Would a single FSH measurement of > 20.0 IU/L rightly alleviates such anxiety?

"I suspect that fewer patients will be "willing" to take HRT as time goes by."

Do you mean that we should be recieving less requests as time goes by? we live with hope.

 regards

Mohammad

>From: ablumsohn <[log in to unmask]> >Reply-To: ablumsohn <[log in to unmask]> >To: [log in to unmask] >Subject: Re: Elusive peri/menopausal state >Date: Thu, 3 Apr 2003 16:44:55 +0100 > >While I agree that FSH, LH and particularly E2 are grossly misused, >not sure that I would personally go along with this extreme a view. >Almost all patients are "symptomatic" (by definition). Measuring these >things in 50 year old women with hot flushes is clearly stupid. >However the other end of your spectrum is where it can be useful. >In this context FSH > say 30 with >LH that does not point to a midcycle peak would certainly be helpful. > > > >Aubrey > >MAJ> You have just confirmed my point. In my experience, FSH is >MAJ> notoriously variable (like a Yo Yo) during the transitional state >MAJ> during a single period and from period to period in the same >MAJ> woman. Having a single reading of FSH is therefore not >MAJ> confirmatory of any thing (? useless). I still can't understand >MAJ> why GPs should rely on it in their decision to start HRT in >MAJ> ladies over 45 years of age who are symptomatic and willing to >MAJ> take the treatment. Education is certainly helpful but NICE >MAJ> guidance will be more effective. > >MAJ> Mohammad > > > > > > > > > > > > > >>From: Graham Beastall > > > > >>Reply-To: Graham Beastall > > > > >>To: [log in to unmask] > > > > >>Subject: Re: Elusive peri/menopausal state > > > > >>Date: Wed, 2 Apr 2003 12:34:32 +0100 > > > > >> > > > > >>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 > > > > >> > > > > >> > > > > >> > > > > >> _____ > > > > >> > > > > >>On the move? Get Hotmail on your mobile phone > > > > >> ------ACB discussion List > > > > >>Information-------- This is an open discussion list for the academic and > > > > >>clinical community working in clinical biochemistry. Please note, > > > > >>archived messages are public and can be viewed via the internet. Views > > > > >>expressed are those of the individual and they are responsible for all > > > > >>message content. > > > > >>ACB Web Site http://www.acb.org.uk List Archives > > > > >>http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions > > > > >>(How to leave etc.) http://www.jiscmail.ac.uk/ > > > > >>------ACB discussion List Information-------- This is an open discussion > > > > >>list for the academic and clinical community working in clinical > > > > >>biochemistry. Please note, archived messages are public and can be > > > > >>viewed via the internet. Views expressed are those of the individual and > > > > >>they are responsible for all message content. > > > > >>ACB Web Site http://www.acb.org.uk List Archives > > > > >>http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions > > > > >>(How to leave etc.) http://www.jiscmail.ac.uk/ > > > > >> > > > > >>------ACB discussion List Information-------- > > > > >>This is an open discussion list for the academic and clinical > > > > >>community working in clinical biochemistry. > > > > >>Please note, archived messages are public and can be viewed > > > > >>via the internet. Views expressed are those of the individual and > > > > >>they are responsible for all message content. > > > > >> > > > > >>ACB Web Site > > > > >>http://www.acb.org.uk > > > > >>List Archives > > > > >>http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html > > > > >>List Instructions (How to leave etc.) > > > > >>http://www.jiscmail.ac.uk/ > > > > > > > > > > >MAJ> Message your friends in real time - and for free. Get MSN Messenger today!------ACB discussion List Information-------- >MAJ> This is an open discussion list for the academic and clinical >MAJ> community working in clinical biochemistry. >MAJ> Please note, archived messages are public and can be viewed >MAJ> via the internet. Views expressed are those of the individual and >MAJ> they are responsible for all message content.ACB Web Site >MAJ> http://www.acb.org.uk >MAJ> List Archives >MAJ> http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html >MAJ> List Instructions (How to leave etc.) >MAJ> http://www.jiscmail.ac.uk/ > > > >Regards > >Aubrey Blumsohn > >------ACB discussion List Information-------- >This is an open discussion list for the academic and clinical >community working in clinical biochemistry. >Please note, archived messages are public and can be viewed >via the internet. Views expressed are those of the individual and >they are responsible for all message content. > >ACB Web Site >http://www.acb.org.uk >List Archives >http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html >List Instructions (How to leave etc.) >http://www.jiscmail.ac.uk/