[How to diagnose menopause? Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines].
Level 5 - mechanism / opinion, no new human data
Clinical practice guideline based on literature review and expert consensus
PubMed 33867317 · doi:10.1016/j.gofs.2021.03.011
What was done
The French National College of Gynecologists and Obstetricians (CNGOF) and the French Menopause and Bone Health Study Group (GEMVi) developed clinical practice guidelines for diagnosing menopause in physiological and complex clinical situations (hormonal contraceptive use, post-hysterectomy, and post-cancer therapy). The authors reviewed literature from PubMed, Medline, and the Cochrane Library alongside guidelines from international societies (IMS, EMAS).
What was found
In standard scenarios (women >45 years old), menopause is diagnosed clinically and retrospectively after 12 consecutive months of amenorrhea; no hormonal assays or imaging are indicated. For women on hormonal contraception (oral, implant, or levonorgestrel-IUD), hormone testing and pelvic ultrasound are not recommended for diagnosis or to guide contraceptive cessation (grade C); the advised approach is stopping contraception and monitoring clinically for amenorrhea (expert opinion). For hysterectomized women, repeated testing showing FSH ≥40 IU/L with estradiol <20 pg/mL at least 3 months post-procedure suggests menopausal status. Following gonadotoxic cancer therapy, 12 months of amenorrhea cannot definitively diagnose menopause, and no specific test is recommended (expert opinion). For breast cancer patients with unknown status due to contraception, patients should default to being classified as non-menopausal for initial hormone therapy selection.
Why it matters
These guidelines standardize the clinical approach to menopause diagnosis, emphasizing that routine hormonal testing is unnecessary in standard presentations and providing specific pathways for confounding clinical scenarios.
Limits
The abstract does not report the number of studies reviewed. Recommendations rely heavily on Grade C evidence and expert opinion, reflecting limited high-quality randomized evidence regarding diagnostic thresholds in complex subgroups (such as post-chemotherapy patients).
Cited by
- supports Menopause is clinically defined as 12 consecutive months without a menstrual period.