Avoid hormone analyses in women over 45 years with menopausal symptoms to determine menopause

Rationale:

Determining whether a woman is in menopause is a clinical assessment based on medical history. Irregular menstruation and vasomotor symptoms are sufficient to conclude that a healthy woman over 45 years is menopausal. Menopause is confirmed when she has not had a period for 12 months. Gonadotropins LH and FSH fluctuate throughout the menstrual cycle and provide only a snapshot. In women over 45 who still menstruate, symptoms are the most reliable diagnostic criteria.

In cases of hormonal IUD use: In women without bleeding due to a hormonal IUD, symptoms will indicate menopause, but the timing of the last menstruation cannot be determined clinically. After the age of 50, the risk of pregnancy is very low, but a pragmatic approach is to leave the IUD in place for contraceptive purposes until age 55.

References:

• National Institute for Health and Care Excellence (NICE). Menopause: diagnosis and management. NICE guideline. 2015 [Oppdatert 05. des 2019] Tilgjengelig fra: https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#diagnosis-ofperimenopause-and-menopause
• R. J. Baber, N. Panay & A. Fenton the IMS Writing Group (2016). 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy, Climacteric, 19:2, 109-150. Tilgjengelig fra: https://www.imsociety.org/wp-content/uploads/2020/08/2016-ims-hrt-health-recommendations-english.pdf
• Øverlie I. et al. Overgangsalder (menopause). Norsk gynekologisk forening. Veileder i gynekologi (2023). ePub. ISBN 978-82-692382-3-5. Tilgjengelig fra: https://www.legeforeningen.no/foreningsledd/fagmed/norsk-gynekologisk-forening/veiledere/veileder-i-gynekologi/overgangsalder-menopause/
• Overlie I, Moen MH, Morkrid L, Skjaeraasen JS, Holte A. The endocrine transition around menopause--a five years prospective study with profiles of gonadotropines, estrogens, androgens and SHBG among healthy women. Acta Obstet Gynecol Scand. 1999;78(7):642-7.
• The Faculty of Sexual & Reproductive Healthcare (FSRH). FSHR Clinical Guideline: Contraception for Women Aged over 40 years. 2017 [Oppdatert juli 2023]. Tilgjengelig fra: https://www.fsrh.org/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/