This is a notoriously difficult area.
In my experience GPs feel more comfortable in prescribing HRT if the
patient has shown a serum FSH of >25U/L (some would say 20U/L) at any
stage since this provides at least some evidence of menopausal
transition. The reverse is not true, however, since FSH is commonly
<25U/L in patients who have symptoms of menopause and in patients who
are genuinely in menopausal transition. The decision on whether to
prescribe HRT when FSH is <25U/L is then for the GP bearing in mind age,
the length and severity of symptoms and other clinical considerations.
Sometimes a GP will take the view that he/she would prefer not to give
HRT at one particular point in time and will bring the patient back in
3-6 months time for reassessment (including repeat FSH). I do not see a
problem with this strategy. As long as GPs understand the limitations
of FSH during menopausal transition I do not feel that we can challenge
their judgment on individual patients. By having a blanket refusal of
FSH requests in this age group we would, in effect, be challenging their
judgment. As always, it is a matter of balance and education.
Graham
-----Original Message-----
From: Mainwaring-Burton Richard (RGZ)
[mailto:[log in to unmask]]
Sent: 02 April 2003 11:08
To: [log in to unmask]
Subject: Re: Elusive peri/menopausal state
should we (are we entitled to) refuse to do the test if the sample is
not taken day 2-5 of cycle ?
same applies to progesterones on inappropriate days .
My view is that a test done on the wrong day is worse than no test at
all
With best wishes
Richard
Biochemistry Department
Queen Mary's Hospital
Sidcup, Kent
DA14 6LT
-----Original Message-----
From: Mohammad Al-Jubouri [mailto:[log in to unmask]]
Sent: Wednesday, April 02, 2003 10:41
To: [log in to unmask]
Subject: Elusive peri/menopausal state
The majority of requests for hormonal profile come from GPs attempting
to diagnose the elusive peri/menopausal state in women over 45 years of
age. Can somebody with scientific authority like NICE issue guidance on
the futility of such investigations in this situation and that starting
HRT should be based on clinical grounds only. Has anybody been
successful at local level in solving this and how?
Thanks
Mohammad
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