Quality statement 1: Diagnosing perimenopause and menopause

Quality statement

Women over 45 years presenting with menopausal symptoms are diagnosed with perimenopause or menopause based on their symptoms alone, without confirmatory laboratory tests.

Rationale

In otherwise healthy women over 45, perimenopause and menopause can be diagnosed based on clinical history alone. In this age group, laboratory tests, particularly follicle-stimulating hormone (FSH), do not help with the diagnosis because hormone levels fluctuate during the perimenopause. Knowing these levels will not change management. Other laboratory tests, for example, blood count or thyroid function tests, may still be needed if non-menopausal causes of symptoms are suspected. Reducing the number of unnecessary tests will reduce stress for women, lead to potential cost savings and empower healthcare professionals to make a clinical diagnosis and provide reassuring support and advice based on their clinical experience.

Quality measures

Structure

Evidence of local arrangements to ensure that women over 45 years presenting with menopausal symptoms are diagnosed with perimenopause or menopause based on their symptoms alone, without confirmatory laboratory tests.

Data source: Local data collection.

Process

Proportion of women over 45 years diagnosed with perimenopause and menopause whose diagnosis is based on their symptoms alone, without confirmatory laboratory tests.

Numerator – the number in the denominator whose diagnosis is based on their symptoms alone, without confirmatory laboratory tests.

Denominator – the number of women over 45 years diagnosed with perimenopause or menopause.

Data source: Local data collection.

Outcome

a) Proportion of women over 45 years with menopause who felt reassured by their healthcare professional about their diagnosis.

Data source: Local data collection.

b) Number of laboratory tests to confirm a diagnosis of menopause in women over 45 years.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (primary and secondary care and community services) ensure that systems are in place for women over 45 years to be diagnosed with perimenopause or menopause based on their menopausal symptoms alone, without confirmatory laboratory tests.

Healthcare professionals (such as GPs, practice nurses and healthcare professionals with expertise in menopause) do not use laboratory tests to confirm a diagnosis of perimenopause or menopause in women over 45 years, but base the diagnosis on menopausal symptoms alone.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services in which women over 45 years are diagnosed with perimenopause or menopause based on their menopausal symptoms alone, without confirmatory laboratory tests.

Women over 45 who visit their GP or practice nurse with common symptoms of the menopause are not offered unnecessary blood tests, but have their symptoms assessed by the doctor or nurse to see whether they have started the menopause or will start the menopause soon. Common symptoms of the menopause include hot flushes, night sweats, mood changes, and no periods or the occasional period.

Source guidance

Menopause (2015) NICE guideline NG23, recommendation 1.2.1

Definitions of terms used in this quality statement

Menopausal symptoms

Menopausal symptoms include the following:

  • no or infrequent periods (taking into account whether the women has a uterus)

  • hot flushes

  • night sweats

  • mood changes

  • memory and concentration loss

  • vaginal dryness

  • lack of interest in sex

  • headaches

  • joint and muscle stiffness.

[Adapted from NICE's guideline on menopause, context section and recommendations 1.2.1 and 1.3.2]

Diagnosed

Diagnose the following without laboratory tests in otherwise healthy women aged over 45 years with menopausal symptoms:

  • perimenopause based on vasomotor symptoms and irregular periods

  • menopause in women who have not had a period for at least 12 months and are not using hormonal contraception

  • menopause based on symptoms in women without a uterus.

[NICE's guideline on menopause, recommendation 1.2.1]

Laboratory tests

FSH tests should not be routinely considered when diagnosing menopause in women aged over 45 years with menopausal symptoms.

[Adapted from NICE's guideline on menopause, recommendation 1.2.5]

Do not use the following laboratory and imaging tests to diagnose perimenopause or menopause in women aged over 45 years:

  • anti-Müllerian hormone

  • inhibin A

  • inhibin B

  • oestradiol

  • antral follicle count

  • ovarian volume.

[NICE's guideline on menopause, recommendation 1.2.3]