorrhea but subtle or ambiguous symptoms
• Diagnosis of premature ovarian insufficiency (POI)
• Ruling out other causes: thyroid disease (TSH), iron deficiency (ferritin/hemoglobin), and diabetes (fasting glucose)

Tests that are not helpful

• Progesterone, LH, and AMH levels have no role in routine menopause diagnosis
• Testosterone should NOT be measured to assess “testosterone deficiency” in women — there is no validated blood level below which a woman can be said to be deficient
• The only indication to measure testosterone is if there is concern about androgen excess (too much testosterone, not too little)