The average woman reaches the menopause — the end of the childbearing years, the end of menstrual cycles, and a stage of life marked by declining estrogen and progesterone levels — at 51. It follows the perimenopause, the time of transition toward the menopause, a stage often marked by unpleasant symptoms like hot flashes and mood swings, and one that can go on for seven years or even longer.
First things first: The symptoms of the perimenopause
Months or years before you hit the menopause, you'll go through the perimenopause. This time of great hormonal fluctuations typically announces itself with symptoms that will give you a good idea as to what's going on. Look out for things like:
- Suddenly irregular menstrual periods
- Hot flashes
- Night sweats
- Mood swings
- Thinning hair on your head, but also sometimes extra hair growth around areas typically associated with men
- Dry skin
- Vaginal dryness
- Lowered libido
- Weight gain, especially around the abdomen
Warning: Early menopause is possible
Women who notice symptoms that look an awful lot like those typically associated with the perimenopause before they've even turned 40 should keep in mind that it is indeed possible to go through the menopause early. A premature menopause is associated with factors like smoking, a family history of early menopause, having an autoimmune disease like arthritis, a chromosomal disorder like Turner's Syndrome, or being HIV positive. An early menopause is also surgically induced in women who need to have a hysterectomy and oophorectomy (removal of the ovaries).
See your doctor to figure out what's going on in this case. You can have your estrogen and follicle stimulating hormone levels tested for diagnostic purposes. Because an early menopause places you at risk of osteoporosis (brittle bones), heart disease, and other adverse health outcomes, it is important not just to let it be, but to have a chat with your doctor about how to manage your health best from now on.
What will your doctor do if you see them about the menopause?
Especially if you're going through the perimenopause at the usual age, sometime in your forties, your doctor usually won't find it necessary to conduct any lab tests to confirm the diagnosis. They will, however, ask you about your:
- Symptoms — hot flashes, mood swings, night sweats, changes in libido, weight gain, and the like.
- The pattern of your menstrual cycle, which is going to be irregular during the perimenopause. It will help your doctor if you keep track of your periods in a journal.
Your doctor or gynecologist will ask about your symptoms, track your cycle, and possibly conduct a few tests. Tests typically aren't needed to diagnose menopause.
2. A physical examination and vaginal swab
Your doctor may ask to conduct a vaginal swab. That is because the pH level of your vagina changes when you hit the menopause, from around 4.5 to about 6. This is a pretty neat diagnostic tool that doesn't require you to get any blood samples taken.
Because your risk of cancers of the reproductive system goes up when you enter the menopause, you'll also be asked to come in for regular pelvic exams to help detect them on time. This doesn't help diagnose the menopause, but it is indeed an important step for your health.
3. Blood tests
In some cases, your doctor will ask for blood tests that will help confirm the menopause and eliminate medical conditions like thyroid dysfunction from the spectrum of possibilities. These tests are:
- Tests to check your levels of follicle stimulating hormone (FSH — which should increase) and estrogen (estradiol — which should decrease). FSH level tests are also available as urine tests you can take at home, but the results will be unreliable since it is important they are taken at the right point in the menstrual cycle.
- A test to check your levels of thyroid stimulating hormone, to rule a slow thyroid in or out.
- A lipid profile — because your levels of "good" cholesterol can go down during the perimenopause as estrogen levels decline, a process that places you at risk of heart disease.
- Your doctor may also want to check your kidney and liver function, as the menopause can change the way in which these important organs function. These tests include ALT, AST, Bilirubin and Albumin.