Quality standard

Quality statement 1: Diagnosing perimenopause and menopause

Quality statement 1: Diagnosing perimenopause and menopause

Quality statement

Women, trans men and non-binary people registered female at birth aged 45 or over presenting with menopause associated symptoms are diagnosed with perimenopause or menopause based on their symptoms alone, without confirmatory laboratory tests.

Rationale

In otherwise healthy women, trans men and non-binary people registered female at birth aged 45 or over, 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 people, 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

The following measure can be used to assess the quality of care or service provision specified in the statement. It is an example of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of women, trans men and non-binary people registered female at birth aged 45 or over 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, trans men and non-binary people registered female at birth aged 45 or over diagnosed with perimenopause or menopause.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

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, trans men and non-binary people registered female at birth aged 45 or over 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, trans men and non-binary people registered female at birth aged 45 or over, but base the diagnosis on menopausal symptoms alone.

Commissioners ensure that they commission services in which women, trans men and non-binary people registered female at birth aged 45 or over are diagnosed with perimenopause or menopause based on their menopausal symptoms alone, without confirmatory laboratory tests.

Women, trans men and non-binary people registered female at birth aged 45 years or over 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: identification and management. NICE guideline NG23 (2015, updated 2024), recommendation 1.3.1

Definitions of terms used in this quality statement

Menopause-associated symptoms

Menopause-associated symptoms include the following:

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

  • vasomotor symptoms (hot flushes and night sweats)

  • effects on mood (for example, depressive symptoms)

  • genitourinary symptoms (for example, vaginal dryness)

  • musculoskeletal symptoms (for example, joint and muscle pain)

  • sexual difficulties (for example, low sexual desire).

[Adapted from NICE's guideline on menopause, context section and recommendations 1.2.2 and 1.3.1]

Diagnosed

Diagnose the following without laboratory tests in otherwise healthy women, trans men, and non-binary people registered female at birth aged 45 or over with menopausal symptoms:

  • perimenopause, if they have vasomotor symptoms that have recently started and any changes in their menstrual cycle

  • menopause, if they have not had a period for at least 12 months and are not using hormonal contraception

  • menopause, in those who have had a hysterectomy, based on the type and combination of symptoms they have (for example, vasomotor symptoms).

[NICE's guideline on menopause, recommendation 1.3.1]

Laboratory tests

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

  • anti-Müllerian hormone

  • inhibin A

  • inhibin B

  • oestradiol

  • antral follicle count

  • ovarian volume.

[NICE's guideline on menopause, recommendation 1.3.4]

Equality and diversity considerations

Healthcare professionals should be aware that people from some ethnic minority backgrounds and people with some lifelong medical conditions may experience menopause at a younger age. This should be considered when reviewing people who have menopause associated symptoms.