Predicting the Final Menstrual Period

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Predicting the Final Menstrual Period

Can it be done?

Predicting the final menstrual period (FMP), although not a critical clinical issue, would be helpful to women. Can clinicians accurately answer the question, "When will my periods stop?" The Study of Women’s Health Across the Nation, ongoing since 1996, is a multiethnic, multicenter, longitudinal investigation of the biologic and psychosocial changes that occur during the menopausal transition. Upon enrollment, participants were aged 42 to 52; all had an intact uterus and at least one ovary and had had one or more menstrual periods during the previous 3 months. They were not pregnant, breast-feeding, or taking reproductive hormones. FMP was defined as the initial day of the last menstrual period preceding 12 consecutive months of amenorrhea, identified retrospectively.

In the current analysis, data were included for 1076 participants who had menstruated during the 12 months preceding the sixth annual follow-up visit and 706 who had experienced their FMP by that time. Compared with menstruating women, those with an FMP were older upon enrollment (mean age, 47.8 vs. 44.7) and reported more vasomotor symptoms and less-frequent or more-variable menses at baseline (all P<0.001). Current smoking and higher follicle-stimulating hormone (FSH) levels were also associated with a shorter time from enrollment to FMP. Although estradiol levels were not related to FMP in a linear fashion, women with estradiol levels $≥$ 100 pg/mL had a much shorter time to FMP than did those with levels <25 mg/mL.

Comment: Evaluating menopausal status with tests such as estradiol or FSH assessment is generally not helpful (Journal Watch Women’s Health Jun 20 2006); furthermore, such testing may not be covered by insurance. Using a complex model encompassing menstrual-cycle variables, smoking status, hormone levels, and ethnicity, these researchers estimated length of time to FMP, but they did not apply their model prospectively. It is most helpful to advise women in their mid to late 40s that the median age at menopause in nonsmoking women is 52 to 53 years and that symptoms such as hot flashes and longer intervals between menses may be the most practical predictors of the approaching cessation of menses. Although fecundability is low in women at this age, ovulation and pregnancy are still possible until 1 year has elapsed since the last period.

— Diane E. Judge, APN/CNP

Published in Journal Watch Women's Health June 21, 2007

Citation(s):

Santoro N et al. Helping midlife women predict the onset of the final menses: SWAN, the Study of Women’s Health Across the Nation. Menopause 2007 May/Jun; 14:415-24.