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Best Tests March 2006

Including: Full colour PDF of ‘best tests’ September 2006. Tiredness PDF

Is this woman menopausal?

A systematic literature review published in JAMA concludes that as no one symptom or test is accurate enough by itself to rule in or rule out perimenopause, clinicians should diagnose perimenopause on menstrual history and age without relying on laboratory tests. Perimenopause refers to the year before and the year after the final menstrual period.

In the early perimenopause ovulation and menstruation usually become irregular because of fluctuating hormone levels. However this may be masked because of hysterectomy or hormonal contraception.

Identification of the perimenopause is important so that clinicians can answer women’s questions about the menopausal transition, relieve symptoms, advise on the need for ongoing contraception and counsel on disease prevention, such as for osteoporosis. The findings of the study are summarised in the following table:

Clinical feature Interpretation Comment
Age 45 years
Age 50 years
Age 55 years
40% peri- or post-menopausal
75% peri- or post-menopausal
98% peri- or post-menopausal
Not helpful for younger women
Mother, sister, aunt or grandmother with menopause <46 years Higher risk of early menopause
(odds ratio 6.1)
 
Current smoker Menopause 1-2 years earlier than non-smokers No clear picture for ex-smokers
Hot flushes Specificity 83-91%
Low sensitivity
Best indicators of perimenopause after menstruation and age but absence of symptoms does not rule it out
Vaginal dryness Specificity 80-97%
Low sensitivity
Night sweats Specificity 74-87%
Low sensitivity
Self rating of going through the ‘change’ Low specificity
Sensitivity 77-94%
Absence helps rule out perimenopause
High FSH levels Specificity 79%
Low sensitivity
Levels fluctuate in perimenopause. Adds little to diagnosis in uncomplicated cases
Low oestradiol levels Not enough data to calculate usefulness Levels fluctuate in perimenopause. Tend to be maintained in early perimenopause and fall in late perimenopause

Reference: Bastian, L., Smith, C., Nanda, K. (2003). Is this woman menopausal? JAMA, 289, 895-902.