From the Guidelines
Menopause is defined as the permanent cessation of menstruation, which can be determined by various criteria, including prior bilateral oophorectomy, age ≥ 60 years, or age < 60 years and amenorrheic for ≥ 12 months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression, as stated in the most recent study 1. The definition of menopause is crucial in clinical practice, particularly in the management of breast cancer.
- The criteria for determining menopause include prior bilateral oophorectomy, age ≥ 60 years, or age < 60 years and amenorrheic for ≥ 12 months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression, and follicle-stimulating hormone (FSH) and estradiol in the postmenopausal range 1.
- If a woman is taking tamoxifen or toremifene and is under 60 years old, the criteria for determining menopause include FSH and plasma estradiol level in postmenopausal ranges 1.
- It is essential to note that amenorrhea is not a reliable indicator of menopausal status in women who have undergone chemotherapy, as ovarian function may still be intact or resume despite anovulation/amenorrhea after chemotherapy 1.
- In such cases, oophorectomy or serial measurement of FSH and/or estradiol are needed to ensure postmenopausal status if the use of aromatase inhibitors is considered a component of endocrine therapy 1. The most recent study 1 provides the most up-to-date criteria for determining menopause, which is essential for guiding clinical decisions and ensuring the best possible outcomes for patients.
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.
- It is also defined as the final menstruation, directly preceding the permanent cessation of ovarian follicular function 4.
- The menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity 5.
- The menopause transition is usually a gradual process occurring over many years, caused by the cessation of ovarian reproductive function, resulting in the end of menstrual bleeding 6.
Key Characteristics
- Menopause involves the permanent cessation of ovarian function and is recognized to have occurred when there has been no menstrual cycle for 12 consecutive months without another cause 3.
- It is heralded by the menopausal transition, a period when the endocrine, biological, and clinical features of approaching menopause begin 5.
- The biology underlying the transition to menopause includes central neuroendocrine changes as well as changes within the ovary, the most striking of which is a profound decline in follicle numbers 5.
Symptoms and Management
- Symptoms of menopause can include vasomotor symptoms, such as hot flushes and night sweats, and genitourinary syndrome of menopause, which includes symptoms of vaginal dryness, dyspareunia, and urinary incontinence 3.
- Management options include lifestyle adjustment, talking therapies, dietary supplements as well as prescribed medications, including hormone replacement therapy 6.