New forms of testing aim to demystify the transition, but they may not be very accurate.
Menopause can be especially hard to pinpoint — even those who are in the midst of it might not know it. Quest Diagnostics, a leading consumer-focused testing company, told us that out of the 51 million Americans experiencing menopausal symptoms, 25 percent aren’t aware of when the early stages of menopause start. Maybe it’s denial, or maybe it’s naivete, but whatever it is, menopause negligence can lead to more serious health issues later down the line.
“Today, most women don’t definitively know if they’ve gone through menopause and in turn might be suffering through symptoms without medical help,” says Karen Racicot, Ph.D., director and medical science liaison for women’s health at Quest Diagnostics.
But what if it didn’t have to be a guessing game? Three experts weigh in on the current methods for diagnosing menopause, whether it’s something that really needs to be identified so precisely, and the available tests that allow women to take charge of their symptoms.
How is menopause typically diagnosed?
Menopause marks the official end of menstrual cycles but it isn’t the type of diagnosis that can be made in a day. Most doctors don’t officially diagnose menopause until a patient goes 12 consecutive months without a period. Over the course of a year, most doctors evaluate symptoms, such as difficulty sleeping or mood swings, but testing isn’t something a majority of healthcare professionals use to confirm menopause.
Still, the reality is most women don’t go see a doctor when they’re experiencing symptoms in the beginning — in fact, a State of Menopause study found that nearly half — 45 percent — of women don’t know the difference between the transitional period leading up to menopause or “perimenopause” and then menopause itself. So, at-home testing offers convenience and a sense of clarity.
When would you want to test for menopause?
Doctors don’t typically test for menopause. Since symptoms like hot flashes and night sweats are generally considered tell-tale signs for doctors, testing isn’t often seen as a requirement for determining whether someone has officially started the change of life or not.
But testing can be a necessary part of the diagnostic process when the cause of symptoms isn’t clear. This is especially true for women who have already stopped menstruating because of other factors, like if they’ve had their uterus taken out. For example, Dr. Faubion, who’s director of the Mayo Clinic Center for Women’s Health, says doing an analysis is helpful for people who have had a hysterectomy, which involves either the partial or total surgical removal of the uterus. In this case, a woman who has had this procedure might not know they’ve hit menopause and may not understand why they’re having certain symptoms, like night sweats. “If you had a hysterectomy before the age of menopause and still have your ovaries, you may not know exactly when you go into menopause,” she explains.
Testing is also a handy tool when it comes to ruling out menopause. For instance, if someone experiences menopause symptoms in their early 40s, which is earlier than the average age of 51, that could be a sign of thyroid disease. For women under 40, menopausal-like symptoms like hot flashes and irregular periods can be a sign of a rare condition known as premature ovarian insufficiency, according to our resident women’s expert Rebecca Brightman, MD. This is where a woman’s ovaries stop producing eggs, sometimes due to chemotherapy or an autoimmune disease.
Where there’s a degree of uncertainty, doctors will check a range of reproductive hormone levels that can help them determine whether or not someone has hit menopause. During menopause, the body tends to make more hormones than others. For instance, the body tends to produce more follicle-stimulating hormone (FSH), luteinizing hormone (LH), and less of a type of estrogen known as estradiol.
How do menopause tests work?
There are several different ways to test for menopause, some, of course, are more accurate than others. Saliva and urine tests aren’t considered to be as accurate, so most doctors opt for blood tests. In fact, they’re embraced in the medical community as “the gold standard.”
“Blood tests allow a practitioner to order a full panel of tests, which saliva and urine tests might not allow for,” says Dr. Desai, who’s the author of Lady Parts: Putting Women’s Health Back Into Women’s Hands. “Also, most data and research to date would cite blood levels, which might be another reason blood tests remain the gold standard in medicine.”
There are even menopause tests that patients can buy directly. For instance, there are menopause urine tests that can be taken in the comfort of your own home. These have been shown to accurately detect your levels of FSH, which is a hormone that plays a key role in sexual functioning, in your urine about 9 out of 10 times, according to The Food & Drug Administration.
Some healthcare companies, like Quest Diagnostics, have even started selling menopause blood tests online that range between $69 and $129. Each test is meant to detect a different stage — early menopause, perimenopause, or post-menopause. This one isn’t a home test — while you can order it yourself, “it’s a blood test that is facilitated in-lab by a phlebotomist,” according to the company. But as promising as these may sound, many experts believe they’re a waste of time and money.
“It’s concerning that some companies are selling direct-to-consumer hormone testing,” says Dr. Faubion. “The tests are just a money generator because unfortunately, the science isn’t advanced enough to make self-tests accurate yet.”
How accurate are menopause tests?
Whether you do an at-home test or ask your doctor for one, testing for menopause isn’t an exact science and there isn’t a single test on the market that can give you an answer without some degree of uncertainty. Dr. Brighman compares testing even by health experts to taking a “shot at a moving target.”
“During perimenopause, hormone levels of FSH, LH, and estradiol fluctuate, so testing is like trying to take a shot of a moving target,” says Dr. Brightman. “One day a woman can look like she is in her peak reproductive years and another she can look as though she is menopausal.”
But just because the technology for menopause testing isn’t there yet, doesn’t mean women shouldn’t seek answers. While there’s no “cure” for menopause, identifying the symptoms and labeling this confusing transition can help some women prepare for the detrimental effects that could come next. People lose an average of 25 percent of their bone mass during menopause due to the natural decline in estrogen, according to the Cleveland Clinic. Meanwhile, a research team at the University of Wisconsin-Milwaukee found last year that declines in this hormone make women more predisposed than men to developing Alzheimer’s disease.
Identifying menopause with the help of a medical professional allows people to make lifestyle adjustments that will protect them from some of this transition’s more worrisome side effects. “Menopause is a risk factor for a lot of diseases and that’s the correlation that needs to be made in healthcare,” Dr. Desai tells us. “Now that we know that, it’s no longer just about knowing why you’re so hot all of a sudden.”
