Diagnosis of Perimenopause Bastian, LA, Smith CM, Nanda K: Is this woman perimenopausal? JAMA 2003:289(7):895-902.

The authors reviewed 1,246 articles and identified 16 that met preset criteria. The studies defined perimenopause as 3 to 11 months of amenorrhea or irregular periods, included a premenopausal control group, and reported clinical examination findings. Besides menstrual history, the most powerful predictor of menopause status is age. The median age at perimenopause is 47.5 years and 87% of women are perimenopausal or postmenopausal by the age of 51 years.

Symptoms that were best for ruling in perimenopausal status were hot flashes (likelihood ratio (LR)+ range 2.15-4.06), night sweats (LR+ 1.90), and vaginal dryness (LR+ range 1.48-3.79). The absence of these findings could not rule out perimenopause.

High follicle-stimulating hormone (FSH) levels (>24 IU/L) and low inhibin B levels (<30ng/L) provided weak evidence to rule in perimenopause (LR+ 3.06 and LR+ 2.05 respectively). Neither normal FSH nor normal inhibin B levels could rule out perimenopause. No study reported enough data to calculate likelihood ratios for estradiol. No single symptom or test is powerful enough to confirm the probability of perimenopausal status.

Although clinicians often measure hormone levels to confirm the diagnosis, these are not reliable. The authors propose that diagnosis of perimenopause should be based on menstrual history and age without relying on laboratory tests.