The vagaries of FSH as a "test" for menopause
posts to alt.suport.menopause

Doctor administered test
"Self Test" - approved December 2001

Extract from: Canadian Consensus on Menopause and Osteoporosis    (Update Sept 12, 2002)


A2 Healthcare providers should not use random serum markers of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol E2 for the purpose of predicting menopause since clear markers for predicting menopause are yet to be identified. (II-2)
I'm shocked because I went to the doctor and he did a blood test called FSH which showed I'm menopausal even though I'm having regular periods. How can this be?
Hormonal blood tests are notoriously unreliable as hormone levels vary widely from day to day and even during the day. The FSH test is basically useless for determining what stage of the perimenopausal transition anybody is in. Here are statements from the abstracts of three studies you can find on Medline.  You might like to print out the whole abstracts and show them to your doctor if you want to convince him. Of course he *could* simply mean "perimenopausal" - the two words are often used interchangeably (and confusingly!)
Clin Endocrinol (Oxf) 1981 Mar;14(3):245-255
Pituitary-ovarian function in normal women during the menopausal transition.
Metcalf MG, Donald RA, Livesey JH

 It is concluded that the appearance of high levels of FSH and LH is characteristic of the perimenopause and often precedes the sustained loss of sex hormone secretion by the ageing ovary. Postmenopausal biochemical parameters are no guarantee of the postmenopausal state
Maturitas 1993 Dec;18(1):9-20 
Perimenopausal patterns of gonadotrophins, immunoreactive inhibin, oestradiol and progesterone.
Hee J, MacNaughton J, Bangah M, Burger HG
Prince Henry's Institute of Medical Research, Clayton, Victoria, Australia. 
It was concluded that typical postmenopausal hormone patterns may occur at the time of entry into the normal menopausal transition, and in some women with anovulatory infertility, but may be completely and relatively abruptly reversible. Elevation of serum FSH into the postmenopausal range, with undetectable INH concentrations, does not provide reliable evidence that the menopause (or permanent ovarian failure) has occurred. INH contributes to elevations of serum FSH during the menopausal transition.
Eur J Endocrinol 1994 Jan;130(1):38-42 
Diagnostic role of follicle-stimulating hormone (FSH) measurements during the menopausal transition--an analysis of FSH, oestradiol and inhibin.
Burger HG
Prince Henry's Institute of Medical Research, Clayton, Victoria, Australia.
It is concluded that FSH measurement is of little value, if any in the assessment of women during the menopausal transition because it cannot be interpreted reliably and because, apparently, ovulatory (and, presumably, potentially fertile) cycles may occur subsequent to the observation of postmenopausal FSH levels. Both oestradiol and inhibin are important negative feedback regulators of circulating FSH.
extract from Menopause 1999;6:29­35. © 1999, The North American Menopause Society
Among U.S. women aged 35­60 years, median FSH and LH levels began to increase for women in their late 40s and reached a plateau for women in their early 50s.This study supports the previously reported association between serum FSH and age (i.e., serum FSH and LH levels increase with age) and smoking (i.e., current smoking was associated with an increased level of serum FSH). At FSH levels of = or >15 IU/L or = or >20 IU/L, 70 and 73% of women, respectively, were postmenopausal. Our study also found an interaction between age and oophorectomy. In addition, the present data suggest that women with only one ovary may have higher FSH levels than women with both of their ovaries.
From: Gail Gillespie <[email protected]>

This discussion of the FSH test took me back to my menopausal transition,  reminding me of some of the more horrifying absurdities foisted on me by the medicalization of menopause. For example, when, at 48, heavy bleeding drove me to the doctor's office, I was given the test - as part of a general check up to see what was going on, or so I thought. When the results came back the doctor told me that they would have to perform an endometrial biopsy to "check for cancer" since my FSH was "similar to a 29 year old's." Great. So, then, after the (very painful for me) endo. biopsy showed nothing abnormal, they put me on ever-increasing doses of provera to curtail the bleeding - which paradoxically increased to the pointt where I had a 70 day continuous bleed accompanied by cramps just this side of childbirth. Weak from exhaustion/anemia, I dragged myself in again to the same doctor  who then gave me a second FSH test. (The fact that I was taking 20 mg of provera a day seemed immaterial to him!) 

Studying the new FSH results, he then told me that because of my unexplained POSTmenopausal bleeding I would require a more-or-less immediate hysterectomy. I should sign up right then and there because he was "very busy" in October. When I reacted with shock, since the biopsy, which was normal, was also based on the FSH results which suggested a NON post-meno. status, the doctor became very condescending. He indicated that this second blood test indicated that my FSH had gone from 9 to 51 (in a couple of months) and suggested that I was now, suddenly,  POST menopausal. Then he began to hint darkly at the possibility that I may have cancer or at least fibroids because POST menopausal bleeding is one of the major signals of serious trouble. As angry as it makes me to recount this, it also strikes me that the fact that the doctor was an insensitive jerk helped in the long run since my  distrust prompted me to check out things on my own.

Fortunately, by this time, I'd discovered and was reading Susan Love's book as well as a number of books on hysterectomy, including Cutler's. Looking back and checking my "bleeding journal," the entire situation reminds me eerily of childbirth, in which case, the fetal monitor, like the FSH test, is often the excuse for rampant, unnecessary intervention in a normal physiological intervention which may, in the end, have dire consequences (such as the loss of perfectly healthy body parts).  Incidentally, this doctor's remark to me when I fired him to get a second opinion, was "don't come crying to me when you get ovarian cancer." 
PS. To the newbies: I am doing just fine now. I feel better than I have since my 30s and have not bled for two years. I take no drugs other than the occasional ibuprofen and a multi-vitamin when I think about it. My only "symptoms" (hate that word) were  a few hot flashes for several months as I made the adjustment to a  drug free state. After what I went through, it was hard to go back to a doctor regularly though I do reluctantly get an annual PAP and mammogram.

So what are "normal" levels for FSH? Note the wide range and overlap - values
Normal values: 
                  male: 4 to 25 U/L 

                       premenopausal: 4 to 30 U/L 
                       midcycle peak: 10 to 90 U/L 
                       pregnancy: low to undetectable 
                       postmenopausal: 40 to 250 U/L 

                  Note: U/L = units per liter 

see also  the soapbox post "FSH test for menopause" and its Google link


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