Age and Symptoms Spell Out Perimenopause

More accurate than medical tests, researchers say

THURSDAY, Feb. 20, 2003 (HealthDayNews) -- A combination of a woman's age, her menstrual history and her symptoms may be the most reliable way to tell if she's in perimenopause -- even more reliable than medical tests alone.

That's the conclusion of a new study in this week's Journal of the American Medical Association. Calling perimenopause a multi-factorial condition, the authors urge doctors to take a broader view of the criteria that make up this mid-life condition.

"No one symptom or test is accurate enough by itself to rule in, or rule out, perimenopause," write the authors, a group of researchers from both Duke University and the Veteran's Affairs Medical Center in Durham, S.C.

Moreover, they write, clinicians should consider both age and menstrual history as the primary indications of perimenopause, without relying on hormone tests to validate their findings.

For gynecologist Dr. Cynthia Krause, the study "preaches" what most doctors practice every day.

"But it's also worth noting that perimenopause isn't so much a specific time of life as much as it is a phase of life, with no clear-cut entry and no clear-cut exit, particularly one that can be marked by a test result or even a group of symptoms," says Krause, an assistant clinical professor of gynecology at the Mount Sinai Medical Center in New York City.

Perimenopause is a relatively new medical term used to describe the life phase just before menopause, a time when all reproductive function ceases.

And it is actually during perimenopause that women experience the bulk of their "menopause" symptoms, which include hot flashes, bleeding irregularities, mood swings and fatigue.

According to the new study, most women enter perimenopause sometime between the ages of 45 and 55, with the majority experiencing symptoms around age 47. The most common age for menopause to begin is between 51 and 52.

The authors say their research shows that a woman's age is the most predictive sign of her menstrual status. The next most reliable signs include her own assessment of her condition, which is usually based on such symptoms as hot flashes, night sweats and vaginal dryness.

The least effective means of predicting perimenopause, they say, are blood tests that measure levels of follicle-stimulating hormone (FSH), which can be high, or inhibin B, which can be low, as a woman's reproductive potential declines.

What is important, however, says Krause, is that doctors and women themselves not overlook the possibility that "perimenopause" symptoms could be the result of some other health problem. They shouldn't automatically categorize a woman's health status based solely on her age, she adds.

"For example, irregular bleeding or even hot flashes are often signs of perimenopause, but they could also be the result of other problems, so you've got to fully investigate the symptoms and not just automatically assume they are linked to a particular time in life," Krause says.

Using the multi-factorial approach, she says, doctors are likely to come up with an accurate diagnosis.

The new research was an analysis of a variety of studies on perimenopause conducted between the years 1966 and 2001. All totaled, the researchers found 1,246 medical articles on the subject and 16 specific trials that matched their exact criteria.

After analyzing results of the 16 studies, the authors found similar criteria kept cropping up again and again as signs of perimenopause: age plus symptoms that include hot flashes, night sweats and vaginal dryness.

Although the authors point out that many doctors rely on hormone tests -- particularly FSH -- to determine a woman's reproductive status, at least in this analysis, the test results were not definitive.

They also indicate that further studies are needed to determine if these tests hold any diagnostic value at all for older women.

More information

To learn more about the signs of perimenopause, check out The Mayo Clinic. Or visit The North American Menopause Society.

SOURCES: Cynthia Krause, M.D., assistant clinical professor, gynecology, Mount Sinai Medical Center, New York City; Feb. 19, 2003, Journal of the American Medical Association
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