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Diagnosing the Onset of Menopause

Educational Objective
To understand how to diagnosis the onset of menopause
1 Credit CME

A 50-year-old woman with a fibroid uterus and heavy menses presents with 4 months of amenorrhea. She would like to know when she will become menopausal because she wishes to avoid a surgical procedure, but does not feel that she can tolerate many more heavy menstrual periods.

The cessation of ovarian function, termed menopause, is an occult event that is only evident after 12 consecutive months of amenorrhea. Longitudinal studies of the 12-month window that defines the final menstrual period (FMP; taken here as defining the onset of menopause) showed that variable estrogen, but no progesterone, production was observed during this time.1 Most of what is known about the timing of the FMP is based upon observations of menstrual interval tracking among women older than 45 years who had regular menstrual cyclicity before entering the transition. Women who have undergone hysterectomy or endometrial ablation have no bleeding events, precluding the use of menstruation to establish menopause. It is also difficult to establish menopause in women whose FMP occurs unusually early in life or in women with chronically irregular cycles or longstanding amenorrhea.

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Article Information

Corresponding Author: Nanette Santoro, MD, Department of Obstetrics and Gynecology, University of Colorado, 12631 E 17th Ave, Aurora, CO 80045 (nanette.santoro@ucdenver.edu).

Published Online: July 22, 2019. doi:10.1001/jama.2019.6250

Conflict of Interest Disclosures: Dr Johnson reports patent numbers 7955846, 8652840, 9267111, and 9962411 issued related to ovarian cell isolation and handling. Dr Santoro is a member of the medical advisory board for Menogenix, Inc and Astellas/Ogeda Pharmaceuticals and reported having stock options in Menogenix Inc.

References
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2.
Harlow  SD, Gass  M, Hall  JE,  et al; STRAW + 10 Collaborative Group.  Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging.  J Clin Endocrinol Metab. 2012;97(4):1159-1168. doi:10.1210/jc.2011-3362PubMedGoogle ScholarCrossref
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Harlow  SD, Mitchell  ES, Crawford  S, Nan  B, Little  R, Taffe  J; ReSTAGE Collaboration.  The ReSTAGE Collaboration: defining optimal bleeding criteria for onset of early menopausal transition.  Fertil Steril. 2008;89(1):129-140.PubMedGoogle ScholarCrossref
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