From the Guidelines
Menopause is diagnosed based on a combination of age, symptoms, and hormone levels, with criteria including prior bilateral oophorectomy, age ≥60 years, or age <60 years with amenorrhea for 12 or more months and follicle-stimulating hormone (FSH) and estradiol in the postmenopausal range, as outlined in the most recent guidelines 1. The diagnostic criteria for menopause, including perimenopause and postmenopause, are multifaceted and consider various factors.
Key Diagnostic Criteria
- Prior bilateral oophorectomy
- Age ≥60 years
- Age <60 years and amenorrheic for 12 or more months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression, with FSH and estradiol in the postmenopausal range
- If taking tamoxifen or toremifene, and age <60 years, then FSH and plasma estradiol level in postmenopausal ranges, as noted in 1 and supported by similar criteria in 1.
Considerations for Diagnosis
- For women over 45 experiencing irregular periods and typical menopausal symptoms, laboratory testing may not be necessary, but blood tests measuring FSH and estradiol levels can help confirm the diagnosis, particularly in younger women or unclear cases, as suggested by 1.
- Additional testing for premature ovarian insufficiency is recommended for women under 40 experiencing menopausal symptoms, including tests for other hormones and possibly genetic testing.
- Thyroid function tests may also be performed to rule out thyroid disorders that can mimic menopausal symptoms.
Importance of Accurate Diagnosis
Accurate diagnosis of menopause is crucial for determining the appropriate treatment and management plan, as menopause is a natural biological process that can significantly impact quality of life if symptoms are severe. The most recent and highest quality study, 1, provides the basis for these diagnostic criteria, emphasizing the importance of considering age, symptoms, and hormone levels in the diagnosis of menopause.
From the Research
Diagnostic Criteria for Menopause
The diagnosis of menopause is typically made retrospectively, based on a 12-month period of consecutive amenorrhea in a compatible age group (after 45 years of age) 2. The diagnostic criteria for menopause include:
- A 12-month period of consecutive amenorrhea in a compatible age group (after 45 years of age) 2
- No hormonal dosage or imaging is indicated to make a diagnosis of menopause in a classic situation 2
- In women using hormonal contraception, implant, or intrauterine device, hormonal assays or pelvic ultrasound are neither recommended to make a diagnosis of menopause nor to decide to stop contraception 2
Special Considerations
In certain situations, the diagnosis of menopause may be more complex, such as:
- In women with a history of hysterectomy, a repeat FSH≥40 combined with low estradiol (<20pg/ml) at least 3 months after the procedure could be a diagnostic orientation towards menopausal status 2
- After cancer, in women who have received gonadotoxic treatment, the classic clinical criteria of 12 months of amenorrhea cannot be used to make a diagnosis of menopause with certainty 2
- In breast cancer, the hormonal status to be taken into account when choosing initial hormone therapy is the one found before starting any treatment 2
Common Symptoms of Menopause
Common symptoms of menopause include: