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Is Your Patient Perimenopausal?

No single test or symptom can accurately predict whether she is or isn't.

These researchers conducted a Medline search for relevant articles to evaluate the reliability of using physical signs, laboratory tests, or self-assessment to diagnose perimenopause. Of more than 1200 identified articles, only 16 met the strictly defined inclusion criteria, which required use of a clinical examination, a premenopausal control group, and a perimenopause diagnosis based on 3 to 11 months of amenorrhea or irregular periods. After adjusting for age, the authors used likelihood ratios (LRs) to determine whether various clinical parameters are predictive of perimenopause.

Self-assessment that perimenopause had begun was only slightly predictive of perimenopause (positive LR, 1.53-2.13). The presence of hot flashes was somewhat predictive (positive LR, 2.15-4.06); the absence of hot flashes, however, did not rule out perimenopause (negative LR, 0.54-0.87). Only 1 study had enough power to calculate whether follicle-stimulating hormone (FSH) levels were predictive: Normal FSH levels did not rule out perimenopause (negative LR, 0.45), and high levels only weakly predicted perimenopause (positive LR, 3.06).

Comment: Whether women merely wish to better understand the reasons for their symptoms or are seeking treatment, the diagnosis of perimenopause is important. Although this study was not original research but rather a Medline review, the findings make an important point: No one symptom or test is accurate enough to predict perimenopause. Clinicians sometimes order tests for estradiol or FSH levels, but such tests are a waste of money, because perimenopausal levels of these hormones fluctuate greatly and may be high or normal. The authors conclude that perimenopause diagnoses should be based on the patient's age and menstrual history.

— Ann J. Davis, MD

Published in Journal Watch Women's Health April 23, 2003

Citation(s):

Bastian LA et al. Is this woman perimenopausal? JAMA 2003 Feb 19; 289:895-902.

• Original article (Subscription may be required)
• Medline abstract (Free)