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Predicting the Start of 'the Change'

January 21, 2002|SHARI ROAN | TIMES HEALTH WRITER

The doctors caution that defining the stages of menopause does not mean that women need to have regular FSH blood tests. And many are dubious about the usefulness of the Home Menopause Test because it just looks at a single symptom of reproductive aging.

While many doctors order FSH blood tests, which cost about $50, for women who are experiencing menopausal symptoms, the home test allows women to learn FSH levels on their own. The urine test was cleared for marketing by the Food and Drug Administration in 1999, although it has not been available in the U.S. until recently.

According to the manufacturer, two consecutive readings of elevated FSH indicate that a woman is in the menopausal transition. What this means to an individual woman may vary, says Henley of Physicians Laboratories. "There are very extensive patient education materials enclosed with the test," Henley says. "Women are recommended repeatedly to discuss the results with their physician."

The test kit, which costs about $60, may appeal to women who think that their doctors don't try hard enough to help them understand reproductive aging, says Susan Doughty, a nurse practitioner and director of the New England WomenCenter in Portland, Maine.

"Women want to know, 'Where am I in the process? When am I likely to stop bleeding?'" she says. "But it's like getting your blood pressure done; it's helpful to take the information and have it put into context. It's a piece of the picture, but it's not the only piece."

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The Stages of a Woman's Reproductive Life

The new method of determining reproductive aging takes into account the length and variability of menstrual cycles, plus the level of a hormone that prompts the ovaries to release eggs. Before menopause, the length of the stages varies.

Early Reproductive--Menstrual cycles variable to regular; level of follicle-stimulating hormone (FSH) is normal.

Peak Reproductive--Menstrual cycles regular; FSH is normal.

Late Reproductive--Menstrual cycles regular, but FSH is elevated.

Early Menopausal Transition--Length of menstrual cycle varies by seven days or more; FSH is elevated.

Late Menopausal Transition--Two or more menstrual cycles are skipped, with an interval between cycles of 60 days or more; FSH is elevated.

(Menopause occurs--This is not a stage but is defined as 12 months without a menstrual period.)

Early Postmenopause--Lasts for four years after menopause; FSH is elevated.

Late Postmenopause--Lasts until death; FSH is elevated.

These stages should not be applied to all women, researchers caution. They recommend the exclusion of women who smoke, who are very heavy or very thin, who do heavy aerobic exercise, who have chronically irregular menstrual cycles, who have had a hysterectomy or who have uterine fibroids or endometriosis.

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