Best Tests March 2006
|Including:Full colour PDF of ‘best tests’ September 2006.|
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:
|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%
|Best indicators of perimenopause after menstruation and age but absence of symptoms does not rule it out|
|Vaginal dryness||Specificity 80-97%
|Night sweats||Specificity 74-87%
|Self rating of going through the ‘change’||Low specificity
|Absence helps rule out perimenopause|
|High FSH levels||Specificity 79%
|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.