How menopause is diagnosed

Perimenopause is not diagnosed by a scan or a single blood result. A doctor identifies it from your story: your age, what your periods are doing and what symptoms you have. NICE NG23 sets out how, for women in England:

• Perimenopause, in otherwise healthy women of 45 and over, if hot flushes or night sweats have started recently and there is any change in periods.
• Menopause, if there has been no period for at least 12 months and no hormonal contraception is being used.
• Menopause after a hysterectomy, from the type and combination of symptoms, since there are no periods to go on.

All three, NICE says, without lab tests (1.3.1). The Pakistan Menopause Society's Table 3 says the same for Pakistan, and the British Menopause Society agrees that the diagnosis rests on careful history taking.

Menopause itself is only certain looking back. The Pakistan Menopause Society defines your final period as the one confirmed after 12 months without another (section 1.2.2).

Under 45 the picture changes, and a blood test can play a part. See Is there a test for menopause? and FSH.

NICE also asks doctors to remember that diagnosis is harder in some situations. It says menopause can be difficult to identify in women taking hormonal treatments, such as for heavy periods (1.3.2), and that women from some ethnic minority backgrounds may reach menopause younger (1.3.3).

The Pakistan Menopause Society's recommendations describe what a good assessment covers. They ask doctors to start with open questions and then use a checklist, and their Table 2 lists the core history to take:

• your age and the date of your last period
• your bleeding pattern now and before, and whether you could be pregnant
• contraception, pregnancies and past gynaecological problems
• any hysterectomy, removal of the ovaries, chemotherapy or radiotherapy
• the medicines and any herbal or home remedies you take
• whether you would prefer hormonal or non-hormonal options

They also ask doctors to assess how symptoms affect your daily life, including sleep, tiredness, work, prayer and physical activity, intimacy and relationships (section 2.2), and to record blood pressure and BMI, and preferably waist size. A breast or pelvic examination is done only when symptoms, risk factors or screening call for it.

Some symptoms need checking in their own right, whatever stage you are in. The Pakistan Menopause Society lists red flags (section 2.3), among them bleeding after menopause, bleeding after sex or between periods, sudden heavy bleeding, and severe low mood or thoughts of suicide.

Above all of it sits NICE's first recommendation: "Tailor your approach to the person at all times when identifying, discussing, investigating and managing menopause" (1.1.1).

You do not need to be sure it is perimenopause before you book. If your periods are changing and your symptoms are affecting your days, that is enough.

Bring what the doctor will ask for. The dates of your last few periods, and whether they are closer together, further apart, heavier or lighter. A list of symptoms, the ones you find hard to say out loud included. Your medicines and anything you take from the chemist or a hakeem. Preparing for your appointment and symptom tracking can help, and Roshara's Where am I? gives you a list of questions to take in.

Nothing Roshara offers can tell you whether you are in perimenopause. Only a doctor who has heard your history can do that.

The Pakistan Menopause Society notes that many Pakistani women may not mention sexual, urinary or mood symptoms unless they are asked respectfully and in private (section 2.2). If your husband, mother-in-law or daughter comes with you, you can still ask for a few minutes alone with the doctor for the things you would rather not say in front of them.

It also lists prayer among the parts of daily life a doctor should ask about. If broken sleep is making Fajr a struggle, or tiredness is changing how you pray, that belongs in the conversation too.