Choosing Wisely:

Don’t obtain follicle-stimulating hormone levels in women in their 40s to identify the menopausal transition as a cause of irregular or abnormal menstrual bleeding.

Rationale and Comments: Menstrual bleeding patterns for women after age 40 are less predictable than in the younger years due to the normal menopausal transition. Menopause is defined as the absence of menstrual periods for one year when no other cause can be identified (it is often accompanied by symptoms such as hot flashes and night sweats). During this time, blood levels of follicle-stimulating hormone vary both from woman to woman and from day to day in the same woman. A follicle-stimulating hormone level does not predict when the transition to menopause will occur, diagnose that it has begun, or provide reassurance that contraception is no longer necessary. If there are no other causes of irregular or abnormal bleeding, the treatment for these women will not change based on the follicle-stimulating hormone level.
Sponsoring Organizations:
  • American Society for Reproductive Medicine
  • Sources:
  • Prospective cohort studies
  • Disciplines:
  • Gynecologic
  • References: • Paramsothy P, Harlow SD, Greendale GA, Gold EB, Crawford SL, Elliott MR, Lisabeth LD, Randolph JF Jr. Bleeding patterns during the menopausal transition in the multi-ethnic Study of Women’s Health Across the Nation (SWAN): a prospective cohort study. BJOG. 2014 Nov;121(12):1564–73.
    • Harlow SD, Lin X, Ho MJ. Analysis of menstrual diary data across the reproductive life span applicability of the bipartite model approach and the importance of within-woman variance. J Clin Epidemiol. 2000 Jul;53(7):722–33.
    • Treloar AE, Boynton RE, Behn BG, Brown BW. Variation of the human menstrual cycle through reproductive life. Int J Fertil. 1967 Jan-Mar;12(1 Pt 2):77–126.
    • Vollman RF. The degree of variability of the length of the menstrual cycle in correlation with age of woman. Gynaecologia. 1956 Nov;142(5):310–4.
    B• urger HG, Hale GE, Robertson DM, Dennerstein L. A review of hormonal changes during the menopausal transition: focus on findings from the Melbourne Women’s Midlife Health Project. Hum Reprod Update. 2007 Nov–Dec;13(6):559–65.
    • Burger HG. Diagnostic role of follicle-stimulating hormone (FSH) measurements during the menopausal transition–an analysis of FSH, oestradiol and inhibin. Eur J Endocrinol. 1994 Jan;130(1):38-42.

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