Perimenopause or menopause transition starts as a result of changes in ovulation and decrease in level of the female hormone, oestrogen.
This change in reproductive life starts about 8 to 10 years before actual menopause. Most women enter this phase of theie reproductive life when they are in their 40s, but it can start in the 30s as well.
Most women can recognise that they are in the perimenopause stage (based on their age, menstrual history, and other symptoms or body changes) and do not need any tests or visits to the doctor for confirmation. But women who have heavy menstrual bleeding should visit the doctor to confirm the cause because several other medical conditions (such as uterine fibroid or cancer) can cause this symptom.
The doctor will take a history, examine you and if needed recommend some tests. The doctor may ask questions such as:
It is recommended that before you consult a doctor, make a note of your problems such as the symptoms, the frequency with which you experience them in a day or week and how severe they are. Inform your doctor about all your medications (prescription, non-prescription and vitamin supplements). Your doctor may be able to diagnose the cause of your symptoms (menstrual irregularity, hot flushes and night sweats) based on your age and examination findings. But if some other cause is suspected, further evaluation may be recommended.
The doctor may recommend tests in certain cases to check hormonal levels (follicle-stimulating hormone, oestrogen and thyroid hormone). Most women do not need more than thyroid hormone level testing. Thyroid-stimulating hormone level is tested as hypothyroidism (low thyroid level) can cause symptoms similar to menopause.
Besides hormonal level testing, your doctor may recommend an ultrasound of the abdomen and pelvis, and CT scans to look at the ovaries and uterus to rule out other medical problems. Endometrial biopsy may be done to confirm if the uterine lining (endometrium) is healthy during the menstrual cycle and to also check for signs of cancer.
Your doctor may recommend bone mineral density test to screen for osteoporosis. This is usually done in women older than 65 years but the screening may start at an earlier age if your doctor considers you to be at higher risk for osteoporosis. Consult your doctor to know about your risk of developing osteoporosis and when to start bone mineral density screening.
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