ABSTRACT
Women who have symptoms of the menopause and are aged over 45 do not usually need a blood test to diagnose it. Follicle-stimulating hormone (FSH) is raised in the menopause, but it is unreliable in the perimenopause and can sometimes be normal in a menopausal woman. An FSH test may be useful in women who have symptoms of the menopause under the age of 45, although not essential if the diagnosis is clear clinically. All women with heavy menstrual bleeding need a full blood count – no other aspect of the examination or investigation is compulsory. For most women who need investigation, NICE advises hysteroscopy as the method of choice, with ultrasound being reserved for those women who decline hysteroscopy. For women at moderate or high risk of breast cancer, a 5-year course of tamoxifen can reduce the risk of developing breast cancer by 40%, a reduction which persists for at least 16 years after the drug is stopped.
