Author Affiliations: The Departments of Internal Medicine (Dr Bastian) and Obstetrics and Gynecology (Drs Bastian and Nanda), Duke University, Durham, NC; The Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC (Dr Bastian and Ms Smith); and Family Health International, Research Triangle Park, NC (Dr Nanda).
The Rational Clinical Examination Section Editors: David L. Simel, MD, MHS, Durham Veterans Affairs Medical Center and
Duke University Medical Center, Durham, NC; Drummond Rennie, MD, Deputy Editor, JAMA.
Context Perimenopause is a time of transition for women at midlife. Women want
to know whether they are starting this change and physicians need to know
the accuracy of a clinical examination in identifying perimenopausal women.These
women should be counseled about alleviating climacteric symptoms, using contraception,
and preventing diseases such as osteoporosis.
Objective To systematically review the accuracy of self-assessment, symptoms,
signs, and laboratory tests in diagnosing women in perimenopause.
Data Sources English-language articles that presented data relevant to diagnosis
of perimenopause were identified in a MEDLINE search from 1966 to 2001. References
of these articles and other publications also were reviewed.
Study Selection Cross-sectional or longitudinal studies of women aged 40 years or older
that used the definition of perimenopause as 3 to 11 months of amenorrhea
or irregular periods, included a premenopausal control group, and reported
a clinical examination finding. Of 1246 articles identified, 16 studies were
included in the analysis.
Data Extraction Two authors independently reviewed articles for quality (L.A.B. and
C.M.S.). Discrepancies were resolved by a third author (K.N.).
Data Synthesis The prior probability of perimenopause is directly related to a woman's
age. After considering age, the following yielded the greatest positive likelihood
ratios (LRs+): self assessment of going through the transition (LR+ range,
1.53-2.13), symptoms of hot flashes (LR+ range, 2.15-4.06), night sweats (LR+
1.90; 95% confidence interval [CI], 1.63-2.21), vaginal dryness (LR+ range,
1.48-3.79), high follicle-stimulating hormone levels (LR+ 3.06; 95% CI, 2.06-4.54),
and low inhibin B levels (LR+ 2.05; 95% CI, 0.96-4.39). Self-assessment of
perimenopausal status had the smallest negative LR (range, 0.18-0.36).
Conclusions No one symptom or test is accurate enough by itself to rule in or rule
out perimenopause. Clinicians should diagnose perimenopause based on menstrual
history and age without relying on laboratory test results.
Bastian LA, Smith CM, Nanda K. Is This Woman Perimenopausal?. JAMA. 2003;289(7):895-902. doi:10.1001/jama.289.7.895