title: Vaginal pH is similar to follicle-stimulating hormone for menopause diagnosis.
abstract: OBJECTIVE
  This paper is intended to demonstrate whether vaginal pH value is associated with menopausal status and symptoms, to review the sensitivity of follicle-stimulating hormone or vaginal pH to diagnose menopause, to compare these findings to a group of practice patients, and to determine whether vaginal pH could be used in place of follicle-stimulating hormone as an initial screen to determine menopause.
  
  
  METHODS
  Sixteen studies regarding vaginal pH and menopausal symptoms before and after estrogen administration were analyzed. Two epidemiologic studies that reported follicle-stimulating hormone or vaginal pH with menopause were reviewed. These findings were compared with similar data from the practice of one of the authors (J.C.C.).
  
  
  RESULTS
  Menopausal women who do not receive estrogen therapy have a weighted average vaginal pH of 6.0, which is reduced significantly to 4.5 with estrogen therapy. To diagnose menopause, follicle-stimulating hormone >or=15 or >or=20 mIU/mL in the Third National Health and Nutrition Examination Survey had a sensitivity of 65% to 68%. In a study in Costa Rica, where 3 definitions of menopause were used, a pH of >5.0 had a sensitivity of 64% to 67%. From the practice patients, the 95% confidence interval sensitivities and positive predictive values of vaginal pH and follicle-stimulating hormone to diagnose menopause overlapped, while a pH <or=4.5 indicated mid follicular phase estradiol levels.
  
  
  CONCLUSIONS
  In women without vaginitis and no estrogen therapy, a vaginal pH of > 4.5 indicates menopause, because it demonstrates a similar sensitivity as follicle-stimulating hormone in epidemiologic studies. In the practice patients, the sensitivity of follicle-stimulating hormone was no different than vaginal pH in the diagnosis of menopause. Furthermore, with estrogen therapy, a vaginal pH of <or=4.5 indicates a mid follicular phase estradiol.
authors.affiliation: Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Women's and Children's Hospital, Los Angeles, California 90033, USA. subirro@usc.edu
authors.forename: S
authors.initials: S
authors.lastname: Roy
authors.forename: J C
authors.initials: JC
authors.lastname: Caillouette
authors.forename: T
authors.initials: T
authors.lastname: Roy
authors.forename: J S
authors.initials: JS
authors.lastname: Faden
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D003955:Diagnostic Tests, Routine; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008593:Menopause / Q000097:blood / Q000502:physiology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D017697:Premenopause / Q000097:blood / Q000502:physiology; D011336:Probability; D012680:Sensitivity and Specificity; D014621:Vagina
chemical_list: D005640:Follicle Stimulating Hormone