The diagnosis of menopause is clinical, based on the absence of menses for 12 months, and does not require further testing for appropriately presenting patients.
Oestrogen therapy is an effective treatment for the management of menopausal symptoms including hot flushes, night sweats, and urogenital symptoms.
For women with an intact uterus, a progestin must be co-administered with an oestrogen to protect against endometrial hyperplasia and cancer.
Arbitrary limits should not be placed on the duration of use of hormone therapy (HT); all patients require individualised decision-making. Reassessment should occur at least annually. Transdermal administration of estradiol is associated with a lower risk of stroke and venous thromboembolism than oral administration of estradiol and is unlikely to increase the risk of stroke and venous thrombosis above that of non-users.
Non-hormonal interventions may help women who have a contraindication to, or cannot tolerate, HT. However, they are less effective than HT in controlling menopausal symptoms.
Onset of the menopause is heralded by the cessation of menses for at least 12 consecutive months, without some other reason for amenorrhoea (such as pregnancy, hormone therapy, or other medical condition). No further testing is indicated for amenorrhoea in an appropriate clinical context or symptoms of the menopause in a woman without a uterus.
Permanent cessation of ovarian function may occur surgically by removal of both ovaries (surgical menopause) or medically, usually due to chemotherapy or radiotherapy (treatment-induced menopause).
The perimenopause includes the years before and after the cessation of menses in an ovulating woman and is marked by irregular menses and menopausal symptoms. Management of menopause symptoms requires individualisation based on each woman’s clinical circumstance.
History and exam
Key diagnostic factors
- presence of risk factors
- irregular menstrual cycle
- hot flushes and night sweats
- vaginal symptoms
- mood changes
Other diagnostic factors
- sleep disturbance
- mild memory impairment
- heavy menstrual bleeding
- age 40 to 60 years
- cancer treatment
- ovarian surgery
- mother's age at the menopause
1st investigations to order
- pregnancy test
Investigations to consider
- follicle-stimulating hormone (FSH)
- serum estradiol
initial presentation with mild vasomotor symptoms
women with a uterus, moderate to severe hot flushes, with/without reduced libido
women without a uterus or with levonorgestrel-releasing intrauterine device fitted in the last 5 years, moderate to severe hot flushes, with/without reduced libido
urogenital atrophy only
urinary stress incontinence only
- Polycystic ovary syndrome
- Management of osteoporosis in postmenopausal women: the 2021 position statement of the North American Menopause Society
- American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis - 2020 update
Menopause: should I take HRT?
Menopause: what is it?More Patient leaflets
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