The Diagnosis of Menopause
In the beginning, the diagnosis of menopause can be a clinical challenge, as its presentation and the changes it produces are variable for each woman. However, it’s possible to suspect it. There are imaging studies and laboratory tests that help confirm the stage.
Under normal conditions, after 35 years of age, the loss of ovarian follicles accelerates, which is accompanied by a decrease in fertility. Menopause indicates the end of reproductive life in women.
The date of the last menstruation and the one-year period that follows it establish the diagnosis of menopause. So, it’s normal to find yourself in a time of premenopause and one of postmenopause.
The stages of menopause and the importance of FSH
The 3 periods (premenopause, menopause, and postmenopause) are included under the term climacteric. In everyday practice, most people use both concepts interchangeably.
The existence of the genitourinary syndrome of menopause (GSM) has also been added to talk about the vulvovaginal and urinary signs and symptoms associated with estrogen deficiency.
Follicle Stimulating Hormone (FSH) is a hormone secreted by the pituitary gland that stimulates the ovary to secrete estrogen. With a sufficient level of estrogen, FSH secretion by the pituitary is inhibited. On the contrary, when there’s a lack of estrogen, the secretion of FSH increases.
The transition to natural menopause is perimenopause. It refers to the period in which there are endocrine changes, and in the menstrual cycle before the cessation of menstruation and up to 1 year after that last cycle. It’s characterized by irregular menstrual cycles.
Premenopause
In the early menopausal transition, the cycles last approximately 7 days persistently. FSH appears with variable but high values. Then comes the late menopausal transition with periods of amenorrhea (absence of menstruation). This period can last 1 to 3 years, and FSH values remain below 25 IU / L.
In the late perimenopause period, the frequency of ovulation is decreasing. In any case, there’s still the possibility of an eventual pregnancy until the patient has amenorrhea for one year.
Vasomotor symptoms are more frequent and there’s a significant acceleration of the loss of bone density.
Postmenopause
Once menstruation has disappeared, we enter the postmenopausal stage. Ovarian function decreases and is divided into two parts:
- Early postmenopause: Lasts between 5 to 8 years. The first stage corresponds to the first 12 months after the last menstruation. FSH values remain variable until they stabilize after two years.
- Late postmenopause: This corresponds to the rest of the woman’s life. The greatest symptoms are related to the urogenital area and aging in the non-reproductive area.
Criteria for the diagnosis of menopause
The Latin American Federation of Obstetrics and Gynecology Societies (FLASOG) suggests the following criteria for the diagnosis of menopause:
- Confirmation of the last normal menstruation after 12 consecutive months of amenorrhea (absence of menstruation for one year) without any other apparent cause.
- Presence of some of the following symptoms: Vasomotor (hot flashes, night sweats), tachycardia and palpitations, insomnia, depression, irritability, low self-esteem, decreased libido, irregular menstrual cycles, genitourinary syndrome of menopause (vaginal dryness, burning sensation, and genital irritation, burning when urinating, urinary urgency, or recurrent urinary infections).
- Female hormone profile: With increased FSH and LH; as well as decreased estradiol and estrogen.
Other tests that can help in the diagnosis of menopause
In addition to conducting an interview about the patient’s history and a physical evaluation, physicians should include the following studies in cimateric women:
- Lipid profile.
- Electrocardiogram.
- Blood glucose.
- General urine test.
- Cervicovaginal cytology.
- Mammography.
- Pelvic ultrasound.
- Bone densitometry. In postmenopausal women, up to 20% of bone density loss occurs during the first 5 years. This study is recommended by the World Health Organization (WHO) for the diagnosis of osteoporosis.
Differential diagnostics
As discussed earlier, the diagnosis of menopause can be difficult when it occurs prematurely. Here are some conditions that can cause alterations in the menstrual cycle and be confused with menopause:
- Pregnancy
- Early menopause
- Hyperthyroidism
- Pelvic tumors, such as gestational trophoblastic disease, or ovarian tumors
Should I see the gynecologist?
Considering that menopause is an endocrinologically unstable period that brings physical and emotional changes, it’s important to see a doctor. The professional can guide the patient and define whether it’s a physiological process or not.
Similarly, every menopausal or postmenopausal woman should have a regular gynecological evaluation.
Menopause can only be confirmed after a full year has gone without menstruation. Therefore, during this entire time, the woman must continue to use her usual contraceptive method.
- The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020; 27 (9): 976-992
- Monterrosa A, et al. Evaluación del síndrome genitourinario de la menopausia con el Vulvovaginal Symptoms Questionnaire en afrodescendientes del Caribe colombiano. Ginecol Obstet Mex. 2021; 89 (2): 115-128.
- Federación Latinoamericana de Sociedades de Obstetricia y Ginecología (FLASOG). Climaterio y menopausia. 2016: 1-17. ISBN 978-607-7548-50-8
- Board of Trustees of The North American Menopause Society (NAMS). Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause, 2010; 17 (1): 25/54. DOI: 10.1097/gme.0b013e3181c617e6
- Who.org. Evaluación del riesgo de fractura y su aplicación en la detección de la osteoporosis postmenopausica. Organización Mundial de la Salud (OMS/WHO). [Citado: julio 2021]. Disponible en:http://apps.who.int/iris/bitstream/handle/10665/37205/WHO_TRS_843_spa.pdf;jsessionid=C6AB3F8E12FD47EA7F64AA4467DB2940?sequence=1
