How is early menopause diagnosed?

From the Guidelines

Early menopause is diagnosed through a combination of medical history, symptom evaluation, and hormone testing, with follicle-stimulating hormone (FSH) and estradiol levels being essential for diagnosis, as indicated in the 2012 guidelines for adolescent and young adult oncology 1.

Diagnosis Criteria

To diagnose early menopause, healthcare providers assess symptoms such as:

• Irregular or missed periods
• Hot flashes
• Night sweats
• Vaginal dryness
• Mood changes
• Sleep disturbances Blood tests are crucial for diagnosis, particularly measuring:
• FSH levels, which are typically elevated above 30 mIU/mL when ovarian function declines
• Estradiol levels, which are usually low (below 30 pg/mL) in menopause

Additional Testing

Additional tests may include:

• Thyroid function tests to rule out thyroid disorders that can mimic menopausal symptoms
• Genetic testing if premature ovarian insufficiency is suspected, especially in women under 40
• Anti-Müllerian hormone (AMH) testing to assess ovarian reserve, which may be useful in distinguishing women with premature ovarian insufficiency (POI) who have little to no follicles remaining from those who are at risk for POI but still have a reasonably sized follicle pool, as suggested by the 2016 recommendations for premature ovarian insufficiency surveillance 1

Confirmation of Diagnosis

A diagnosis of early menopause is confirmed when these symptoms and hormone changes occur before age 45, with premature menopause specifically referring to onset before age 40. For postpubertal females who were treated with alkylating agents and/or radiotherapy to which the ovaries were potentially exposed, a detailed menstrual history and physical examination, with specific attention paid to POI symptoms, are recommended, along with laboratory evaluation of FSH and estradiol, as recommended in the 2016 guidelines 1.

From the Research

Diagnosis of Early Menopause

To diagnose early menopause, several tests and clinical evaluations can be performed. The diagnosis is typically based on a combination of clinical presentation, medical history, and laboratory tests.

• Clinical Presentation: Early menopause, also known as premature ovarian insufficiency (POI), is characterized by the cessation of menstruation before the age of 40 2. Women may experience symptoms such as irregular menstrual periods, hot flashes, and infertility.
• Laboratory Tests:
  • Follicle-Stimulating Hormone (FSH) Test: Elevated FSH levels can indicate reduced ovarian function 3, 2.
  • Estradiol Test: Low estradiol levels can confirm estrogen deficiency 3, 2.
  • Other Hormone Tests: Tests for luteinizing hormone (LH), testosterone, and other hormones may also be performed to rule out other conditions 3, 4.
• Ovary Biopsy: In some cases, an ovary biopsy may be performed to confirm the diagnosis of early menopause 2.
• Medical History: A thorough medical history is essential to identify any underlying medical conditions or risk factors that may contribute to early menopause, such as radiation therapy, chemotherapy, or genetic disorders 2, 5.

Diagnostic Criteria

The diagnosis of early menopause is typically based on the following criteria:

• Age: Cessation of menstruation before the age of 40 2.
• Menstrual Irregularity: Irregular menstrual periods or amenorrhea 3, 2.
• Hormonal Imbalance: Elevated FSH and low estradiol levels 3, 2.
• Ovarian Function: Reduced ovarian function confirmed by laboratory tests or ovary biopsy 2.