Menopause: Hormone Replacement and Testing Guidelines

Menopause Confirmation and Hormone Replacement Therapy

In August 2021, menstrual flow decreased, and by December, menstruation had stopped (age 44).
There were sleep disturbances, and after an ultrasound examination, the doctor stated that there were no issues with the uterus and it was likely not menopause.
Medication "Makarong" (Tingqing tablets) was prescribed.
Continued use until August 2022, when switched to the oral contraceptive "Qilian," which is still being taken.
Now at age 46, there is an awareness of the need for hormone supplementation during menopause.
I would like to ask: (1) Should I have a blood test to confirm if I am in menopause? (2) If a blood test is necessary, how long should I stop the medication beforehand? (3) Is the current dosage of the oral contraceptive sufficient to replace hormone replacement therapy for menopause? Thank you.

kiki, 40~49 year old female. Ask Date: 2023/04/30

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
This is the most definitive diagnostic method.
2.
There is no need to discontinue medication.
3.
This is not the correct approach; the dosage of the contraceptive is too high.

Reply Date: 2023/04/30

More Info

Understanding menopause and hormone replacement therapy (HRT) is crucial for women navigating this significant life transition. Menopause typically occurs between the ages of 45 and 55, with the average age being around 51. It is characterized by the cessation of menstrual periods for 12 consecutive months, marking the end of a woman's reproductive years. However, the transition can begin years earlier, often referred to as perimenopause, where women may experience irregular periods, hot flashes, sleep disturbances, and other symptoms due to fluctuating hormone levels.

In your case, since you are 46 years old and have experienced a reduction in menstrual flow followed by a complete cessation, it is reasonable to consider that you may be entering menopause. However, it is essential to confirm this through appropriate testing and consultation with your healthcare provider.

1. Blood Testing for Menopause Confirmation: Yes, it is advisable to conduct blood tests to determine your hormone levels, specifically measuring follicle-stimulating hormone (FSH) and estradiol. Elevated FSH levels (typically above 30 mIU/mL) and low estradiol levels can indicate that you are in menopause. These tests can provide clarity on your hormonal status and help guide treatment options.

2. Timing of Blood Tests Relative to Medication: If you are currently taking hormonal medications, such as the oral contraceptive "祈麗安" (which contains ethinyl estradiol and levonorgestrel), it is generally recommended to stop these medications for at least 4-6 weeks before testing. This timeframe allows your body to return to its natural hormonal state, providing a more accurate assessment of your menopausal status.

3. Current Oral Contraceptive Use and HRT Needs: The oral contraceptive you are taking may help manage some menopausal symptoms, such as irregular periods and hot flashes, due to its estrogen content. However, it is not specifically designed for hormone replacement therapy in menopausal women. HRT typically involves a different formulation and dosage tailored to alleviate menopausal symptoms and protect against osteoporosis and cardiovascular disease. Therefore, while your current contraceptive may provide some benefits, it may not be sufficient as a long-term solution for managing menopause-related symptoms.

In conclusion, it is essential to have an open discussion with your healthcare provider regarding your symptoms, current medication, and the potential need for HRT. They can guide you through the testing process, interpret the results, and recommend an appropriate treatment plan based on your individual health needs. Remember, every woman's experience with menopause is unique, and personalized care is vital for managing this transition effectively.

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