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[Hurdity]

Hi everyone

It's been a while since I posted this link but the recent discussions about FSH, and experiencing menopausal symptoms while having fairly regular periods prompted me to have another look at this paper. It is the summary of a workshop entitled “Stages of Reproductive Ageing” published by the International Menopause Society in 2012.
http://www.imsociety.org/downloads/email_downloads/2012_02_16_1773491/straw10.pdf

The workshop and summary paper identifies by stages the reproductive years, the menopausal transition and post-menopause in relation to menstrual cycles and the hormonal status  – chiefly FSH and the other lesser known hormones (Anti Mullerian hormone and inhibin B – which we don't hear much about – although AMH is mentioned on this site:  http://www.menopausematters.co.uk/diagnose.php

This is the paper where I got the information that I often quote, about estradiol levels continuing to fall for two years following the last period and then stabilising – this is clear from the graph on p3.

The different stages are shown in a table on p5 – pity I can't put it on here!

This time of reading several different things stood out for me:

1   In the second phase of the late reproductive stage just before the menopausal  transition period, FSH levels begin to vary, and there are subtle changes in blood flow and cycle length, and specifically that cycles become shorter as reported by several of you on here. The text also highlights that “critical endocrine parameters begin to change before overt changes in menstrual cyclicity” so it's no wonder that some women being to experience other symptoms at this time.

2   In the late menopausal  transition stage ( defined as more than two months without a period), menstrual cycles “are characterized by increased variability in cycle length, extreme fluctuations in hormonal levels, and increased prevalence of anovulation. In this stage, FSH levels are sometimes elevated into the menopausal range and sometimes within the range characteristic of the earlier reproductive years, particularly in association with high estradiol levels".

Several of you have mentioned being diagnosed as post-menopausal from single FSH readings within the post-menopausal range, despite not having been without periods for 12 months but it is clear from this paper that this diagnosis should not be given – rather, that you may well be still in peri-menopause.

Hope some of you find this helpful 

Hurdity x

[dazned]

Thanks for you time looking into this for us all.

I'm so pc illiterate I couldn't even paste a link ! 

X

[honorsmum]

Thank you for a really helpful post, Hurdity.
I won't pretend to understand it all (!), but page 5 was particularly informative. Going by the diagram, it looks like I'm pre-peri as I don't have cycles varying by 7 days or more consistently, but I have had a couple of years of varying cycle lengths.

[dazned]

Honoursmum I'm not going to pretend I understand any of it ! 

I'm a really simple soul 

[BrightLight]

Thank you. I have studied the chart several times over the last few years. My cycles were becoming a bit shorter but regular and I thought I was in the -3a late reproductive stage, which seemed about right for my age. I left it at that until the recent strange bleeding which resulted in a high FSH blood test and preliminary diagnosis of menopause.

I seemed to skip the -2 phase of shifting lengths between cycles of >7 days which is indicated to last 2-3 years. My GP had not asked any questions about synptoms or cycle changes when de said high FSH = menopause. I am still befuddled by my situation and try not to think about it to be honest and just get on with it. Every women is different but my doctors aren't interested in explaining or engaging in my personal experience.

I went to the GP again last week and he still says none of my vague symptoms are menopause related and the menopause is a seperate thing going on (?) I said is it usual to have no symptoms and he then deemed my sensitive, red, warm face issues as hot flushes, so it's likely the menopause. He said I might expect another few periods over the year.

So, the story continues. 2 days after seeing him a period started, nearly 60 days since the last which puts me in the late perimenopause section on the chart referenced. For some reason that is reassuring, ha, that I am following some sort of 'norm'. I have another FSH test tomorrow and will be interested to see what it is. Technically it will be day 3 of my 'cycle' which I read is ideal, the last one was taken just before I was expecting a period, which never came.

The schoolgirl in me hopes the FSH is lower, not to deny I am in perimenopause but to prove my GP wrong on making a sweeping diagnosis. If he's proved right, I will have to concede to his 'wisdom', but never to his lack of ability to educate or communicate

My periods have definitely changed, thinner and I told him this, he said nothing, but reading things I understand thus is a sign of imbalance with the thickening and thinning process. So despite regular cycles and few typical menopausal symptoms, the quality of my period seems to have been my major 'sign' had I realised at the time. A simple change in 'thickness' really.

The body has a mind of its own

[BrightLight]

Sorry about above typos, typing on my phone, it's a small keyboard

[Hurdity]

Hi Brightlight

Whatever your FSH reading after your test tomorrow - your doctor was wrong in diagnosing you as post-menopausal on the basis of one high FSH reading from your previous test, when you hadn't been 12 months without periods. The fact that you have now had another period - as most of us thought you would - proves that you are somewhere in peri-menopause (as you say the table/diagram in the paper is a model which not every woman will conform to and the age and length of each stage will vary). Even if you have another very high FSH reading -  you will have to go 12 months before this reading can be shown to demonstrate that you are now post-menopausal.

One of the main points I was tryng to highlight from this paper was that it says that FSH readings during the menopausal transition can go into the post-menopausal range and I'm not sure why doctors get so hung up about them when women clearly present with menopausal symptoms and changing cycles!

Because I knew nothing about any of this until I was late peri-menopause I ignored it all until the hot flushes and sweats became too much to bear.

At least you know you are not in early menopause and are proceeding as you say quite "normally" - although it may be that your age of menopause may end up being a few years below the average age of 50-52. I hope the arrival of your period and the rise in oestrogen that preceded it, has or will provide a relief from some of your symptoms 

Hurdity x

[BrightLight]

I appreciate your support Hurdity, I have lost confidence during interactions with the GP's. I needed educating from them not just a blood test result! He simply scared me and left me to try and make sense.

 I'm fairly sure I am not ovulating, which doesn't mean I won't. I clearly have estrogen levels of some sort and the reason I visited the GP last week is because I had awful swollen ankles, which reminded me of pre mentrual bloating I used to get but was all in my ankles and I was concerned. I'd done a lot of new excercise the day before. The doctor said it was unrelated to hormones or exercise impact and I needed to move more and maybe use support stockings. I now disagree with him as the swelling disappeared and the period arrived, for me, this is hormonal. If doctors won't educate on the possibility of hormone influenced symptoms it can cause stress. I know they can't be definitive but an acknowledgement wouldn't go amiss.

My symptoms aren't too bad thank you, mostly emotional and changes in hair and skin which I think reflect hormones still going a bit mad as one day it's all looking healthy, the next everything is lifeless ha

This change is hard at times, simply because it is change and I appreciate the reassurance that change happens to all of us in one way or another and in our own way.

So upset with my GP and feel sure I now have a label as a somatic/hypochondriac patient. Despite not visiting often until the last year. I have read this happens to many women and its depressing really.

I love the link you posted, it's useful and a good reference. Thank you

[BrightLight]

Hurdity, unrelated to FSH but when I first arrived we talked about the thyroid factor on all this, I still think mine is subclinically under active which might explain some of my symptoms the GP says are not menopause related. Hair, skin etc. The ironic thing in all this is that I don't necessarily want treatment, I wanted an explanation so I could stop 'worrying' and choose treatment appropriately.

Take home message is to be wary of using a single blood test to determine anything, watch, wait and retest if necessary but focus on feeling well and accepting changes

[dogdoc]

Thanks Hardily...this definitely applies to me. It's sad that I'm still early perimenopausal in a way because I have no way of knowing how long this will last. I am considering doing an AMH test...it's more acurate than FSH in predicting the final menstrual period. I'm being a bit of a chicken though...if it's super low...I likely have less than 5 years to my final menstrual period...but if it's not low...it might last FOREVER lol.

You are passed all the peri stuff right Hurdity? Do you do well on the hormones you're on? Are you level? I just want positive news from someone who's been there and done that.
Tara

[Hurdity]

Hi dogdoc - missed your post as was away over the weekend....

Yes I am well post-menopause - will be 62 in a couple of months  . Yes I have always done well on the hormones I am on  - I mean not ideal as I would prefer oestrogen to be higher,  but that comes at a cost (extra progesterone). However for me since I started HRT (late menopausal transition age almost 54), 50 mcg patch has always prevented all the worst symptoms of flushes and sweats - with the bonus that this dose will give greater protection against osteoporosis. Being free from the symptoms has enabled me to live a (relatively) normal life without worrying unduly about all that stuff that gets in the way! However libidio is another thing altogether - not the subject of this thread though! I am also getting much more tired these days though....

Brightlight - I am sure there are many women in your position - I sometimes wonder if I am too (sub-clinical underactive thyroid), although it comes out as "normal" - and/or low testosterone - which might explain my extreme tiredness.

Hurdity x

[dogdoc]

Thanks Hurdity. It's good to hear when someone is 'stable'.

Think of checking testosterone and dhea-s for fatigue and lethargy. I too think there's something to the subclinical hypothyroid idea.

Tara

[CLKD]

Let the medication you are already taking begin working first or you won't know what is/not working  [we have a 'hows the weather with you' thread too - sometimes we even discuss menopause  ]

[Hurdity]

Yes I know it's an ancient thread - but I'm bumping it for Focus to save writing about it again!

Hurdity x

[pepperminty]

Hi Hurdity,

great info. Made me think that at 52 years my Femosten 1/10 ( plus half a Zumenon estrogen tablet every other day is not quiet enough now) hense the aching joints and the anxiety creeping back. I had a surge of estrogen last year resulting in painful boobs, but no that has all changed and I think I have gone further down the meno route and I may need an increase. I shall do this very slowly though but quatrering the tablets until i get to the 2/10 dose.

Peppermintyx