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- Wed Aug 31, 2005 3:05 pm
To the doctors
i am 24years old and i last did my FSH and LH test and they turned out to be FSH 18 and LH 25 . these were not the Day 3 tests but i suppose day 14 or 15 tests. I was on HRT a month before these tests were taken because of my irregular periods. but now im not taking any HRT anymore. my doctor sees these tests as normal ??? im not sure need some second opinion ??? Please help. :?: :?:
| Dr. Shank
- Mon Sep 05, 2005 10:42 pm
Technically, your physician is correct, BUT . . . .
These LH & FSH levels are normal, IF they represent the midcycle surge that should result in ovulation (release of an egg). However, the facts that you have had irregular menstrual cycles and have just discontinued HRT make me suspect that they are actually elevated due to relatively low estrogen levels. Unless he obtained estrogen and progesterone levels at the same time, it is impossible to know. The fact that he measured LH and FSH right after stopping the HRT tells me that your physician was probably not an endocrinologist (a hormone specialist).
Have you had thyroid function testing performed? This should be automatic for menstrual abnormalitiies, but it is often overlooked. Make sure that you hve a free T4 and a TSH level. Despite whatever the pathologists' reference range may be on the lab, a TSH greater than 2 is definitely abnormal and is usually due to hypothyroidism.
Another very common cause of irregular menstrual periods at your age is PCOS. Much to-do has been made of "cysts" on the ovaries, which are usually nothing more than the "follicles" that produce eggs (although there are exceptions to this rule). In extreme cases of PCOS, numerous follicles form but do never rupture to release an egg, because of secondary abnormalities that develop in the hormonal control of ovulation. Surgeons noted these abnormal follicles, biopsied them (because that is what surgeons do), and accidentally treated the abnormal production of androgens by reducing the amount of ovarian tissue that was producing them. To this day, many people mistakenly believe that "cysts" (follicles) on the ovaries are the cause, rather than the result. We now know better, but, until we can agree upon a better name, the condition is officially known as "PCOS" (which no longer stands for "polycytic ovarian syndrome" or anything else). PCOS results from elevated "male-type" hormones (androgens), almost always as a result of insulin resistance with compenstory elevations in insulin levels (to keep the blood sugar normal) that stimulate the ovaries to produce "male-type" hormones (Very rarely, it can be due to elevated levels of insulin-like growth factor 1, as a result of acromegaly.). Since all naturally occuring "male-type" hormones are converted to "female type" hormones (estrogens), it is unlikely that PCOS or the other causes of excess "male-type" hormone production would account for the potentially elevated LH and FSH by themselves. However, temporarily reducing "male-type" hormone levels by suppressing the ovaries with HRT and then stopping it could produce exactly this picture, until the ovaries recovered (most likely after a few months).
Prolactin levels should always be checked, but they rarely are. Abnormal menstrual cycles may be the only evidence for a large tumor on the pituitary gland, and it is possible that the LH and FSH levels were artificially elevated by the prior months' HRT.
Premature menopause is an uncommon of abnormal menstrual cycles and elevated LH and FSH at your age, except in the presence of other diseases in which the body attacks itself ("autoimmune" diseases, such as type 1 diabetes, most thyroid diseases, many rheumatologic disorders, Chron's disease, ulcerative colitis, and a variety of others). I have found that ob-gyn's usually dismiss this possibility out of hand. Your physician should at least think about it, even if he concludes that a diagnostic evaluation is not warranted.
As a minimum, your physician should check free T4, TSH, prolactin, testosterone (preferably free testosterone), baseline 17-OH-progesterone (and if in the upper limits of the normal range or higher, after a cosyntropin stimulation test), DHEA-S, and either DHEA, androstenedione, or both (Even though thse terms are probably unfamiliar to you, he will know what they mean.). In addition, he should measure a fasting blood glucose and insulin level, which will allow him estimate your body's resistance to insulin using a well-known formula known as "HOMA." In selected cases, an IGF-1 level (to screen for acromegaly, caused by too much somatotropin or "growth hormone," which is a rare cause of PCOS), adrenal gland imaging (to evaluate for adrenal masses or provide clues about congenital adrenal hyperplasia), or ovarian imaging (to exclude an ovarian mass--NOT to look for "cysts") should be performed.
I suggest that you see an endocrinologist for a second opinion.