Evaluation of Amenorrhea


Question

I'm a French General Practitioner and working in private practice in France,and need to ask about evaluation of an amenorrheic patient.I have a 38 y old lady who has been lately anovulating and has been having only withdrawal bleeding after a 10 day progesterone treatment.

The question is:When is the proper timing to measure FSH,LH,E2 as well as inhibin B for this lady in order to have accurate readings?my concern is that if a day 3 -after withdrawal bleeding -measurement is done the values will be artificially lowered and i won't have reliable results and if measurements are to be measured later in the cycle,what will be the reference lab values that i should follow to assess her .Thank you very much for your help. louis Leclerc

Response

With any anovulatory woman, it really does not matter when a blood sample is obtained for basal hormone measurements. What tests are warranted? Simply stated, three: FSH, TSH, and prolactin. If you are concerned about the possibility of ovarian failure, you might wish to obtain a basal estradiol level – but this can wait until you see the results of the first three tests. If the FSH is greater than 10 mIU/mL, it probably bears repeating because it is abnormally elevate and may indicate that the patient is in the menopausal transition or developing premature ovarian failure. Any value greater than 30 mIU/mL is indicative of ovarian failure. There is generally no need to measure LH clinically. I also see no reason at this time to measure inhibin. Robert Rebar, MD