From the Guidelines
Menopause is diagnosed primarily through a combination of symptoms and hormone testing, with a woman having gone 12 consecutive months without a menstrual period being a key indicator, as stated in the study by 1. A healthcare provider will typically diagnose menopause when a woman has gone 12 consecutive months without a menstrual period, provided there are no other causes for this absence. Common symptoms that suggest menopause include:
- hot flashes
- night sweats
- vaginal dryness
- sleep disturbances
- mood changes
- decreased libido Blood tests measuring follicle-stimulating hormone (FSH) levels can help confirm the diagnosis, as FSH levels typically rise significantly during menopause (usually above 30 mIU/mL) 1. Additionally, estradiol levels often decrease (typically below 30 pg/mL). These hormone tests are most useful when symptoms are unclear or when menopause is suspected at an unusually early age. It's essential to note that hormone levels can fluctuate during perimenopause, so a single test may not be definitive. For women under 45 experiencing menopausal symptoms, additional testing may be recommended to rule out other conditions that could cause premature ovarian insufficiency. The criteria for determining menopause, as outlined in the study by 1, include:
- prior bilateral oophorectomy
- age ≥ 60 years
- age < 60 years and amenorrhea for ≥ 12 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. Menopause is a natural biological process marking the end of reproductive years, occurring when the ovaries stop producing significant amounts of estrogen and progesterone, leading to the cessation of menstrual cycles and fertility.
From the Research
Diagnosing Menopause
- The diagnosis of menopause is a clinical diagnosis, made retrospectively, based on a 12-month period of consecutive amenorrhoea 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 oestroprogestogen or progestative-only-pill contraception, implant, or Levonorgestrel-intrauterine device (LNG IUD), hormonal assays or pelvic ultrasound are neither recommended to make a diagnosis of menopause (grade C), nor to decide to stop contraception (grade C) 2.
- The proposed strategy is the discontinuation of oral contraception, removal of the implant or LNG-IUD, and clinical follow-up (occurrence of amenorrhea) (expert opinion) 2.
Special Considerations
- In women with a history of hysterectomy, in the absence of evaluable clinical symptoms (amenorrhea), 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 (expert opinion) 2.
- No further examination can be recommended to make a definite diagnosis of menopause (expert opinion) 2.
Menopausal Symptoms
- Common symptoms of menopause are vasomotor (i.e., hot flashes and night sweats) and genitourinary (e.g., vulvovaginal irritation and dryness, dyspareunia, urinary problems) 3, 4.
- Estrogen-containing hormone therapy is effective treatment for vasomotor symptoms 3.
- Nonhormonal medications for vasomotor symptoms include selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and gabapentin 3.
- Hormone-free vaginal moisturizers are noninferior to estrogen-based therapies for treating genitourinary syndrome of menopause 3.