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 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 and 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 These criteria are based on the understanding that menopause is the permanent cessation of menses, accompanied by a profound and permanent decrease in ovarian estrogen synthesis 1.
Considerations in Special Populations
For women who have undergone chemotherapy, the diagnosis of menopause can be more complex, as amenorrhea may not be a reliable indicator of menopausal status due to potential ovarian function recovery 1. In such cases, serial measurement of FSH and/or estradiol may be necessary to confirm postmenopausal status, especially when considering the use of aromatase inhibitors as part of endocrine therapy 1.
Laboratory Testing
While laboratory tests, including FSH and estradiol levels, can support the diagnosis of menopause, they are not always necessary, particularly for women over 45 with typical menopausal symptoms 1. However, for women under 45, these tests become more crucial in distinguishing between premature menopause and other conditions that may cause similar symptoms 1.
Clinical Diagnosis
Ultimately, the diagnosis of menopause is clinical, combining age, symptom assessment, and selective laboratory testing when needed, with the goal of improving the patient's quality of life by appropriately managing menopausal symptoms and related health issues 1.
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: