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Is this woman perimenopausal?
Lori A Bastian1, Crystal M Smith, Kavita Nanda
1Department of Internal Medicine, Duke University, Durham, NC, USA. basti001@mc.duke.edu
JAMA
|February 18, 2003
Summary
Diagnosing perimenopause accurately is crucial for midlife women. While symptoms like hot flashes and lab tests can offer clues, a combination of menstrual history and age remains the most reliable diagnostic approach.
Area of Science:
- Reproductive Endocrinology
- Women's Health
- Clinical Diagnostics
Background:
- Perimenopause signifies a transitional phase for midlife women, necessitating accurate identification for appropriate counseling and care.
- Physicians require reliable methods to diagnose perimenopause, addressing concerns like climacteric symptoms, contraception, and disease prevention (e.g., osteoporosis).
Purpose of the Study:
- To systematically review the diagnostic accuracy of self-assessment, symptoms, clinical signs, and laboratory tests for identifying perimenopause.
Main Methods:
- A comprehensive MEDLINE search (1966-2001) identified English-language articles on perimenopause diagnosis.
- Included studies involved women aged 40+ with 3-11 months of amenorrhea or irregular periods, a premenopausal control group, and reported clinical findings; 16 studies were analyzed.
Main Results:
- Age is a primary factor in perimenopause probability.
- Positive indicators include self-assessment of transition, hot flashes, night sweats, vaginal dryness, elevated follicle-stimulating hormone (FSH) levels, and low inhibin B levels.
- Self-assessment of perimenopausal status showed the lowest negative likelihood ratio, indicating limited utility in ruling out the condition.
Conclusions:
- No single symptom or laboratory test can definitively confirm or exclude perimenopause.
- Clinical diagnosis should primarily rely on a patient's menstrual history and age, rather than solely on laboratory test results.
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