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Menopause

Pharmacy technician Vicky is crossing the shop floor when she hears a polite “excuse me”.

“Oh hello Jo, sorry, I didn’t see you!” says Vicky, turning around. “Are you OK?”

“Not too good actually, and I was hoping you’d be here today for a chat,” replies Jo, who has been a regular, if infrequent, customer of the pharmacy since she moved nearby some 20 years previously.

“Of course, what can I help you with?” enquires Vicky.

“I’ve not been feeling too good,” Jo admits, sadly. “Blowing hot and cold, dropping things, forgetting things, and I feel like I’m barely sleeping. Things are drying up – downstairs and also in the bedroom – and I’m tired and achy.”

“Sorry to hear that, Jo,” responds Vicky. “Have you talked to anyone about it, you know, seen the doctor or anything like that?”

“Well, I think I will,” asserts Jo. “I think it’s the change, you know, the menopause. I am 50 this year, after all. But I’d like a blood test or something so I know that is definitely what it is. That’s possible, isn’t it, with it being hormone-related? I’m sure I saw something online about a new test that can predict when a woman is likely to have her last ever period, which is pretty much the same thing, surely?”

Answer

The blood test that Jo is referring to in her last statement is anti-Müllerian hormone (AMH) and it hit the headlines earlier in 2020 due to a study conducted in the USA. 

The researchers involved stated that AMH was a better way of estimating when a woman would undergo her final menstrual period, particularly when compared to measuring follicle stimulating hormone (FSH), which is sometimes used as a way to work out whether a woman is approaching or has gone through the menopause. 

However, in the UK, AMH tends only to be measured for specific purposes only – for example, during assisted conception procedures such as in vitro fertilisation (IVF), because the test is relatively new and therefore not routinely available. 

In other parts of the world, AMH is sometimes used to define what is known as ovarian reserve – a calculation of a woman’s fertility.

The bigger picture

The most common way in which the menopause is diagnosed is by discussion of symptoms with a doctor. These symptoms usually include irregular or absent periods and sometimes issues such as hot flushes, night sweats, vaginal dryness, low libido, joint and muscle pain and low mood, although these will vary on an individual basis. 

A follicle stimulating hormone (FSH) test is recommended by the National Institute for Health and Care Excellence (NICE) to aid diagnosis of menopause in women under 45 years only. Other tests, including AMH, are not recommended in the UK.

FSH is used as a measure because the level of this hormone rises as a woman approaches menopause due to a drop in the functioning of the ovaries, which would otherwise keep the amount at a lower level. However, FSH results can be affected by the use of certain medicines – most commonly hormone treatments such as contraceptives – but also clomifene, which is used for fertility treatments; the gastrointestinal agent cimetidine; and levodopa, which is often used for the management of Parkinson’s disease.

The reason why most women do not undergo any formal diagnostic testing for the menopause is because such investigations are not particularly useful or accurate, and do not inform its management.

Extend your learning

•  Read more about the study mentioned in this scenario via Lab Tests Online
  Find out more about the AMH test
•  Refresh your understanding of the hormonal changes that take place in the run up to the menopause 
  Get to grips with the NICE guideline NG23 on the diagnosis and management of the menopause. 

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