From the Guidelines
Menopause is defined as the permanent cessation of menses, characterized by a profound and permanent decrease in ovarian estrogen synthesis, and can be determined by criteria including prior bilateral oophorectomy, age ≥60 y, or age <60 y and amenorrheic for 12 or more months with FSH and estradiol in the postmenopausal range. The definition of menopause is crucial in breast cancer management, as it affects treatment decisions and outcomes 1. Some key points to consider when determining menopause include:
- Prior bilateral oophorectomy
- Age ≥60 y
- Age <60 y and amenorrheic for 12 or more months in the absence of chemotherapy, tamoxifen, toremifene, or ovarian suppression and follicle-stimulating hormone (FSH) and estradiol in the postmenopausal range
- If taking tamoxifen or toremifene, and age <60 y, then FSH and plasma estradiol level in postmenopausal ranges It is essential to note that amenorrhea is not a reliable indicator of menopausal status in women who are premenopausal at the beginning of adjuvant 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 as a component of endocrine therapy. Menopausal status cannot be assigned to women who are receiving an LHRH agonist or antagonist, highlighting the complexity of defining menopause in certain clinical scenarios 1.
From the Research
Definition of Menopause
- Menopause is defined as the point in time 12 months after a woman's final menstrual period 2
- It is also defined as the cessation of menstrual period for 12 consecutive months 3
- Menopause is characterized as the permanent cessation of menstrual periods, determined retrospectively after a woman has experienced 12 months of amenorrhea without any other obvious cause 4
- The onset of menopause marks the end of the reproductive life cycle and can have both short and long term effects on women 5
Key Characteristics
- Menopause is often a gradual process, preceded by a transitional period known as perimenopause 5
- The average age of menopause varies, with an average age of 49 years in Singapore 3 and 51 years in the UK 5
- Menopause is marked by a decrease in estrogen and accompanying symptoms, including vasomotor and genitourinary symptoms 2