How can you tell whether you are entering a new stage of life known as menopause?
While the average age when a woman reaches menopause is 51, the exact point when this life stage transition begins varies widely from person to person — as does the degree of menopausal symptoms.
So how do you know you're approaching this new phase of your life? How is the onset of perimenopause, the transitional period lasting 2 to 10 years before menopause is officially reached, diagnosed? The following are frequency asked questions about menopause and perimenopause, with expert comments from the specialists.
What are the signals that you are approaching perimenopause?
Aside from age, the number one sign that a woman is entering perimenopause is irregular menstrual cycles — be it the amount of blood discharged, the frequency of menstruation, or the intervals between periods. "Changes in the menstrual cycle are really the best clue to women that they're entering this transition," says Jan Shifren,MD, director of the Vincent Menopause Program at Massachusetts General Hospital in Boston and an associate professor of obstetrics, gynecology, and reproductive biology at Harvard University Medical School. Beyond that, vaginal dryness, hot flashes, night sweats, and sudden mood changes are other common signals that a menopausal transition has begun.
Can perimenopause symptoms resemble symptoms of other medical conditions?
Some of the symptoms of perimenopause are similar to some of those connected to diabetes or thyroid disease. For this reason, doctors will occasionally test for these diseases, just to be sure that menopause is in fact the explanation. "If you're in your late forties and you're starting to get hot flashes and irregular menstrual cycles, the odds are much higher that you're going through some type of menopausal transition as opposed to a thyroid issue," says Ronald Burkman, MD, an ob-gyn on staff at Baystate Medical Center in Springfield, Massachusetts, and a professor of obstetrics and gynecology at Tufts University Medical School.
How does your doctor determine whether you are becoming menopausal?
In most cases, a doctor makes this determination based on your age, your description of the symptoms, your medical history, and your family's medical history. "In general, clinically, if you're in the appropriate age group and you're having these symptoms, it's likely perimenopause," Dr. Shifren says. "And diagnosis isn't that important, but management is." Early menopause can increase a woman's risk of heart attack, stroke, and bone disease later in life.
Are lab tests necessary to confirm the diagnosis?
Doctors will sometimes draw blood to test estrogen levels or to test for the presence of follicle stimulating hormone (FSH), a pituitary hormone that prompts the ovaries to produce estrogen and other hormones. While an elevated FSH level may indicate that a woman has entered a menopausal phase in her life, it's not that straightforward. "They're really not very valuable," Dr. Burkman says of FSH tests, "because women will have a lot of fluctuation at this particular time so it doesn't really matter [what their FSH level is]."
What about home tests — do they work?
FDA-approved at-home FSH test kits are available over the counter at drugstores. The tests are generally accurate in measuring FSH levels, but doctors are usually dismissive of their usefulness. "I would absolutely discourage women from taking that kind of test," Shifren says. Without getting a fuller perspective from your doctor, who can explain test results and review options for symptom management, at-home tests are an iffy way to determine if you're in menopause.
When will you know that the transition is complete?
Just as there are variations in the age when a woman begins this phase and variations in the degree to which each woman experiences symptoms, how long this stage lasts also varies from person to person. You will know that you have reached official menopause when a full year has passed since you've had your last period.
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