Mom's Day Monday: Predicting Menopause

Predicting the age of menopause is of interest to women because of the health consequences, as much as for the decision as to when to give up birth control. The average age of menopause in most studies used to be 51.4, the average age in many studies is closer to 49.5-50.5 years of age. Most women will have indications such as changing menstrual periods or presence of hot flashes, but many do not have any specific signs until menopause is upon them. Hot flashes actually begin earlier than we thought and thus are not quite as predictive of a menopause that is close at hand.

The new way to test this is to use AMH tests over time to predict the time to menopause.  As increase risk of cardiovascular disease, intestinal, breast and uterine cancer risks increase, and the risk of bone loss increases. Menopause has also been associated with increasing risk of neurological and psychological diseases. Since prediction of the age of menopause can help taking proactive action against risk of these diseases, it would be helpful to your care. Few women want to still be fertile in their mid to late 40's but some so. Some women are able to be fertile until they are quite old, others are running out of usable eggs even though they are quite young. There are tests of the age of your ovaries, but then usually it's only fertility patients who get these tests; and while very interesting it doesn't typically change medical care to know whether you are still fertile unless you are seeking pregnancy. In the past continued fertility in your 40s was one of the questions a recent Practice Committee of the American Society for Reproductive Medicine opinion tried to answer for you: how to use tests of ovarian aging.. We tend to have clues, the age of average menopause, the age your mom went through menopause, and other factors. Ultrasounds have been used to look at how many growing eggs are in the ovary at the start of the menstrual cycle to determine if you have many eggs or fewer than you should, and this is literally a count of follicles that are between 2 and 10 mm in size. The measurements of your estrogen levels have been used to just name a few tests, and just the plain old obvious: are you still having regular periods. Now new blood tests may be what you need to determine if you have any ovarian reserve, or to put it bluntly, do you have any eggs left. So you may need a series of measurements.  Two tests that we now use are FSH (follicle stimulating hormone) and AMH (Anti-Mullerian hormone), and each woman seems to have her own trajectory of AMH levels. The older you are, and the lower your level is, the closer you are to menopause. Women who have AMH measured over 5-7 years, if it is dropping rapidly, you are very close to menopause.


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