History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include age 40 to 60 years, history of chemotherapy or pelvic radiation, and smoking.
amenorrhoea
Sixty or more days of amenorrhoea during the previous year has sensitivity of 94% and specificity of 91% for predicting the menopause within 2 years.[27]
It is important to remember the possibility of late-life pregnancy in a woman with amenorrhoea.
irregular menstrual cycle
Irregularity in the menstrual cycle during the late 40s marks the entry into perimenopause. Other causes of infrequent/reduced menstrual bleeding (such as polycystic ovarian syndrome) should also be evaluated in the proper clinical context.
hot flushes and night sweats
Vasomotor symptoms (VMS) may begin several years before the menopause. A multi-ethnic observational study of menopausal transition among 3302 women found that the median total VMS duration was 7.4 years.[4] Among the women who had a specific final menstrual period, the median length of VMS was 4.5 years, but women who reported hot flushes when they were premenopausal or in early perimenopause had a median total duration of >11.8 years.[4] African-American women reported a median 10.1 years of VMS, the longest of any ethnicity in the study.[4]
Up to 15% of women continue to have hot flushes many years after the menopause.[29]
vaginal symptoms
Dryness, itching, and dyspareunia are consistently associated with menopause transition and are related to decreased circulating levels of oestrogen, which leads to urogenital atrophy. Vaginal symptoms may affect up to 45% of menopausal women.[30] Pale, dry vaginal mucosa with decreased rugae is often found on pelvic examination and may cause pruritus or dyspareunia and lead to urinary tract infections.
mood changes
Irritability and mood swings, which range from sadness and crying for no reason to withdrawal from social interaction, are not uncommon.
Other diagnostic factors
common
sleep disturbance
These symptoms are commonly associated with the menopause transition and are worsened by nocturnal hot flushes.
mild memory impairment
Minor memory lapses are not usually predictive of developing dementia, and may be related to variable hormone levels and poor sleep (due to hot flushes).
uncommon
heavy menstrual bleeding
Approximately 25% of women have at least one episode of heavy menstrual bleeding in the perimenopause, usually before the onset of infrequent/reduced menstrual bleeding. The annual rate of presentation to health services with heavy menstrual bleeding increases from around 2% per year to between 4% and 5% in women >40 years of age, and peaks in women aged between 45 and 49 years.[31]
Menstrual bleeding that is heavier, longer, or more frequent may be indicative of problems such as endometrial polyps or malignancy.
Risk factors
strong
age 40 to 60 years
In healthy women living in the developed world, the menopause is a natural event that usually occurs between 40 and 60 years of age, following a normal distribution pattern. The median age at menopause in Europe ranges from 50.1 to 52.8 years, in North America from 50.5 to 51.4 years, in Latin America from 43.8 to 53 years, and in Asia from 42.1 to 49.5 years.[2][12]
cancer treatment
Chemotherapy and pelvic radiation may destroy ovarian follicles and result in abrupt menopause. The risk varies with chemotherapeutic agent, dose, and age at the time of treatment. It is higher with alkylating agents, which can result in primary ovarian insufficiency in approximately 40% of treated cases.[13] Risk attributable to radiotherapy is dependent on the site exposed to radiation, dose, and age at the time of treatment.
smoking
Smokers undergo the menopause about 2 years earlier than non-smokers and have more hot flushes.[14]
ovarian surgery
Removal of the ovaries for any reason will immediately precipitate the menopause. It is commonly done during treatment for malignancy of the pelvic organs, such as ovarian cancer. Bilateral oophorectomy is less commonly performed in younger women at the time of hysterectomy, but can be part of a treatment programme for severe endometriosis. Premenopausal women who are carriers of the BRCA gene mutation may undergo risk-reducing surgery, including prophylactic oophorectomy.[15]
weak
mother's age at the menopause
The mother’s age at onset of the menopause is not a strong predictor for her daughters.
Use of this content is subject to our disclaimer