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Make the Diagnosis: Menopause

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Prior Probability

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The probability of menopause is estimated best from the patient's age (see Figure 31-1).

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At age 36 to 39 years, the incidence is approximately 20%; 40 to 43 years, approximately 34%; and 44 to 45 years, 43%.

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Figure 31-1

Median age at perimenopause is 47.5 years, and median age at postmenopause is 51.3 years. Adapted with permission from McKinlay et al.9 Massachusetts Women's Health Study (n = 5547).

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Population for Whom Perimenopause Should Be Considered

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  • Women with irregular menses or amenorrhea for more than 3 months

  • Women with hot flashes or night sweats

  • Those who have had hysterectomy

  • Those undergoing chemotherapy

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Findings for Perimenopause

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Most findings other than age have low accuracy for identifying women in perimenopause. The presence of a family history of early menopause or hot flashes and the results of a home test for FSH may be the best findings (Table 31-5).

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Table 31-5Likelihood Ratios of Findings for Perimenopause
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Reference Standard Test

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Menstrual history.

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Original Article: Is This Woman Perimenopausal?

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Clinical Scenarios

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Are These Women Perimenopausal?
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For each of the following cases, the clinician may need to determine the probability that the patient is perimenopausal.

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Case 1
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A 45-year-old woman who had a hysterectomy at age 42 years for uterine fibroids reports that she has hot flashes and has felt irritable for the past month.

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Case 2
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A 41-year-old woman tells her physician that she thinks she is starting menopause. She smokes 1 pack of cigarettes a day, as she has for the past 20 years.

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Case 3
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A 47-year-old woman who has been taking oral contraceptives for the past 25 years requests information ...

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