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JAMA Insights
July 22, 2019

Diagnosing the Onset of Menopause

Author Affiliations
  • 1Department of Obstetrics and Gynecology, University of Colorado, Aurora
JAMA. 2019;322(8):775-776. doi:10.1001/jama.2019.6250

A 50-year-old woman with a fibroid uterus and heavy menses presents with 4 months of amenorrhea. She would like to know when she will become menopausal because she wishes to avoid a surgical procedure, but does not feel that she can tolerate many more heavy menstrual periods.

The cessation of ovarian function, termed menopause, is an occult event that is only evident after 12 consecutive months of amenorrhea. Longitudinal studies of the 12-month window that defines the final menstrual period (FMP; taken here as defining the onset of menopause) showed that variable estrogen, but no progesterone, production was observed during this time.1 Most of what is known about the timing of the FMP is based upon observations of menstrual interval tracking among women older than 45 years who had regular menstrual cyclicity before entering the transition. Women who have undergone hysterectomy or endometrial ablation have no bleeding events, precluding the use of menstruation to establish menopause. It is also difficult to establish menopause in women whose FMP occurs unusually early in life or in women with chronically irregular cycles or longstanding amenorrhea.