Diagnosing perimenopause without labs
Also known as:
STRAW+10 staging, clinical diagnosis
Age and cycle pattern make the diagnosis after 45. When labs help, and the mimics to exclude.
Written and reviewed by Farhan Tahir, MD · Last reviewed
VIDEO LESSON
Staging
• Early menopause transition (STRAW+10 stage -2): a persistent difference of 7 days or more in consecutive cycle lengths
• Late transition (stage -1): 60 days or more of amenorrhea
• Menopause: 12 months without a period
When to order labs
• Under 40: evaluate for POI with FSH and estradiol
• Ages 40 to 45 with symptoms: consider FSH
• Atypical features, contraception or hysterectomy obscuring cycle data
Mimics to exclude
• Thyroid disease
• Pregnancy
• Hyperprolactinemia
• Anemia from heavy bleeding
• Depression, sleep apnea and medication effects
Clinical pearls
Do not use a single normal FSH to rule out perimenopause. Treat symptoms on clinical grounds, and evaluate abnormal uterine bleeding on its own merits.
Key studies and references
Educational content only, written and reviewed by Farhan Tahir, MD. It does not replace individual medical advice. For sudden chest pain, trouble breathing or stroke symptoms, call 911.
AT A GLANCE
Section
Diagnosis & monitoring
Also known as
STRAW+10 staging, clinical diagnosis
Reviewed by
Farhan Tahir, MD
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