How exactly does a doctor determine that a woman’s symptoms are due to unopposed estrogen instead of something else? Dr Steven R. Goldstein, a Perimenopause Specialist in NYC, and past President of the International Menopause Society and a Certified Menopause Practitioner says that the first place to begin is with menstrual history, which is why it is very important for women to keep a good calendar.
In addition, the doctor inquires about subtle symptoms such as mood changes (depression), free-floating anxiety, sleep disturbances, forgetfulness, changes in libido, difficulty concentrating etc.
Doctors can also do blood tests to verify this transition. One test measures the level of estradiol in the blood. Estrogen isn’t really one hormone, but three – estrone, estradiol, and estriol. Estradiol is the predominant estrogen in terms of potency. Estradiol comes mainly from the ovaries, which is why this is the type of estrogen your gynecologist is most interested in.
The second test is for FSH (follicle stimulating hormone) level. FSH is the hormone that tells the ovary to release an egg. It will also appear in your blood.
Sometimes, however, these blood tests can give confusing results. Many patients have estrogen levels that are not in the menopausal range (in other words they are still making estrogen), but their FSH levels have started to rise (greater than 30, which is typical for post menopausal women), and their interpretation when given the laboratory’s norms will be in the menopausal status. It appears paradoxical, because the patient’s estrogen level is premenopausal, but the patient’s FSH level is post menopausal.
How does this happen? In Perimenopause sometimes an ovary responds and sometimes it doesn’t. Sometimes it responds only given a high level of FSH. The ovaries do not turn themselves off like a light switch. They often “sputter”. What this means to you is that a single measurement of FSH or estradiol may be insufficient in telling you whether you are perimenopausal or menopausal. It also means that you’d be wise to request these tests more than once if your fertility is an issue or if you’ve been told that you’re in menopause.
If a doctor measures only estradiol, he or she may conclude that you are not menopausal if you still make some estrogen. If FSH is the only thing tested, and the reading is high, a doctor might conclude that you are menopausal and recommend hormone replacement therapy (HRT), when in fact it isn’t necessary yet.
Dr Steven R. Goldstein, a Perimenopause Specialist in NYC , says that any diagnosis he makes is aided greatly by the use of transvaginal ultrasound as part of the overall pelvic exam. Transvaginal ultrasounds show if a patient is indeed having episodes of anovulation (not ovulating or releasing an egg), and unopposed estrogen, the gynecologist will expect to see a nonsecretory endometrium and not to find a corpus luteum in either ovary on ultrasound. He or she expects to see multiple follicles present and a relatively homogenous uterine lining suggestive of unopposed estrogen.
Dr Steven R. Goldstein is a Perimenopause Doctor in NYC and co-author of the book “Could it be….Perimenopause?”
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