Perimenopause and menopause are usually clinical diagnoses based on your age, symptoms and menstrual pattern and often no investigations are needed. But in certain circumstances, investigations may be helpful as discussed below. If indicated these can all be easily arranged as part of your Norfolk Menopause service
Blood tests are rarely required to diagnose perimenopause or menopause in women over the age of 45. In fact, they are often unhelpful due to fluctuations in hormone levels in the perimenopause. In younger women, an FSH blood test can be helpful, and FSH levels can also help guide women to know when they can safely stop contraception. In certain circumstances, oestradiol levels can be helpful if we are concerned about your absorption of oestrogen when on HRT. Baseline testosterone and testosterone levels on treatment can be performed when testosterone treatment is indicated.
For most women experiencing menopausal issues, scans are not necessary. However, there are some situations when a scan may be helpful. Changes to menstrual patterns are common during the perimenopause, before periods eventually stop; however, erratic, heavy bleeding can be a sign of other problems in the womb, and pelvic pain and bloating can be a sign of problems in the ovary and pelvis. An ultrasound scan can therefore help assess the pelvic organs.
An ultrasound is usually performed using a small probe that is placed in the vagina, although scans on the abdomen are also used. The scans are not painful and take around 20 minutes. These scans check that the ovaries, womb, and womb lining are all healthy. Following an initial assessment by our specialists, you will be advised if a scan is necessary. We offer a comprehensive service and can provide further investigations and treatment for any problems that arise from the scan.
The endometrium, or womb lining, can sometimes need checking during the perimenopause and menopause. This can be required following bleeding after the menopause or when bleeding occurs on a “bleed free” HRT preparation. A scan can also be indicated if bleeding is heavy or prolonged during the perimenopause. Occasionally, an ultrasound scan can show a thickening of the womb that needs to be checked. A biopsy (small tissue sample) is taken to check the endometrium, and this sample is sent to the laboratory for analysis. Samples can be taken in the clinic using a small plastic tube inserted into the womb. Usually, only mild to moderate discomfort occurs but if it is too uncomfortable samples can be taken under an anaesthetic using a camera (hysteroscopy). Having the capacity to offer an endometrial assessment is an important component of a comprehensive menopause service as significant problems, such as cancer, can occur. However, it is important to emphasise that most women attending clinic will not need an endometrial assessment. In those that do need a biopsy, most will not have a serious problem.
Oestrogen supports bone density and falling levels during menopause transition make it more likely for women to develop osteoporosis which can lead to fractures. A DEXA scan uses low dose xrays to measure bone density.
Using HRT to replace oestrogen is a very effective and safe treatment for osteoporosis. DEXA scanning can help women understand more closely the risks and benefits of HRT for them as individuals.