Value of measuring FSH and LH levels in women aged 45 or over
Record ID 32005000247
CNAMTS (the French National Health insurance fund for salaried workers) asked ANAES to assess whether measuring gonadotrophin levels (FSH and LH) in women aged 45 or over has any value in the diagnosis and management of the menopause or perimenopause. The aim was to prepare a Target Agreement on Best Practice (ACBUS). Three areas were identified for study: (i) changes in hormone levels at these times, (ii) the diagnostic power of the biochemical and clinical markers used to make the diagnosis of menopause or perimenopause, and (iii) existing guidelines on the subject.
Authors' results and conclusions:
Changes in hormone levels: In women over 35, FSH levels rise gradually at the beginning of the follicular phase. This rise becomes more marked after the age of 45 and at onset of signs of perimenopause (changes in menstrual cycles, irregular cycles, menopausal symptoms). The rise continues until after the menopause. LH levels also rise at the menopause but to a much lesser extent than FSH levels. Longitudinal follow-up of women from premenopause to perimenopause and menopause has shown that hormone levels fluctuate considerably in the same individual, with high values alternating with normal values, thus indicating that hormone tests are not a reliable way of diagnosing perimenopause or menopause. As periods of ovulatory and anovulatory cycles alternate, effective contraception should be used up to the menopause.
Diagnostic power: FSH and LH assays have no greater diagnostic power than menopausal symptoms. Studies have failed to identify any clinical or biological markers of menopausal status. In addition, different standards used in FSH assay methods makes it impossible to establish a precise threshold.
Current guidelines: All guidelines except one (the American Association of Clinical Endocrinologists) state that FSH and LH assays are not reliable for tackling issues such as assessing ovarian function, diagnosing perimenopause or menopause, or deciding that contraception may be stopped or hormone replacement therapy started.
In the light of this critical review and expert opinion, it was concluded that in women over 45: 1. an LH test is NOT recommended as it is of no benefit;
2. an FSH test should NOT be ordered: a. to diagnose perimenopause or menopause. The key factors are age and clinical signs (irregular cycles, amenorrhoea with hot flushes, vaginal dryness, night sweats). A progestogen test is indicated. FSH tests should be reserved for clinical situations such as: - hysterectomy (combined with an oestradiol test) - to look for gonadotrophin deficiency in a patient with amenorrhoea but without menopausal problems - during follow-up of GnRH-analogue therapy;
b. to decide whether to prescribe hormone replacement therapy;
c. to decide whether to stop contraception (opinion of most experts). Instead, oral contraception should be replaced by another form of contraception and onset of amenorrhoea and any menopausal symptoms should be monitored.
English language abstract:
An English language summary is available
- Follicle Stimulating Hormone
- Luteinizing Hormone
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