Overview
Introduction
Menopause is identified by the menstrual history first, not by a single laboratory result.
Menopause is identified by the menstrual history first, not by a single laboratory result. Natural menopause is established retrospectively when 12 consecutive months have passed without menstruation and no other explanation accounts for the amenorrhea. The clinical task has three parts: determine whether the final menstrual period can be identified, recognize when ovarian function has ended earlier than expected, and separate menopause from findings that require an independent workup. This distinction matters because a 52-year-old with 14 months of amenorrhea and hot flashes usually needs no confirmatory FSH test, whereas a 36-year-old with irregular menses needs evaluation for premature ovarian insufficiency. Bleeding after menopause is not a menopausal symptom; it is a new clinical problem until assessed.