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Make the Diagnosis: Menopause

Prior Probability

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

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

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).

Population for Whom Perimenopause Should Be Considered

  • 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

Findings for Perimenopause

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).

Table 31-5Likelihood Ratios of Findings for Perimenopause

Reference Standard Test

Menstrual history.

Original Article: Is This Woman Perimenopausal?

Clinical Scenarios

Are These Women Perimenopausal?

For each of the following cases, the clinician may need to determine the probability that the patient is perimenopausal.

Case 1

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.

Case 2

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.

Case 3

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

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