Guideline Summary for Menopause Evaluation and Associated Health Screening

Diagnosis of Menopause

Menopause should be diagnosed clinically by the absence of menstrual periods for 12 months in women with an intact uterus; routine laboratory testing is not required for diagnosis. – Endocrine Society 1
In women aged 45‑55 years with an intact uterus and a typical menopausal age, no laboratory testing is needed; the diagnosis is based solely on clinical criteria. – Endocrine Society 1
Measurements of sex steroids, gonadotropins, inhibin B, or anti‑Müllerian hormone do not aid in diagnosing menopause, cannot predict the timing of the final menstrual period, and do not influence management unless the patient is pursuing fertility. – Endocrine Society 1

Laboratory evaluation is warranted in women who have undergone hysterectomy (without bilateral oophorectomy) when menopausal status is uncertain. – Endocrine Society 1
Laboratory testing should be performed when menstrual history is insufficient to determine menopausal status. – Endocrine Society 1
In cases of suspected premature menopause (age < 40 years), laboratory confirmation is recommended. – American College of Endocrinology & American Association of Clinical Endocrinologists 2

Follicle‑stimulating hormone (FSH) measurement – elevated levels support menopausal status; results should be obtained on multiple occasions because single measurements are unreliable. – Endocrine Society 1 & American College of Endocrinology & American Association of Clinical Endocrinologists 2

All women aged ≥ 65 years should undergo bone mineral density (BMD) testing with dual‑energy X‑ray absorptiometry (DXA). – American College of Endocrinology & American Association of Clinical Endocrinologists 2
For younger postmenopausal women, BMD testing is indicated based on individualized fracture‑risk assessment. – American College of Endocrinology & American Association of Clinical Endocrinologists 2
In women being considered for pharmacologic osteoporosis therapy, laboratory evaluation should be performed to identify coexisting conditions that may contribute to bone loss. – American College of Endocrinology & American Association of Clinical Endocrinologists 2

Fasting lipid panel to assess dyslipidemia. – American College of Endocrinology & American Association of Clinical Endocrinologists 2
Fasting glucose or hemoglobin A1c to screen for diabetes mellitus. – American College of Endocrinology & American Association of Clinical Endocrinologists 2
Blood pressure measurement for detection of hypertension. – American College of Endocrinology & American Association of Clinical Endocrinologists 2

Routine ordering of FSH and estradiol in women with a typical menopausal presentation is unnecessary, wastes resources, and does not change management. – Endocrine Society 1
Reliance on a single FSH measurement is discouraged because hormone levels fluctuate markedly during the perimenopausal transition. – Endocrine Society 1

Menopause is defined as the permanent cessation of menstrual periods for at least 12 consecutive months in women with an intact uterus, typically aged 45–55 years; the diagnosis is made retrospectively and does not require hormonal assays or imaging in classic presentations. (American College of Endocrinology & American Association of Clinical Endocrinology) 3

Menopause reflects the irreversible loss of ovarian reproductive function due to progressive ovarian failure that usually begins in the late 30s, with most women achieving near‑complete estrogen deficiency by their mid‑50s. (American College of Endocrinology & American Association of Clinical Endocrinology) 4

Approximately 70 million women in the United States are older than 50 years, and women now spend roughly one‑third of their lifespan in the peri‑ or post‑menopausal phases. (American College of Endocrology & American Association of Clinical Endocrinology) 3