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Model predicted final menses
Researchers at UCLA have developed a model to estimate the timing of a woman’s final menstrual period. According to researchers, the model has the potential to help physicians and patients determine when the menopausal transition is complete and estimate bone loss.
“We need a better way to answer women’s questions about when to expect the final menstrual period,” researcher Gail A. Greendale, MD, from UCLA’s David Geffen School of Medicine, said in a press release. “If further research bears out our approach, it could be the first step to developing Web-based calculators and other tools women can use to estimate where they are in the menopause transition and how far away their final period is.”
Greendale and colleagues included 554 women from the Study of Women’s Health Across the Nation (SWAN). They designed the probability of meeting specific landmarks: 2 years before, 1 year before and the final menstrual period (FMP).
“For example, some researchers have proposed that an intervention begun 1 or 2 years before the final menstrual period would greatly decrease future fracture risk by preventing the very rapid bone loss that occurs in the few years before and few years after the final menses,” Greendale said. “But before ideas such as this can be tested, we need to accurately predict where a woman is in her timeline to menopause.”
Therefore, the researchers assessed the probability of being in restricted intervals: 1 to 2 years before FMP, 2 years before FMP and FMP, or 1 year before FMP and FMP. Additionally, the markers that best predicted having crossed each landmark were determined, with the ideal markers defined as the greatest area under the receiver-operator curve (AUC).
Researchers wrote that the final models included the current estradiol and follicle-stimulating hormone (FSH), age, the stage of menopause transition, race/ethnicity and whether serum was collected during the early follicular phase.
Data indicate the AUC of final models predicted the probability of a woman having crossed 2 years before (0.902), 1 year before (0.926) and the FMP (0.945), researchers wrote. If they identified women as having crossed the 2 years before the FMP landmark when predicted probability extended beyond 0.3, the sensitivity was 85% and specificity 77%, they added.
Despite limitations, Greendale and colleagues conclude that the clinical practice implementation of their model is conceivable. However, further studies are warranted to determine validation of these findings.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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One of the most pressing questions for women traversing the menopause transition is, “How long is this going to take?” There are practical implications regarding contraception, as well as compromises in productivity for those with erratic, heavy bleeding. Bone loss also begins prior to the final menstrual period. In this analysis from the Study of Women Across the Nation, Greendale et al pose a model, incorporating two sets of serum FSH and estradiol measurements, to predict the final menstrual period. As the authors conclude, “model replication in an independent sample is necessary before clinical use.” They also anticipate, however, that once validation occurs, women, armed with a few hormonal measurements, will likely be able to check on a web-based calculator and finally answer the question, “How long is this going to take?”