Overview

• Retrospective diagnosis, after a woman has had no periods for 12 months.
  • Lack of ovarian follicular function. Low oestrogen and progesterone. High LH and FSH.
  • <50 yrs + amenorrhoeic for 2 years or >50 yrs + amenorrhoeic for 1 yr.
• Mean age is 51 years old.
• Perimenopause → period begins when symptoms of menopause start and continues until 12 months after the last menstrual period. This is typically in women >45.
• Premature Menopause → <40 years old. A result of premature ovarian insufficiency.
  • Diagnosis → raised FSH levels, tested twice (4-6 weeks apart).
  • Addisons Disease → association with POI.
  • Management → HRT until 51 years old. Can also use COCP.
    • Fertility → donor oocyte IVF.
    • Complications to monitor → osteoporosis (regular DEXA scans), hypothyroidism, sexual dysfunction, insomnia, stroke, heart disease.

Making Diagnosis

Clinical Features

• Change in Periods → irregular, may be heavier or lighter.
• Vasomotor Symptoms → hot flushes, night sweats, palpitations.
• Urogenital Changes → vaginal dryness and atrophy, urinary frequency.
• Psychological → anxiety, depression, memory impairment.
• Longer Term risks due to lack of oestrogen → CVD/Stroke, osteoporosis, pelvic organ prolapse, urinary incontinence.

Clinical Diagnosis → >45yo + no period in last 12 months.

Investigations

• FSH/LH → high. Oestradiol → low.
  • For women ≤45 years old → serum FSH to aid diagnosis of menopause (will be raised). (>45yo = NO INVESTIGATIONS)
• Pregnancy Test → sexually active woman with amenorrhoea.