GPAtlas🧭 When to suspect
Diagnose perimenopause and menopause clinically, without laboratory tests, in otherwise healthy women aged over 45 with typical symptoms. Suspect perimenopause when recently-started vasomotor symptoms accompany any change in the menstrual cycle, and menopause after 12 months of amenorrhoea in someone not using hormonal contraception (or, after hysterectomy, on the symptom pattern alone).
The oestrogen-deficiency picture is broad: vasomotor (hot flushes, night sweats), musculoskeletal (joint and muscle pain), psychological (low mood, anxiety, irritability, ‘brain fog’), genitourinary (vaginal dryness, dyspareunia, recurrent urinary tract infection) and low sexual desire. Symptoms range from trivial to disabling and may last months or years.
The two skills in primary care are to identify younger-onset disease – suspect premature ovarian insufficiency (POI) under 40 and early menopause at 40–45, both of which need confirmation and active replacement – and to never attribute new bleeding to ‘just the menopause’ without excluding pathology.
| Term | Typical age | How to identify |
|---|---|---|
| Perimenopause | ~45 onwards | Recently-started vasomotor symptoms plus menstrual cycle change; clinical diagnosis, no tests. |
| Menopause | Average 51 | 12 months amenorrhoea (not on hormonal contraception), or symptom pattern after hysterectomy; clinical. |
| Early menopause | 40–44 | Menopause within this band; consider serum FSH; offer psychological support. |
| Premature ovarian insufficiency (POI) | Under 40 | Menopausal symptoms plus two FSH levels > 30 IU/L, taken 4–6 weeks apart. |
Source: NICE NG23
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