ESSENTIALS OF DIAGNOSIS
Natural menopause diagnosed after 12 months of amenorrhea with no obvious pathologic cause
Average age 51 years• Estradiol < 20 pg/mL and follicle-stimulating hormone level 21–100 mU/mL helpful in establishing the diagnosis
Induced menopause is defined as permanent cessation of menstruation after bilateral oophorectomy or ablation of ovarian function (ie, by chemotherapy or radiation)
Premature menopause defined as menopause reached at or before age 40 and can be natural or induced
Perimenopause/menopause transition defined by menstrual cycle and hormonal changes that occur a few years before and 12 months after the final menstrual period resulting from natural menopause
May be associated with vasomotor symptoms, sleep disturbance, and vaginal/urinary symptoms
According to the 2014 US census, of the > 159 million women in this country, approximately 45 million were 55 years of age or older. Most of these women had or shortly would have their last menstrual period, thus becoming postmenopausal. As a woman at age 55 years can expect to live another 28 years, a large portion of the female population is without ovarian function and lives about one-third of their lives after this function ceases. Consequently, physicians caring for women must understand the hormonal and metabolic changes associated with the menopause, or “change of life,” and the potential benefits and risks of hormone therapy (HT).
According to the Comite des Nomenclatures de la Federation Internationale de Gynecologie et d’Obstetrique, the climacteric is the phase of the aging process during which a woman passes from the reproductive to the nonreproductive stage. The signals that this period of life has been reached are referred to as “climacteric symptoms” or, if more serious, as “climacteric complaints.” Perimenopause, or menopausal transition, refers to the part of the climacteric before the menopause occurs when the menstrual cycle is likely to be irregular and when other climacteric symptoms or complaints may be experienced. The menopause is the final menstruation, which occurs during the climacteric. Postmenopause refers to the phase of life that comes after the menopause.
To develop a more functional staging system of reproductive aging, the Stages of Reproductive Aging Workshop (STRAW) was held in 2001 and again 10 years later in another workshop called “STRAW +10.” The specific goals of the workshop were to (a) develop a useful staging system for reproductive aging, (b) revise nomenclature, and (c) identify knowledge gaps that should be addressed by the research community. STRAW + 10 also added more supportive criteria using endocrinologic parameters (follicle-stimulating hormone [FSH], anti-müllerian hormone [AMH], inhibin B, and antral follicle count [AFC]). According to STRAW +10, reproductive aging is divided into 7 stages (−5 to +2), with −5 beginning with menarche and +2 being defined as the late menopause. This staging system is not applicable to women who have undergone hysterectomy or endometrial ablation, who have chronic menstrual irregularity such as polycystic ovarian syndrome, or who have chronic illness and undergoing chemotherapy. STRAW +10 may also not be applicable to women ...