Is This Woman Perimenopausal?

Abstract

ContextPerimenopause is a time of transition for women at midlife. Women want to know whether they are starting this change and physicians need to know the accuracy of a clinical examination in identifying perimenopausal women.These women should be counseled about alleviating climacteric symptoms, using contraception, and preventing diseases such as osteoporosis.ObjectiveTo systematically review the accuracy of self-assessment, symptoms, signs, and laboratory tests in diagnosing women in perimenopause.Data SourcesEnglish-language articles that presented data relevant to diagnosis of perimenopause were identified in a MEDLINE search from 1966 to 2001. References of these articles and other publications also were reviewed.Study SelectionCross-sectional or longitudinal studies of women aged 40 years or older that used the definition of perimenopause as 3 to 11 months of amenorrhea or irregular periods, included a premenopausal control group, and reported a clinical examination finding. Of 1246 articles identified, 16 studies were included in the analysis.Data ExtractionTwo authors independently reviewed articles for quality (L.A.B. and C.M.S.). Discrepancies were resolved by a third author (K.N.).Data SynthesisThe prior probability of perimenopause is directly related to a woman's age. After considering age, the following yielded the greatest positive likelihood ratios (LRs+): self assessment of going through the transition (LR+ range, 1.53-2.13), symptoms of hot flashes (LR+ range, 2.15-4.06), night sweats (LR+ 1.90; 95% confidence interval [CI], 1.63-2.21), vaginal dryness (LR+ range, 1.48-3.79), high follicle-stimulating hormone levels (LR+ 3.06; 95% CI, 2.06-4.54), and low inhibin B levels (LR+ 2.05; 95% CI, 0.96-4.39). Self-assessment of perimenopausal status had the smallest negative LR (range, 0.18-0.36).ConclusionsNo one symptom or test is accurate enough by itself to rule in or rule out perimenopause. Clinicians should diagnose perimenopause based on menstrual history and age without relying on laboratory test results.

Venlafaxine in the treatment of depressive and vasomotor symptoms in women with perimenopausal depression

“…There was no significant change in FSH over time (F[3,36] 5 1.56, Po.23), although considerable variability was observed for each patient from visit to visit as reported previously [Bastian et al, 2003;Guthrie et al, 1996]. Baseline estradiol concentrations, 42.4726.6 pg/mL, were not related to vasomotor symptom status (data not shown).…”

“…Women who (1) reported one or more climacteric symptoms (hot flushes, sweating, vaginal dryness, menstrual irregularity) and (2) were between 42-51 years old [McKinlay, 1996] were deemed perimenopausal. Although endocrinological criteria for perimenopause have been proposed [WHO, 1996], a recent meta-analysis concluded that age and climacteric symptoms are the most reliable predictors of menopausal status [Bastian et al, 2003]. Additional inclusion criteria included: (1) current depressive disorder confirmed by the Structured Clinical Interview for DSM-IV Axis I Disorders [First et al, 1996]; (2) no psychotropic therapy or ERT for 1 month; and (3) a non-hormonal method of contraception.…”

Hot Flushes and Night Sweats in Midlife: Why do Some Women Have Them and Others do Not?

“…Also, it can be thought that socio-cultural factors (such as the identifi cation with menopausal-peers), as well as the perception of age progressing towards an age interpreted as "menopausal", might infl uence the interpretation of elevated body temperature (for reasons other than hormonal) as vasomotor symptoms. Despite these hypotheses, the assessment of the menopausal status through age and self-assessment of the menstrual history, as done in the present research, has been evidenced as a more accurate way of determining the menopausal status rather than using the presence of particular symptoms (such as vasomotor symptoms) or hormone levels given by laboratory tests (Bastian, Smith, & Nanda, 2003). The structural model encompassing socio-demographic, health, menopause-related, lifestyle and psychological variables (stress and depressive mood), demonstrates that there are several factors that can predict the presence of vasomotor symptoms in midlife women.…”

Acupuncture May Improve Quality of Life in Menopausal Women: A Meta-Analysis of Randomized Controlled Trials

“…The term perimenopause is defined as follows: 3-11 months of amenorrhea and increased menstrual irregularity for those without amenorrhea [6]. Postmenopausal women are defined as those who have experienced more than 12 months of spontaneous amenorrhea or are 6 weeks after bilateral ovariectomy.…”