 |
 |
After exchanging a few emails with Katy Cooper on the issue of the minipill and menopause, I have been ‘encouraged’ to summarise the current understanding on the issue. I am sure many of us have come across too many unjustified requests of FSH and LH levels in women approaching menpause or during their perimenopausal transition. However, FSH measurement does sometimes have its role in this age group. Firstly, is FSH measurement indicated at all in women taking the progestogen-only pill (POP)? POP is a useful option of contraception in older women for many reasons which are beyond the scope of this email. Because some women on POP have amenorrhoea, measurement of FSH will help the clinician to decide the perimenopausal status. If FSH is repeatedly high (>30 U/L in some labs), further discussion can be made to decide whether POP can be stopped and an alternative, e.g. barrier method, be tried. If the FSH is not raised, it is likely that POP will be continued if wished. Since measurement of FSH in this situation is going to affect the management, it is clinically indicated Secondly, how does POP affect FSH and LH levels? The traditional teaching is that all POPs work by changing the cervical mucus and does not affect FSH, LH or oestradiol levels or ovulation pattern at all. This notion is not true any more. Ceracette (desogestrel 75 micrograms daily) is an exception and it has been used in the UK for less than 10 years, as far as I know. Unlike the older generations of POP such as norethisterone etc, Ceracette (desogestrel) can suppress pituitary functions and thus FSH and LH levels. It is believed that its main mechanism of action is more ovulatory inhibition than altered mucus. Therefore, in women taking desogestrel 75 ug, FSH interpretation can be tricky. In his book “Contraception: Your Questions Answered”, John Guillebaud (2004) suggests substituting desogestrel with an old-type POP and measuring FSH again (if still amenorrhoic) in these women. Hope the above helps to answer some queries around the issue of POP. Comments from the mailbase collective would be very welcomed. With best wishes, Clement ----- Clement Ho Specialist Registrar Clinical Biochemistry Royal Infirmary of Edinburgh University of Edinburgh Little France Crescent Edinburgh EH16 4SA United Kingdom _________________________________________________________________ 25GB of FREE Online Storage – Find out more http://clk.atdmt.com/UKM/go/134665320/direct/01/ ------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/ LEGAL DISCLAIMER This electronic message is from Bromley Hospitals NHS Trust and it may contain confidential and privileged information. If you are not the intended recipient any disclosure, copying, retransmission, distribution, dissemination, action taken or omitted to be taken in reliance upon this email is strictly prohibited and may be unlawful. If you have received this email in error, please accept our apologies and notify the sender. Any views expressed in this message are those of the individual sender, except where the sender specifies and with authority to be the views of Bromley Hospitals NHS Trust. ------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/