What is the best way to diagnose menopause?

■ Evidence summary Since natural menopause is clinically defined as the final menstrual period, the best way to diagnose it is to retrospectively observe 12 consecutive months of amenorrhea. Several studies followed women longitudinally and found the characteristics that best predicted actual transition to menopause within 4 years were amenorrhea of between 3 and 12 months duration (sensitivity=0.16–0.32; specificity=0.98–1.0; positive likelihood ratio [LR+]=14.4–∞; negative likelihood ratio [LR–]=0.69–0.84), cycle irregularity within 12 months (sensitivity=0.65–0.66; specificity=0.77–0.85; LR+ =2.84-4.17; LR– =0.42–0.84), and age ≥50 years (sensitivity=0.35; specificity=0.98; LR+ =15.4; LR– =0.66). Change in the amount of flow is more sensitive but less specific (sensitivity=0.81; specificity=0.30; LR+ =1.15; LR– =0.65). A woman’s global perception of being perimenopausal can also be useful for “rulingin” transition to menopause within the next several years (sensitivity=0.18; specificity=1; LR+ =∞; LR– =0.82). No studies were identified that prospectively studied the usefulness of laboratory or radiologic findings C L I N I C A L C O M M E N T A R Y