Menopause should be differentiated from other diseases presenting with menstrual irregularities (oligomenorrhea/amenorrhea).
Adrenal insufficiency
Hypothyroidism
Breast tissue atrophy
Decreased axillary and pubic hair growth
Pancytopenia
Eosinophilia
Hyponatremia
Low fasting plasma glucose
Decreased levels of anterior pituitary hormones in blood
Clinical diagnosis
Most senitive test: Low baseline prolactin levels w/o response to TRH
Sequential changes of pituitary enlargement followed by:
Shrinkage and necrosis leading to decreased sellar volume or empty sella
Pituitary hormone stimulation tests (Metoclopramide and clomiphene citrate stimulation tests)
Associated with autoimmune conditions
Generalized headache
Retro-orbital or Bitemporal pain
Mass lesion effect such as visual field defects
DI
Autoimmune thyroiditis
Decreased pituitary hormones(Gonadotropins most common)
Hyperprolactinemia(40%)
GH excess
Pituitary biopsy: lymphocytic infiltration
CT & MRI: Features of a pituitary mass
Diffuse and homogeneous contrast enhancement
Anti-TPO
Anti-Tg Ab
Nausea and vomiting
Paralysis of eye muscles (diplopia)
Changes in vision
Visual acuity defects
CN palsies (nerves III, IV, V , and VI)
Decreased levels of anterior pituitary hormones in blood.
MRI
CT scan without contrast: Hemorrhage on CT presents as a hyperdense lesion
MRI: If inconclusive CT
Blood tests may be done to check:
PT/INR and aPTT
Pituitary hormonal assay
Erectile dysfunction
Headache
Low libido
Signs of raised intracranial pressure may be present
Nipple discharge
Decreased levels of pituitary hormones in the blood.
MRI
Empty sella containing CSF
Pituitary hormone stimulation tests (Metoclopramide and clomiphene citrate stimulation tests)
Cachexia
Premature aging
Progressive emaciation
Loss of body hair
Decreased levels of anterior pituitary hormones in the blood.
MRI
Done to rule out any pituitary cause
Pituitary hormone stimulation tests (Metoclopramide and clomiphene citrate stimulation tests)
Cold intolerance
Constipation
Dry skin
Bradycardia
Hair loss
Myxedema
Delayed relaxation phase of deep tendon reflexes
Low T3,T4
Normal/ low TSH
Rest of pituitary hormone levels WNL
TSH levels
Done to rule out any pituitary cause
Assays for anti-TPO and anti-Tg Ab
FNA biopsy
Hot flushes
Energy and mood changes
Decreased libido
Breast tissue atrophy
Decreased maturation of vaginal mucosa
Low estrogen, testosterone
High FSH/LH
FSH
LH
Done to rule out any pituitary cause
Genetic tests  (karyotype)
Measurement of total and free testosterone and 17-hydroxyprogesterone concentrations
Infertility
Subfertility
Puerperal agalactogenesis
No workup is necessary
Decreased prolactin levels
Done to rule out any pituitary cause
Prolactin assay in 3rd trimester
LH, FSH
Thyrotropin and free thyroxine
Polyuria
Polydipsia
Features of hypothyroidism and hypoadrenalism
Growth failure
B/L hemianopsia
Papilledema
All pituitary hormones decreased
MRI
Done to rule out any pituitary cause
Left hand and wrist radiograph for bone age
Hypoglycemia
Hypotension
Dehydration
Hyperpigmentation
loss of pubic and axillary hair
Hyponatremia with/without hyperkalemia
Plasma renin activity to aldosterone ratio
Abdominal CT
Abdominal CT
Serum cortisol testing
Serum ACTH testing
Anti-adrenal Ab testing
Hot flashes
Insomnia
Weight gain and bloating
Mood changes
Vaginal atrophy
Loss of pelvic muscle tone
↑ FSH
↓ Estradiol and inhibin
FSH > LH
Endometrial biopsy
Menopause Differential Diagnosis
Differential Diagnosis of Menopause
Menopause laboratory findings
Ovarian cancer risk factors
Polycystic ovary syndrome risk factors
Delayed puberty risk factors
Prostate cancer risk factors
Gynecomastia risk factors