There is no unique clinical picture that establishes an early menopause diagnosis. However, various tests are required to confirm a diagnosis of early menopause, among them are:

1. Doctor's Anamnesis Examination
2. Physical Examination
3. Auxiliary Laboratory Examination

#1. Anamnesis The doctor's anamnesis examination is conducted in relation to the symptoms of estrogen deficiency. The primary symptom is the cessation of menstruation, which is preceded by changes in the menstrual cycle. Menopause symptoms include vasomotor, urogenital, and psychogenic symptoms.

#2. Physical Examination Physical examinations for early menopausal women include vital signs, anthropometry data, vaginal examination, and Pap Smear. Differential Diagnosis If menopause occurs at age 45 and above, a diagnosis can be clinically established. However, if it occurs at a younger age or in early menopause, other diagnoses causing secondary amenorrhea must be ruled out.

The most common cause of amenorrhea at a young age is pregnancy, so it needs to be ruled out first. Other causes of amenorrhea are anatomical abnormalities such as uterine outflow obstruction and Asherman's Syndrome, which is uterine scar tissue after a dilation and curettage procedure. The condition of amenorrhea can also result from dysfunction of the hypothalamus-pituitary-gonad axis.

#3 Auxiliary Laboratory Examination Supporting examinations towards menopause can be conducted to establish a diagnosis. Some of them are laboratory examinations such as examination of estradiol hormone levels, prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), and anti-Mullerian hormone (AMH). ▪ Hormone Levels In women with menopause, an increase in serum FSH above 40 mIU/mL can be found, but this increase is not specific to menopause. The levels of circulating estradiol tests are found to be much lower after menopause occurs.

Anti-Mullerian hormone (AMH) is a hormone produced by granulosa cells of ovarian follicles. AMH is found to be useful in assessing ovarian reserves and can predict when someone will experience menopause. AMH levels are found to be very low or undetectable in women experiencing early menopause compared to normal women. Currently, a single AMH measurement is more meaningful in assessing ovarian reserves compared to estradiol, FSH, LH examinations.

References

1. Nelson H. Menopause. The Lancet. 2008; 371(9614): p. 760-770.
2. Coney P. Menopause. Medscape, 2018. https://emedicine.medscape.com/article/264088-overview#a2.
3. American College of Obstetricians and Gynecologists. Practice Bulletin No. 141. (2014). Obstetrics & Gynecology, 123(1), 202–216. doi:10.1097/01.aog.0000441353.20693.78
4. Peacock K, Ketvertis KM. Menopause. [Updated 2019 Nov 22]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507826/
5. Kruszyńska A, Srzednicka J. Anti-Müllerian hormone (AMH) as a good predictor of time of menopause. Prz Menopauzalny. 2017 Jan; 16(2): p. 47-50.

Author: Prof.Dr.dr. Ellyza Nasrul Sp.PK(K) (Head Doctor of PRAMITA Clinical Laboratory Jl. Ahmad Yani No. 39, Padang)