Treatment Guideline Chart

Menopause is associated with decreased estrogen production which leads to vasomotor symptoms and vulvovaginal atrophy. The woman may experience hot flushes, night sweats, dyspareunia or vaginal dryness. Spontaneous or natural menopause occurs when the final menstrual period is 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).


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


  • Ask for patient’s age, personal history including menopausal symptoms, obstetric, gynecologic, menstrual and sexual history, past and current medical and surgical history, family history, social history (eg alcohol use, smoking, dietary history, physical activity), and current medications including sensitivities and allergies
  • Perimenopausal women experiencing abnormal uterine bleeding (AUB) should always be evaluated based on the FIGO classification system of PALM-COEIN (polyps, adenomyosis, leiomyoma, malignancy, coagulation disorders, ovulatory disorders, endometrial causes, iatrogenic causes and causes not otherwise classified)

Physical Examination

  • Complete and thorough physical exam including patient’s vital signs, BMI 
    • Perform breast, thyroid, abdominal and pelvic exams
    • A vaginal examination may be performed in women presenting with AUB, to evaluate pelvic floor and to exclude pelvic masses, cervical lesions or infections

Laboratory Tests

  • Fasting blood sugar, lipid profile [low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and total cholesterol]
  • Renal and liver function tests (LFTs)
  • Complete blood count, urinalysis
  • Thyroid stimulating hormone (TSH); coagulation profile for AUB
  • 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

Diagnostic Tests

  • Breast ultrasound and/or baseline mammogram if indicated
  • A pelvic ultrasound may be requested for sexually active women presenting with AUB
  • Bone densitometry if risk factors for osteoporosis are present
    • Use WHO FRAX™ for estimating probability of a hip fracture and a major osteoporotic fracture (clinical spine, forearm, shoulder, or hip fracture) in 10 years 
  • Papanicolaou smear


Menopausal Symptom Evaluation Using 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
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