menopause%20-and-%20hormone%20therapy
MENOPAUSE & HORMONE THERAPY
Spontaneous/Natural menopause is the final menstrual period confirmed after 12 consecutive months of amenorrhea with no pathological cause.
Induced menopause is the permanent cessation of menstruation after bilateral oophorectomy (ie surgical menopause) or iatrogenic ablation of ovarian function (eg pelvic radiation therapy, chemotherapy).
Perimenopause/Menopause transition/Climacteric is the duration when menstrual cycle & endocrine changes occur a few years before and 12 months after the final menstrual period resulting from natural menopause.
Premature menopause is menopause before 40 years of age whether natural or induced while early menopause is spontaneous or induced menopause that occurs before the average age of natural menopause at 51 years or under 45 years of age.

Menopause%20-and-%20hormone%20therapy Diagnosis

Physical Examination

  • Complete thorough physical exam
    • Papanicolaou smear
    • Breast exam

Laboratory Tests

  • Baseline mammogram if indicated
  • Bone density if risk factors for osteoporosis are present
    • Use World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX™) for estimating probability of a hip fracture and a major osteoporotic fracture in 10 years (other major bones include clinical spine, forearm, shoulder, or hip fracture)
  • Lipid profile [low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and total cholesterol]
  • Liver function tests (LFTs)
  • Urinalysis
  • Thyroid stimulating hormone (TSH)
  • If atypical clinical features are present: Follicle stimulating hormone (FSH)/luteinizing hormone (LH)/Estradiol to confirm menopause
    • FSH test may be used to diagnose menopause in women aged <40 years old in whom premature menopause is suspected or aged 40-45 years with symptoms of menopause 
  • In healthy women >45 years old presenting with menopausal symptoms, the following may be diagnosed in the absence of lab tests:
    • Perimenopause from irregular periods and vasomotor symptoms
    • Menopause in those without a period for at least 12 months and are not using hormonal contraception
    • Menopause from symptoms in women with no uterus

Evaluation

Rating Scales

  • Each symptom is graded according to its severity (eg Menopause Rating Scale, Greene Climacteric Scale) and how it affects the patient’s well-being (Menopause-Specific Quality of Life)
  • Reliable and valid tools for assessment of menopausal symptoms
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Stephen Padilla, 28 Nov 2018
A low-carbohydrate diet increases energy expenditure during weight loss maintenance, consistent with the carbohydrate-insulin model, a study has shown. This metabolic effect may contribute to the success of obesity treatment, particularly among those with high insulin secretion.
Natalia Reoutova, 07 Jul 2020

A hospital-based observational cohort study finds an association between higher fasting blood glucose (FBG) levels and unfavourable outcomes, including death, among Chinese patients with diabetes mellitus (DM) following acute ischaemic stroke (AIS).

Elaine Soliven, 06 Jul 2020
Adding liraglutide to metformin led to a significantly longer duration of glycaemic control in patients with type 2 diabetes (T2D) compared with an oral antidiabetic drug (OAD), according to the LIRA-PRIME* study presented at ADA 2020.