Menopause Investigations
Clinical Diagnosis Without Laboratory Testing
Menopause should be diagnosed clinically based on 12 months of amenorrhea in women aged 45-55 years without requiring laboratory testing. 1
The diagnosis is straightforward: menopause is defined as 12 consecutive months of amenorrhea in the absence of other pathological causes, occurring at a mean age of 51 years (95% between ages 45-55). 1 This clinical approach is endorsed by the American College of Obstetricians and Gynecologists and eliminates unnecessary testing in the majority of women. 1
When Laboratory Testing IS Indicated
Laboratory testing should be reserved for specific clinical scenarios only:
- Women under age 45 with suspected premature ovarian insufficiency who present with amenorrhea and menopausal symptoms 1
- Women with prior chemotherapy or tamoxifen use where the standard 12-month amenorrhea definition may not apply 1
- Women aged 40-45 with menopausal symptoms where diagnosis is uncertain 2
- Women under 40 with suspected early menopause 2
When testing is indicated, measure FSH levels to confirm ovarian failure. 2
Essential Clinical Assessment Components
Symptom Characterization
Document the following specific parameters:
- Vasomotor symptoms: frequency and severity of hot flashes and night sweats, including whether night sweats are drenching enough to require changing bedclothes 1
- Genitourinary symptoms: vaginal dryness, dyspareunia, urinary urgency, and pruritis 1
- Impact assessment: effects on sleep quality, daily functioning, work performance, and overall quality of life using standardized tools like the Greene Scale 3, 1
- Associated symptoms: mood changes, cognitive dysfunction, and sexual dysfunction 1
Health Risk Assessment
Bone density evaluation is critical: obtain baseline dual absorptiometry (DEXA scan) for all women at menopause, with regular long-term monitoring if abnormal at baseline. 4 This is particularly important for women at risk of osteoporosis due to early-induced menopause or treatment-related factors. 4
Cardiovascular risk assessment should be performed before considering hormone therapy, including lipid profile if there is history of arterial disease. 2
Breast cancer risk should be evaluated through history and counseling, with consideration of mammography referral if high risk is identified. 2
Thrombophilia screening should be considered in women with high risk of venous thromboembolism, though a negative screen does not eliminate risk. 2
Ruling Out Alternative Diagnoses
Laboratory work is necessary only when ruling out conditions that mimic menopausal symptoms:
- TSH and free T4 if thyroid dysfunction is suspected 5
- Complete blood count if infection or malignancy is suspected 5
Common Pitfalls to Avoid
Do not assume all symptoms are menopause-related; some may be due to aging, psychological disorders, or other medical conditions requiring separate evaluation. 1 The multifactorial nature of symptoms requires comprehensive assessment rather than attributing everything to menopause. 3
Do not overlook fertility counseling in young women with amenorrhea, as they may still become pregnant despite irregular menses. 1