New advances in detecting, managing menopause: What PCPs need to know
Menopause occurs at an average age of 51 years for most women in the United States, according to Mayo Clinic. However, about 5% of women younger than 45 years experience early menopause.
Early menopause may intensify the typical symptoms and health risks of menopause, such as hot flashes, heart disease and early death. Detecting and properly treating early menopause can help mitigate these symptoms and risks and aid in family planning in women who desire pregnancy.
“Menopausal women need primary care providers to understand menopause and help them navigate it,” JoAnn Pinkerton, MD, executive director of The North American Menopause Society and professor of obstetrics and gynecology at the University of Virginia Health System, told Healio Internal Medicine. “Seventy-five percent of women going through menopause will have hot flashes and about 25% of those will have them severe enough to need medical treatment.”
Recently, the FDA approved a new diagnostic test to determine menopause status, known as PicoAMH Elisa. This new blood test in combination with other clinical assessments and fertility evaluations can provide important information about the timing of menopause and the ovarian reserve, Pinkerton said.
Risk over 5 to 10 years
PicoAMH Elisa, measures the amount of anti-Müllerian hormone (AMH) in the blood, representing one indicator available to clinicians to determine whether a woman between the ages of 42 and 62 years is approaching or is likely to have reached her final menstrual period.
“PicoAMH Elisa is not meant to be used by itself but combined with age and other clinical assessments and laboratory findings,” Pinkerton said.
The test is not intended to diagnose a regular or natural menopause, which is defined as 12 months without menses, she said.
“However, using the AMH test may help determine whether women are likely to go into menopause in the next 5 or 10 years,” Pinkerton said.
The test may benefit women with difficult perimenopausal symptoms, menopausal symptoms at an early age or a desire for fertility at a late age, she said.
Women who are missing menses, but desire to get pregnant can undergo the PicoAMH test to determine how successful they may be and when menopause may occur, according to Pinkerton. She noted that AMH plus age is highly predictive of ovarian reserve and timing of menopause.
“Serum AMH levels become low approximately 5 years before the final menstrual period and are undetectable in postmenopausal women,” she said. “A majority of studies indicate that AMH is relatively stable throughout the menstrual cycle; however, it should not be used alone to make decisions about fertility plans or whether contraception is needed to prevent pregnancy.”
PicoAMH should be used in conjunction with other clinical and laboratory findings, such as antral follicle count, to determine the likelihood of pregnancy, she emphasized. The test can aid in deciding whether to freeze eggs for future fertility and starting or delaying fertility therapy, she said.
“Having an FDA-approved AMH assay gives patients and health care providers results that are more trustworthy, as it should provide consistent and dependable results,” Pinkerton said.
“Women with abnormal AMH suggestive of higher risk of menopause need to be informed that menopause may occur early, including discussion of decreased fertility as well as typical menopausal symptoms and health risks,” Pinkerton said.
Early menopause occurs prior to turning age 40 years, she said.
Hot flashes, night sweats or sleep disruption are common symptoms of early menopause, according to Pinkerton. Less common symptoms include worsening of premenstrual symptoms, headaches, joint aches, vaginal dryness or painful sex, depression or loss of sex drive, she said.
“Early menopause is associated with a higher risk of osteoporosis and fracture, heart disease, cognitive changes, vaginal changes and loss of libido, and mood changes,” Pinkerton said. “Women with early menopause, whether spontaneous or due to surgery or medications such as chemotherapy, should be counseled to take adequate calcium, vitamin D, keep their weight down through eating healthy and exercising regularly, and be evaluated for risk for bone loss, heart disease, mood changes or vaginal changes.”
The PicoAMH plus age test can be very useful in predicting the timing of menopause in women with suspected early menopause, according to Pinkerton.
“For women with early menopause due to chemotherapy, the AMH test will help clinicians understand the risks of bone loss leading to future risk of osteoporosis and fracture or heart disease and whether hormone therapy should be considered,” she said.
The use of current tests of menopausal status, such as follicular stimulating hormone and estradiol, cannot predict how soon a woman may go through menopause, but AMH can offer reassurance that symptoms are either premenstrual syndrome, stress or in fact, early menopause, she said.
Managing symptoms, complications of menopause
Hormone therapy should be considered for women diagnosed with early menopause who are experiencing bothersome symptoms and do not have contraindications to help relieve symptoms and prevent health risks, according to Pinkerton.
Lifestyle change can help reduce symptoms and health risks in women who are contraindicated for hormone therapy, she said. Additionally, low-dose antidepressants or gabapentin can decrease menopausal symptoms and vaginal symptoms can be managed with lubricants and vaginal moisturizers or vaginal hormone therapies, she said.
Complications such as bone loss, heart disease and weight gain may occur in menopausal women, according to Pinkerton. Hormone therapy has been proven to reduce such health risks, as well as mood and cognition, in women with early menopause, she said.
Additionally, Pinkerton recommended that to prevent bone loss, women receive 1,200 mg of calcium, 1,000 IU to 2,000 IU of vitamin D and strength training or weight-bearing exercise. To prevent heart disease and encourage weight loss, she advised that women with early menopause combine cardio exercises and strength training, eat vegetables and fruits as well as foods rich in fiber, avoid fried and fat-laden foods and drink six to eight glasses of water a day.
“Declining estrogen levels may lower the rate of energy used during exercise,” she said. “Weight loss habits and workout routines used in younger years often aren’t as effective as we age. It takes more work to lose weight. Loss of estrogen may make insulin less effective at lowering glucose, and more effective at storing fat.”
Pinkerton noted that women with early menopause should be referred to menopausal specialists. – by Alaina Tedesco
Disclosure: Pinkerton reports no relevant financial disclosures.