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Jane: What tests should I ask for?
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sabine48 posted:
Hi again, I will be seeing my gyn next week to check on a problem that has seemed to come about the last 3 months, a vaginal discharge that seems to occur while on my BCP which I'd thought was worse closer to my period but it seems to be occuring throughout my pill pack to some degree. I am 49 (a little while longer thank you!) The past year went on a stronger dose of BCPs due to some uncontrollable heavy bleeding that had to be stopped. The stronger does seems to have helped the problem, I got through a period of anemia during the bleeding and since changing the pill and taking medication for the anemia things seem to be okay except for this discharge! So, I'm going to see what I can find out. I am due a mammogram since 2009 was my last one, I am wondering what other kind(s) of tests I might request so far as blood work to see if I am somehwere into menopause and if my thyroid should be checked, etc.. I crave sweets, have a lot of tiredness, etc.. which I read it wouldn't be a bad idea to rule out. I'm not sure what to ask about with the blood tests, could you maybe advise? I just had my yearly in February, didn't have this discharge enough to notice then and my results were normal. Since I haven't had bloodwork for a couple of years but was advised to I think maybe it's time yet I'm not sure what all to ask for.

Thanks as ever for your time!
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Jane Harrison Hohner, RN, RNP responded:
Dear Sabine: The increased discharge might be related to the "stronger" birth control pill (BCP) you are currently taking. The estrogen component in a BCP is usually responsible for increased vaginal wetness. Thus if your current BCP has more estrogen than your former BCP, that might account for the increased discharge. As always, the discharge should be checked under the microscope to rule out any sign of infection.

There are a couple of schools of thought about how to assess for menopause in a BCP user. Some women will start to have noticeable hot flashes by the day 5-7 of the placebo pills as the estrogen effect from the BCP wears off. Some GYNs will draw an FSH blood level on placebo day 7 to see if the FSH is markedly elevated. Others will just leave the woman on the BCP until she is 50 or 51 then begin checking an FSH yearly.

There was one study, published in the journal Contraception, which found that it may take longer than 5-7 days to get an accurate FSH level in a 50 year old BCP user. I could not relocate that study so here is another, older citation from teh National Library of Medicine site:

Fertil Steril. 1996 Jul;66(1):101-4.
Laboratory criteria for menopause in women using oral contraceptives.
Creinin MD.
Source

University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, Pennsylvania 15213-3180, USA.

OBJECTIVE:

To evaluate laboratory criteria for menopause in women talking oral contraceptives (OC).
DESIGN:

Prospective, uncontrolled pilot study.
SETTING:

San Francisco General Hospital, San Francisco, California, and Magee-Womens Hospital, Pittsburgh, Pennsylvania.

Fourteen menopausal women received triphasic 35 micrograms ethinyl E2 and 180-215-250 micrograms norgestimate, and 14 menopausal women received monophasic 30 micrograms ethinyl E2-150 micrograms desogestrel.
MAIN OUTCOME MEASURES:

Serum FSH, LH, and E2 levels were evaluated on days 14 and 28 (day 7 of the pill-free interval) of the third cycle of pills.
RESULTS:

Twelve women in each group completed the study. Fifteen (62.5%) subjects still had a serum FSH < 30 mIU/mL (30 IU/L) on the 7th day of the pill-free interval of the third pill package. All subjects had a serum FSH:LH ratio > 1 and 20 of 21 (95%) subjects had E2 < 20 pg/mL (73 pmol/L) at the end of the pill-free interval of the third cycle.
CONCLUSIONS:

.... These findings suggest that the mid-cycle FSH:LH ratio and measuring FSH on the seventh day of the pill-free interval are not reliable indicators of menopause. Instead, a serum FSH:LH ratio of 1 or an estradiol level of 20 pg/ml on the seventh day of the pill-free interval may be a more reliable indicator of menopause in women using OCs in their later reproductive years.

Bottom line, you should see what your GYN uses as the criteria for diagnosing menopause in their older BCP patients.

Yours,
Jane
 
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sabine48 replied to Jane Harrison Hohner, RN, RNP's response:
Thank you so much for all the information you took the time to share. I will print it off to read and absorb more closely. Sounds like it isn't easy to assess menopause with complete accuracy in BCP users my age with any one test.

I haven't had any significant 'hot flashes' although I believe I have experienced them in the past 10 years perhaps 5-10 times that I could say I actually broke out in an all soaking sweat overnight, never during my inert pills that I've noticed. I have noticed I'm moody, easily depressed, crave carbs etc.. which have made me wonder if it's related.

I thank you for addressing my concerns, it is always a priveledge coming here and getting help when I've had questions important to enough to me to have been able to seek a better understanding or more clarity of.

Kind regards!


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