It seems to me that the question is a bit like PSA, or free PSA in detecting prostate cancer. Its not diagnostic but may have a likelihood ratio (pos or neg) depending on the FSH level, that can improve the probability of a correct diagnosis. The risk side of the equation for long term HRT would seem to me to suggest any improved diagnostic accuracy (over and above clinical assessment) may be worthwhile. The question is whether FSH measurement can provide this. Isn't this the sort of question an evidence-based approach can solve? Has  anyone done such a systematic review or a controlled study? Since senior members of the profession have differing views and many of the rest of us just plain don't know authorative evidence-based recommendations are surely what is needed.
 
steve
 
 
-----Original Message-----
From: Mohammad Al-Jubouri [mailto:[log in to unmask]]
Sent: Friday, April 04, 2003 10:08 AM
To: [log in to unmask]
Subject: Re: Elusive peri/menopausal state

I am sorry to be persistent on this, but a single reading of FSH of 5.0 IU/L in a 45 year-old lady with hot flushes does not exclude perimenopausal state, such is the dishonesty of the FSH in providing useful insight into the transitional period.

I am not saying that GPs should rush and put such a patient on HRT but rather to use their clinical judgement based on full menstrual history and clinical assessment of severity and persistence of menopausal signs and symptoms. Once they are convinced that such symptoms are most likely, in this age group, to be due to naturally failing ovaries and not due to thyrotoxicosis for e.g, full discussion with the patient about choices and risk- benefit analysis of HRT must ensue. Patients may tolerat e the symptoms and defer using HRT until age of 48 years (for e.g), they may wish to start HRT immediately or they may not wish to have HRT altogether. Such decisions should not be based  on a single visit to the GP but enough time (months) should be allowed for the GP and the patient to be convinced about a bilaterally satisfactory course of action. This is the logical approach and FSH should no be consulted as it lacks insight.

The reality is that more women (rightly or wrongly) are choosing to have HRT (youth elixir)than ever before and for longer periods as well.

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 17:45:56 +0100
>
>No, but it would help. We know that about 10% of women of age 45
>to 50 who have no periods for 6 months will have at least 1 more
>ovulatory cycle with a period, and the biochemistry will follow
>accordingly. However finding FSH = 5 LH = 5 in a flushing 45 year old
>would help I think?
>
>Aubrey
>
>MAJ> Dear Aubrey
>
>MAJ> "There would be real anxiety about starting HRT in a 45y old
>MAJ> woman with a very short period of amenorrhoea who would otherwise
>MAJ> have continued cycling for the next 8 years or so."
>
>MAJ> Would a single FSH measurement of > 20.0 IU/L rightly alleviates
>MAJ> such anxiety?
>
>MAJ> "I suspect that fewer patients will be "willing" to take HRT as
>MAJ> time goes by."
>
>MAJ> Do you mean that we should be recieving less requests as time
>MAJ> goes by? we live with hope.
>
>MAJ>  regards
>
>
>
>MAJ> Mohammad
>
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