Make the Diagnosis: Menopause
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%.
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 |Favorite Table|Download (.pdf) Table 31-5 Likelihood Ratios of Findings for Perimenopause
|Finding ||Development of Perimenopause Within 36 Months |
|LR+ (95% CI) or Range ||LR– (95% CI) or Range |
|FSH (≥24 mIU/mL)a ||3.1 (2.1-4.5) ||0.45 (0.36-0.56) |
|Family history of early menopause ||2.0 (1.1-3.5) ||0.9 (0.9-1.0) |
|Hot flashes ||2.1-4.1 ||0.54-0.87 |
Original Article: Is This Woman Perimenopausal?
Are These Women Perimenopausal?
For each of the following cases, the clinician may need to determine the probability that the patient is perimenopausal.
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.
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.
A 47-year-old woman who has been taking oral contraceptives for the past 25 years requests information about ...