Intérêt des dosages hormonaux de FSH et LH chez les femmes à partir de 45 ans - Dosages hormonaux GB abstract

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Description

Posted on Jan 01 2005 A summary statement in English will be available in due course. Posted on Jan 01 2005

Sujets

• Biologie
• Ménopause
• Andropause
• Médecine

Informations

• Publié par: haute-autorite-sante-techniques-et-procedures-de-diagnostic
• Publié le: 01 janvier 2005
• Nombre de lectures: 53
• Licence : En savoir +
  Paternité, pas d'utilisation commerciale, partage des conditions initiales à l'identique
• Langue: Français

Extrait

Value of measuring FSH and LH levels in women aged 45 or over    Haute Autorité de Santé (French National Authority for Health), Saint-Denis La Plaine, France Author: Nathalie Poutignat, M.D     Aim   CNAMTS (the French National Health insurance fund for salaried workers) asked ANAES to assess whether measuring gonadotrophin levels (FSH and LH) in women aged 45 or over has any value in the diagnosis and management of the menopause or perimenopause. The aim was to prepare a Target Agreement on Best Practice (ACBUS). Three areas were identified for study: (i) changes in hormone levels at these times, (ii) the diagnostic power of the biochemical and clinical markers used to make the diagnosis of menopause or perimenopause, and (iii) existing guidelines on the subject.     Results of critical review   (i)Changes in hormone levels.women over 35, FSH levels rise gradually at the  In beginning of the follicular phase. This rise becomes more marked after the age of 45 and at onset of signs of perimenopause (changes in menstrual cycles, irregular cycles, menopausal symptoms). The rise continues until after the menopause. LH levels also rise at the menopause but to a much lesser extent than FSH levels. Longitudinal follow- up of women from premenopause to perimenopause and menopause has shown that hormone levels fluctuate considerably in the same individual, with high values alternating with normal values, thus indicating that hormone tests are not a reliable way of diagnosing perimenopause or menopause. As periods of ovulatory and anovulatory cycles alternate, effective contraception should be used up to the menopause. (ii)Diagnostic power. and LH assays have no greater diagnostic power than FSH menopausal symptoms. Studies have failed to identify any clinical or biological markers of menopausal status. In addition, different standards used in FSH assay methods makes it impossible to establish a precise threshold. (iii)Current guidelines. Association of Clinical American guidelines except one (the All Endocrinologists) state that FSH and LH assays are not reliable for tackling issues such as assessing ovarian function, diagnosing perimenopause or menopause, or deciding that contraception may be stopped or hormone replacement therapy started.     Conclusions    In the light of this critical review and expert opinion, it was concluded that in women over 45: ·an LH testis NOT recommended as it is of no benefit; ·an FSH testshould NOT be ordered: - to diagnose perimenopause or menopause. The key factors are age and clinical   signs (irregular cycles, am enorrhoea with hot flushes, vaginal dryness, night sweats). A progestogen test is indicated. FSH tests should be reserved for clinical situations such as: -hysterectomy (combined with an oestradiol test) -to look for gonadotrophin deficiency in a patient with amenorrhoea but without menopausal problems -during follow-up of GnRH-analogue therapy; to decide whether to prescribe hormone replacement therapy;