Diagnosis

Most people can tell by the symptoms that they’ve started menopause. If you have worries about irregular periods or hot flashes, talk with your healthcare professional.

Tests most often aren’t needed to diagnose menopause. But sometimes, your healthcare professional may suggest blood tests to check your levels of:

• Follicle-stimulating hormone (FSH) and estrogen (estradiol). FSH goes up and estrogen goes down during menopause. Because hormones go up and down during perimenopause, it can be hard to tell from these tests whether you’re in menopause.
• Thyroid-stimulating hormone (TSH). Overactive thyroid, called hyperthyroidism, can cause symptoms like those of menopause.

You can get home tests to check FSH levels in your urine without a prescription. The tests show whether you have higher FSH levels. This might mean that you’re in perimenopause or menopause.

But FSH levels rise and fall during your menstrual cycle. So home FSH tests can’t really tell you whether you’re in menopause.

Treatment

Menopause needs no treatment. Treatments aim to ease symptoms and prevent or manage ongoing conditions that may happen with aging. Treatments may include:

• Hormone therapy. Estrogen therapy works best for easing menopausal hot flashes. It also eases other menopause symptoms and slows bone loss.Your healthcare professional may suggest estrogen in the lowest dose and for the time needed to relieve your symptoms. It’s best used by people who are younger than 60 and within 10 years of the onset of menopause.If you still have your uterus, you’ll need progestin with estrogen. Estrogen also helps prevent bone loss.Long-term use of hormone therapy may have some heart disease and breast cancer risks. But starting hormones around the time of menopause has shown benefits for some people. Talk with your healthcare professional about whether hormone therapy may be safe for you.
• Vaginal estrogen. To relieve vaginal dryness, you can apply estrogen to the vagina using a vaginal cream, tablet or ring. This treatment gives you a small amount of estrogen, which the vaginal tissues take in. It can help ease vaginal dryness, pain with intercourse and some urinary symptoms.
• Prasterone (Intrarosa). You put this human-made hormone dehydroepiandrosterone (DHEA) into the vagina. It helps ease vaginal dryness and pain with intercourse.
• Low-dose medicines to treat depression, called antidepressants. Some antidepressants may ease menopausal hot flashes. These are called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRI). A low-dose antidepressant may help manage hot flashes in people who can’t take estrogen for health reasons or for those who need an antidepressant for a mood disorder.
• Gabapentin (Gralise, Neurontin). Gabapentin is approved to treat seizures, but it also has been shown to help reduce hot flashes. This medicine is useful for people who can’t use estrogen therapy and for those who also have nighttime hot flashes.
• Clonidine (Catapres-TTS-1, Nexiclon XR). This pill or patch most often treats high blood pressure. It might give some relief from hot flashes. It’s not often prescribed for hot flashes because of the possible side effects, such as low blood pressure, headache, sleepiness and constipation.
• Fezolinetant (Veozah). This medicine is free of hormones. It treats menopause hot flashes by blocking a pathway in the brain that helps manage body temperature. It’s FDA approved for managing menopause symptoms. It can cause abdominal pain, liver problems and make sleep problems worse.
• Oxybutynin (Oxytrol). This medicine treats overactive bladder and urinary urge incontinence. It’s also been shown to relieve menopause symptoms. But in older adults, it may be linked to cognitive decline.
• Medicines to prevent or treat the bone-thinning condition called osteoporosis. Your healthcare professional might suggest medicine to prevent or treat osteoporosis. Several medicines can help reduce bone loss and risk of fractures. Your healthcare professional also might prescribe vitamin D supplements to help strengthen bones.
• Ospemifene (Osphena). Taken by mouth, this selective estrogen receptor modulator (SERM) medicine treats painful intercourse linked to the thinning of vaginal tissue. This medicine isn’t for people who have had breast cancer or who are at high risk of breast cancer.

Before deciding on any form of treatment, talk with your healthcare professional about your choices and the risks and benefits of each. Review your choices yearly. Your needs and the treatment choices may change.