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Abstract：
The diagnosis of menopause is sometimes difficult. The objective of this chapter is to describe the process of diagnosing menopause in a physiological situation, then in different clinical situations: women using hormonal contraception (per os, implant or intrauterine device), women with a history of hysterectomy, women previously treated for cancer. A review of the literature was carried out via Pubmed, Medline and Cochrane Library. The recommendations of international societies were also taken into account: International Menopause Society (IMS) https://www.imsociety.org, European Menopause and Andropause Society (EMAS) https://www.emas-online.org. In a classic situation, the diagnosis of menopause is a clinical diagnosis, made retrospectively, based on a 12-month period of consecutive amenorrhoea in a compatible age group (after 45 years of age). No hormonal dosage or imaging is indicated to make a diagnosis of menopause in a classic situation. In women using oestroprogestogen or progestative-only-pill contraception, implant, or Levonorgestrel-intrauterine device (LNG IUD), hormonal assays or pelvic ultrasound are neither recommended to make a diagnosis of menopause (grade C), nor to decide to stop contraception (grade C). The proposed strategy is the discontinuation of oral contraception, removal of the implant or LNG-IUD, and clinical follow-up (occurrence of amenorrhea) (expert opinion). In women with a history of hysterectomy, in the absence of evaluable clinical symptoms (amenorrhea), a repeat FSH≥40 combined with low estradiol (<20pg/ml) at least 3 months after the procedure could be a diagnostic orientation towards menopausal status. After cancer, in women who have received gonadotoxic treatment, the classic clinical criteria of 12 months of amenorrhea cannot be used to make a diagnosis of menopause with certainty (expert opinion). No further examination can be recommended to make a definite diagnosis of menopause (expert opinion). In breast cancer, the hormonal status to be taken into account when choosing initial hormone therapy is the one found before starting any treatment. If at the time of diagnosis of breast cancer the menopausal status is not known due to hormonal contraception, it is preferable to consider the patient as non-menopausal by default for the choice of hormone therapy for the cancer.
摘要：
更年期的诊断有时很困难。本章的目的是描述在生理情况下诊断更年期的过程，然后在不同的临床情况下：使用激素避孕的女性(每个操作系统，植入物或宫内节育器)，有子宫切除术史的妇女，以前接受过癌症治疗的女性。通过Pubmed，Medline和Cochrane图书馆。还考虑了国际社会的建议：国际更年期协会（IMS）https://www。imsociety.org,欧洲更年期和Andropause协会（EMAS）https://www.emas-online.org。在经典的情况下，更年期的诊断是临床诊断，回顾性地制作，基于兼容年龄组（45岁后）连续闭经12个月的时间。在经典情况下，没有激素剂量或影像学检查可诊断更年期。在使用雌激素或仅供孕激素避孕药的女性中，植入物,或左炔诺孕酮宫内节育器（LNG宫内节育器），激素测定或盆腔超声都不建议诊断更年期（C级），也不决定停止避孕（C级）。拟议的战略是停止口服避孕药，移除植入物或液化天然气宫内节育器，和临床随访（闭经的发生）（专家意见）。在有子宫切除术史的女性中，在没有可评估的临床症状（闭经）的情况下，术后至少3个月重复FSH≥40并低雌二醇(<20pg/ml)可能是对绝经状态的诊断方向.癌症之后,在接受性腺毒性治疗的女性中，12个月闭经的经典临床标准不能用于明确诊断绝经(专家意见).不建议进一步检查以明确诊断更年期（专家意见）。在乳腺癌中，选择初始激素治疗时要考虑的激素状态是在开始任何治疗之前发现的。如果在诊断乳腺癌时，由于激素避孕而不知道绝经状态，在选择激素治疗癌症时,优选将患者默认为未绝经.
