Menopausal Status Assessment

Definition and Diagnosis

• The National Comprehensive Cancer Network defines menopause as amenorrhea for ≥12 months with FSH and estradiol in postmenopausal ranges for women under 60 1, 2
• For women ≥60 years old, menopause can be diagnosed without hormone testing, according to the National Comprehensive Cancer Network 1, 3

Hormone Levels and Menopausal Status

• FSH and estradiol are unreliable markers of menopausal status during the transition due to frequent fluctuations, and serial measurements are needed for definitive classification 1, 2
• A woman's age, such as 50 years, can indicate she is in the expected age range for the menopausal transition, with the median age of menopause being 51 years 4

Clinical Implications

• The American College of Cardiology and other organizations imply that distinction between perimenopause and menopause matters for contraceptive counseling, hormone replacement therapy decisions, and cardiovascular and bone health monitoring 4, 5, 6

Perimenopause Diagnosis and Management

Clinical Diagnosis and Hormone Interpretation

• The National Comprehensive Cancer Network recommends that menopause diagnosis requires amenorrhea ≥12 months PLUS FSH and estradiol in postmenopausal ranges (elevated FSH with LOW estradiol) 7
• Women on tamoxifen, toremifene, or with chemotherapy-induced amenorrhea require special consideration and serial testing 7
• Women receiving LH-RH agonists/antagonists cannot have menopausal status reliably assessed 7, 8
• Serial measurements over time are needed for women considering aromatase inhibitor therapy who have therapy-induced amenorrhea 7