This woman’s presentation is consistent with menopause. Laboratory findings associated with menopause include decreased levels of estrogen, progesterone, and testosterone as well as increased FSH and LH levels.
An increased FSH level is the diagnostic marker of menopause. Common symptoms of menopause include hot flashes, night sweats, mood swings, headaches, and atrophic vaginitis (pruritis or dyspareunia). The average age of onset of menopause in the U.S. is 52 years. The primary treatment option is hormone replacement therapy, often with an estrogen and progesterone combination.
Morelli et al. discuss alternative therapies beyond hormone replacement therapy in the treatment of menopause symptoms. They focus specifically on hot flashes and state that exercise has a demonstrated association with a decrease in vasomotor symptoms. Research trials have suggested that both black cohosh and soy may reduce menopausal symptoms. Soy has also been shown to lower lipid levels and increase bone density.
Burger et al. review the hormonal changes associated with the transition to menopause. They conclude that FSH is a valid and well-established indirect marker of follicular activity. FSH concentration, especially in the early follicular phase, begins to increase several years before there are any apparent clinical symptoms of menopause. This rise in FSH is a result of falling amounts of inhibin B, which mirrors the reduction in the number of ovarian follicles.
Illustration A depicts the hormone levels seen with menopause (FMP = Final Menstrual Period).
Answer 1: Menopause is associated with a decrease in serum estrogen and an increase in serum LH levels.
Answer 2: Menopause is characterized by decreased levels of progesterone.
Answer 4: Both estrogen and progesterone levels decrease with the onset of menopause.
Answer 5: Testosterone levels decrease with menopause. Estrogen levels drop by a greater amount in comparison, leading to an increased androgen-to-estrogen ratio that manifests with androgen-associated symptoms such as facial hair, deeper voice, etc.
Morelli V, Naquin C. Alternative therapies for traditional disease states: menopause. Am Fam Physician. 2002 Jul 1;66(1):129-34.
PMID:12126027 (Link to Abstract)
Burger HG, Dudley EC, Robertson DM, Dennerstein L. Hormonal changes in the menopause transition. Recent Prog Horm Res. 2002;57:257-75.
PMID:12017547 (Link to Abstract)
USMLE World Step 1 QBank Question #215. Copyright © USMLEWorld, LLC 2012