A 46 year old lady, seeing her Family Doctor. Clinical information is 'On
progesterone-only contraceptive pill. Amenorrhea for 3 months'.
Serum FSH: 32.1 U/L
(Follicular phase, 2-11; Peak, 5 - 34; Luteal phase, 1 - 8, Menopausal, 28
- 133)
This Case attracted 26 participants. Although there was considerable
concensus, there were a few dissenting voices.
Only 3 participants would 'phone the Family Doctor; [-1.3]
18 participants commented possible/likely/peri menopausal status; [1.7]
(I particularly liked 'get ready for hot flashes (sic) - thank you, Bill)
2 participants said that lab tests cannot be used to confirm menopausal
status, [1.5]
2 said that it was difficult to interpret FSH in the presence of of a POP;
[0.3]
2 said that POPs can cause menstrual irregularities; [0.3]
1 each said
'POPs associated with decreased FSH in a third of cases'; [1.0]
'POPs have no negative feedback on gonadotropins'. [1.0]
3 participants would exclude pregnancy by measuring HCG; [0.3]
1 said that FSH was not suggestive of established pregnancy. [0.8]
1 would check the oestradiol, if low suggesting menopausal status; [0]
1 would suggest LH and prolactin; [0.2]
1 would suggest a repeat FSH with LH, oestradiol, prolactin; [0.2]
1 said an oestradiol measurement was probably of no benefit. [1.5]
5 would suggest stopping the POPs, [-1.5]
1 repeating FSH in 2 weeks; [0.3]
4 in 2 - 3 months. [1.0]
2 would also add LH and oestradiol to the FSH request. [0]
4 would suggest alternative contraception/ contraceptive cover; [1.0]
1 would suggest referral to a Gynaecologist/ Endocrinologist. [-0.3]
Sorry that this Summary is late. Ping and I are both away for most of the
next few weeks, so the Summary for Case 60 will be distributed at the end
of next week; and Case 61 should be circulated after the IFCC meeting in
mid-June.
Best wishes
Gordon Challand
Li Ping
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