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
Hope the above helps to answer some queries around the issue of POP. Comments from the mailbase collective would be very welcomed.