Approach
The diagnosis of menopause is a clinical one, made retrospectively after the absence of menses for 12 months in a patient of an appropriate age for menopause (e.g., >45 years).[1]
History
Sixty or more days of amenorrhea during the previous year has sensitivity of 94% and specificity of 91% for predicting menopause within 2 years.[27] Hot flashes and menstrual irregularity are not helpful for predicting the onset of menopause, because these symptoms may precede menopause by years. It is important to remember the possibility of late-life pregnancy in a woman with amenorrhea. Heavy bleeding carries the possibility of endometrial pathology, and increasing menstrual symptoms of any kind require further investigation.
Exam
There are no consistent characteristic findings in early menopause. Some patients may display thinning of the labia minora or pallor of the vestibule. On speculum exam, there may be loss of rugae and mild pallor to the vaginal mucosa. Generally these changes will occur well after the onset of menopause.
Tests
Menopause is a clinical diagnosis, based on the absence of menses for 12 months.
Serum follicle-stimulating hormone (FSH) is recommended for diagnosis in women under 40 years of age, and may be helpful in women ages 40 to 45 years.[1][28] An elevated FSH level may be predictive of impending menopause after several months of amenorrhea. Measurement of serum FSH is not recommended in women over 45 years of age. Testing for FSH early in perimenopause is usually not helpful because of variability in levels from day to day and during the menstrual cycle.[29]
Serum estradiol testing is not usually indicated.
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