Hormone Testing to Understand if You Crossed into Menopause

You are missing menstrual periods, having a hot flash, having some mood symptoms, and yet on a birth control pill. If this is happening to you it may be a sign of menopause.

Women all want to know if and when they are going to go through menopause; and once they do they want proof they are there. We know the age of menopause is related to just how old you are, we know the age of menopause is related to your mom’s age at menopause, and we know it has something to do with the reserve of eggs in the ovary. But there is also a blood test that can help us out. It is known as ovarian reserve testing and it’s mostly used in women considering children, but want to know if they still have healthy eggs.

The Stages of Menopause are helpful when knowing what tests to use to check your fertility:

Stages of Menopause and Roughly what to expect from hormone testing

• Perimenopause
  • First signs of irregular menstrual periods, overall progesterone lowers, most estrogen, testosterone and FSH levels are normal
• Late Perimenopause
  • 3-11 months with no menstrual period, hormone levels can be variable and test widely differently periodically
• Menopause (Average age 51.4)
  • One full year with no menstrual period, elevated FSH, low estrogen, and low progesterone
• Surgical Menopause: Both Ovaries Removed
  • With or Without Hysterectomy, elevated FSH, low estrogen, testosterone and progesterone
• One Ovary Removed
  • With or without Hysterectomy
• Post menopause

1. Fertility peaks at age 30 before the first stage of menopause. So women who are older, can have children, but it’s harder because they enter menopause. Only 1% of women will reach menopause by age 40. Over 95% of women reach menopause by age 55, so around age 50, regardless of what else is going on, many women are wondering if they have gone through menopause.

2. A study from the Family Planning Association of Hong Kong published in a recent Contraception begins to answer a question that has confounded gynecologists for over 50 years. If a woman in on birth control pills, how can she tell if she has gone through menopause? Simplistic answers are to stop the birth control pills, wait until their effects wear off and see if a woman then goes without a period for the requisite year by which menopause would be defined. Waiting a year for an answer is a clearly ludicrous solution and one that puts women at risk without the benefit of their effective contraception for those who have not yet crossed over into menopause. When women are not on their pills they have symptoms of menopause, an ultrasound with no evidence of egg development, and some classically known blood level changes. Their FSH levels rise and their estrogen levels decrease. But on birth control pills these tests are not particularly accurate, even if performed in the few days a month a woman is not taking pills. Other women stop getting their period for reasons connected with being on the pill and nothing to do with being menopausal.

3. We know there are other substances secreted by the ovary and the brain, so many years ago the gynecologist in Hong Kong decided to explore what other tests might give us a better answer. The ovary produces an egg from a follicle, the follicle is built of cells called the granulose cells in the early stages. These cells secrete a unique hormone called the Anti-mullerian hormone (AMH). Infertility physicians have used these tests, although these tests have some flaws, as the levels are decreased in premature menopause and extra high in women with polycystic ovaries. These researchers looked at AMH levels in women before and after and during the use of birth control and found that they are not affected by taking oral contraceptives! This may then be the best blood test of whether women are in menopause as they get older and are still taking the birth control pills. Come gab with your gyno to see what tests you may need as you transition through the menopause.

4. Both Inhibin B and FSH can be used to predict menopause, but they rise very late in life, and are not so useful for predicting whether you can still be pregnant. Antral follicle count, and clomid challenge testing can be used as ell. Women treated for cancer can have a return of their fertility, but be patient, this can take awhile after the chemotherapy is done.