How to diagnose menopause in a woman using Mirena (levonorgestrel)

From the Guidelines

To diagnose menopause in a woman using Mirena (levonorgestrel), the most reliable approach is to have a healthcare provider perform blood tests to measure follicle-stimulating hormone (FSH) levels, ideally on two separate occasions 4-6 weeks apart, as the hormonal effects of Mirena often mask typical menopause symptoms 1.

Diagnosis Considerations

When diagnosing menopause in women using Mirena, it's essential to consider the following:

• FSH levels above 30 IU/L typically indicate menopause, though Mirena may slightly affect these results 1.
• Menstrual changes are an unreliable indicator of menopause in women using Mirena, as they often experience lighter periods or no periods at all 1.
• Common menopause symptoms to monitor include hot flashes, night sweats, mood changes, vaginal dryness, and sleep disturbances, though Mirena's levonorgestrel hormone may reduce or eliminate these symptoms 1.

Clinical Evaluation

A thorough clinical evaluation is necessary to determine menopausal status, including:

• Medical history and physical examination
• Laboratory tests, such as FSH levels, to confirm menopause
• Assessment of symptoms and overall health status

Management

If menopause is confirmed, the healthcare provider will discuss the following:

• Contraception needs and potential hormone therapy options
• Management of menopause symptoms, if present
• Regular follow-up appointments to monitor health status and adjust treatment as needed It's crucial to prioritize the patient's overall health and well-being when diagnosing and managing menopause in women using Mirena, considering the potential risks and benefits of continued contraceptive use and hormone therapy 1.

From the Research

Diagnosing Menopause in Women Using Mirena (Levonorgestrel)

To diagnose menopause in a woman using Mirena (levonorgestrel), the following points should be considered:

• 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.
• In women using hormonal contraception, such as Mirena, hormonal assays or pelvic ultrasound are not recommended to make a diagnosis of menopause or to decide to stop contraception 2.
• The proposed strategy is the discontinuation of Mirena, and clinical follow-up (occurrence of amenorrhea) 2.
• Menopause is characterized by permanent cessation of menstrual periods and is clinically diagnosed after 12 months of complete amenorrhea 3.

Key Considerations

• The use of Mirena can affect menstrual bleeding patterns, and amenorrhea can be a common side effect 4.
• The contraceptive efficacy of Mirena has been shown to continue beyond 5 years of use, with no pregnancies detected over 967 and 1403 women-years up to seven and 15 years, respectively 4.
• Extended use of Mirena beyond the manufacturer-approved time period may be considered, but the risk of pregnancy and other factors should be taken into account 5.

Diagnostic Approach

• A clinical diagnosis of menopause can be made based on the presence of amenorrhea and other symptoms, such as hot flashes and night sweats 6.
• Hormonal assays, such as follicle-stimulating hormone (FSH) and estradiol levels, may be used to support the diagnosis of menopause in certain situations, such as in women with a history of hysterectomy 2.
• However, these tests are not necessary for all women and should be used judiciously 2.