The menopause: when it is all over or is it?

The menopause is defined rigorously as the cessation of menstruation as a result of ovarian follicular depletion. Although in common clinical usage, the term is used to encompass the menopausal transition, a period which may average 4 years in duration, and during which alterations in menstrual regularity and/or flow may be accompanied by somatic or psychological symptoms. Measurement of serum follicle-stimulating hormone (FSH) with or without oestradiol (E2) is frequently advocated as providing a useful indicator of menopausal status. Several studies have shown an increase in serum FSH, with or without decrease in E2, in women over the age of 40 years who continue to cycle regularly. Abrupt fluctuations in serum FSH and E2 may be observed, with typically post menopausal levels subsequently returning to the normal reproductive range. In a cross sectional study, of regularly cycling women randomly selected from the Melbourne community, and over the age of 45 years, 7% had FSH levels typical of the post menopause, and 39% had levels above those found during the follicular phase in women aged less than 35 years. It is concluded that serum FSH is of little diagnostic value in the assessment of menopausal status, which can currently be made only on clinical grounds. An elevated serum FSH level cannot tell us reliably 'when it is all over'.