From the Guidelines
A woman is considered to be in menopause after experiencing 12 consecutive months of amenorrhea (absence of menstruation) with no other identifiable physiological or pathological cause. This definition is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1. The 12-month timeframe is the standard clinical definition used to confirm that a woman has transitioned from perimenopause to menopause.
Key Considerations
- The average age of menopause is 51 years, though it can occur naturally between ages 45 and 55.
- Symptoms of perimenopause, such as hot flashes, sleep disturbances, and mood changes, may begin several years before the final menstrual period and can continue for years afterward.
- Women should still use contraception during this 12-month period if they wish to avoid pregnancy, as conception remains possible until menopause is confirmed.
- If a woman younger than 40 experiences this pattern of amenorrhea, it may be classified as premature menopause or primary ovarian insufficiency, which warrants medical evaluation.
Clinical Guidelines
The definition of menopause should include both natural menopause (at least 12 months of amenorrhea prior to initiation of chemotherapy or endocrine therapy) and menopause induced by ovarian ablation or suppression (but not the cessation of menses due to chemotherapy alone) 1. In women age ≥ 60 years with a previous hysterectomy and ovaries left in place, luteinizing hormone, follicle-stimulating hormone, and serum estradiol should be in the postmenopausal range and measured prior to initiation of any systemic therapy to receive adjuvant bisphosphonates.
Recent Studies
A more recent study published in 2020 suggests that menopausal status following chemotherapy can be empirically diagnosed in case of amenorrhea for at least 2 years, a persistent postmenopausal hormonal profile, and a vaginal ultrasound indicating the ovaries are no longer functioning 1. However, this study does not supersede the standard clinical definition of menopause as 12 consecutive months of amenorrhea, as it specifically addresses menopausal status following chemotherapy.
From the Research
Definition of Menopause
- Menopause is defined as the permanent cessation of menstrual periods, determined retrospectively after a woman has experienced 12 months of amenorrhea without any other obvious cause 2, 3, 4.
- The average age of onset in the United States is 51 years, but symptoms can be present for many years before and after menopause 2.
- Menopause is diagnosed retrospectively after 12 consecutive months of amenorrhea 2, 3, 4.
Diagnosis of Menopause
- A woman is considered to be in menopause if she has experienced 12 consecutive months of amenorrhea without any other obvious cause 2, 3, 4.
- The diagnosis of menopause is based on the cessation of menstrual periods, and it is determined retrospectively 2, 3, 4.
- Other factors, such as symptoms and medical history, may also be considered in the diagnosis of menopause 2, 3.
Management of Menopause
- Hormone replacement therapy (HRT) is the most effective management for menopause symptoms 2.
- Other management options, such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, gabapentin, and clonidine, are available, but they are less effective than HRT 2.
- Local vaginal therapy is effective and recommended for management of isolated vulvovaginal symptoms 2.