Menopause

Last reviewed: 3 Jun 2022
Last updated: 13 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • amenorrhea
  • irregular menstrual cycle
  • hot flashes and night sweats
  • vaginal symptoms
  • mood changes
More key diagnostic factors

Other diagnostic factors

  • sleep disturbance
  • mild memory impairment
  • heavy menstrual bleeding
Other diagnostic factors

Risk factors

  • age 40 to 60 years
  • cancer treatment
  • smoking
  • ovarian surgery
  • mother's age at menopause
More risk factors

Diagnostic investigations

1st investigations to order

  • pregnancy test
More 1st investigations to order

Investigations to consider

  • follicle-stimulating hormone (FSH)
  • serum estradiol
More investigations to consider

Treatment algorithm

ACUTE

initial presentation with mild vasomotor symptoms

ONGOING

women with a uterus, moderate to severe hot flashes, with/without reduced libido

women without a uterus or with levonorgestrel-releasing intrauterine device fitted in the last 5 years, moderate to severe hot flashes, with/without reduced libido

urogenital atrophy only

urinary stress incontinence only

Contributors

Authors

Heather Currie, MB BS, FRCOG, DRCOG, MRCGP

Clinical Director Women and Sexual Health

NHS Dumfries and Galloway

Dumfries and Galloway Royal Infirmary

Scotland

UK

Disclosures

HC declares that she has no competing interests.

Haitham Hamoda, MBChB, MD, FRCO

Consultant Gynaecologist

Clinical Lead for Menopause Service

King's College Hospital NHS Trust

London

UK

Disclosures

HH declares that he has no competing interests.

Bradford W. Fenton, MD, PhD, FACOG

Independence Park Medical Services

Anchorage

AK

Disclosures

BWF declares that he has no competing interests.

Acknowledgements

Dr Heather Currie, Dr Haitham Hamoda, and Dr Bradford W. Fenton would like to gratefully acknowledge Dr Rebekah Wang-Cheng, a previous contributor to this topic.

Disclosures

RWC declares that she has no competing interests.

Peer reviewers

Nan Gillespie O’Connell, MD

Assistant Professor

Department of Obstetrics and Gynecology

Virginia Commonwealth University

Richmond

VA

Disclosures

NGOC declares that she has no competing interests.

Carolyn Simpkins, MD, PhD

Internist

Daniel Island

SC

Disclosures

CS declares that she has no competing interests.

Edward Morris, MD

Consultant

Honorary Senior Lecturer and Clinical Director

Department of Obstetrics and Gynaecology

Norfolk and Norwich University Hospital

Norwich

UK

Disclosures

EM declares that he has no competing interests.

Michelle Warren, MD

Professor of Medicine and Obstetrics & Gynecology

Obstetrics and Gynecology

Columbia University in New York Medical Center

New York

NY

Disclosures

MW has received research funding from Ferring and Pfizer Wyeth; has acted as an advisory board consultant for Pfizer Wyeth, QuatRx, and Yoplait; and is on the speakers' bureau of Amgen, Upsher Smith, and Warner Chilcott. MW is also an author of a reference cited in this topic.

  • Differentials

    • Pregnancy
    • Polycystic ovary syndrome
    • Hyperthyroidism
    More Differentials
  • Guidelines

    • Management of osteoporosis in postmenopausal women: the 2021 position statement of the North American Menopause Society
    • Menopause: guidance for nurses, midwives and health visitors
    More Guidelines
  • Patient leaflets

    Menopause: should I take HRT?

    Menopause: what is it?

    More Patient leaflets
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