Is there a test that can accurately tell that my menopause has occurred?

Many authorities suggest that one-year of amenorrhoea (no periods) in the late forties or beyond indicates that the menopause has been reached while others would accept six months without a period. There is no clinical or hormone test that can une quivocally prove that your ovaries have been completely depleted of potentially functional oocytes (eggs). If you are still having periods, hormone tests are even less helpful at indicating when your menopause will occur.

During the reproductive years there is a monthly cycle of hormone changes involving the ovaries and the pituitary gland (situated at the base of the brain) (menstrual cycles). When oestrogen production falls at the end of each menstrual cycle, the pituitary produces an increase in a stimulating hormone (FSH - follicle stimulating hormone). When the ovaries are functioning they respond by producing oestrogens and this keeps the FSH in the blood from becoming high. When the ovaries have run out of eggs, they cease to function, and cannot respond and the oestradiol (one of the main oestrogens) level usually falls (to less than 80pmol/l) and the FSH level rises (to greater than 20nmol/l). Occasionally there may be a few ova lying dormant and after a while they become active. A high FSH level cannot, therefore, exclude the possibility of the ovaries regaining some function. If you are in your fifties or perhaps late forties, your periods have stopped and your FSH levels are high, further ovarian function is unlikely and spontaneous pregnancy would be exceptionally rare.

The story of a lady who presented at the age 49 years with menorrhagia (heavy periods) illustrates the difficulty in deciding when the menopause has taken place. We performed a D and C (hysteroscopy D and C) for her and her periods were then controlled with medical treatment. Within a year her periods ceased and she became troubled by hot flushes and night sweats. Her FSH level was high on two occasions and well into the menopausal range. She was commenced on se quential HRT (daily oestrogen with progestogen for 12 days of each course) (HRT and progestogen) but the resulting withdrawal bleeds were unacceptably heavy. The HRT was discontinued but she continued to experience heavy monthly bleeds and her FSH had fallen to normal (no longer menopausal) levels. This time medical treatment failed to control her heavy periods. She came to total abdominal hysterectomy and bilateral salpingo-oophorectomy (Q 24.23) and an oestradiol implant was introduced.

A 30 year old woman presented for consideration of IVF with a regular 28 day cycle for several months after discontinuation of HRT for premature menopause. Her gonadotrophins proved to be in the menopausal range and her previous gynaecologist confirmed that four years earlier she had presented with irregular periods and her FSH levels had been at menopausal levels even then.

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