The pituitary gland is very sensitive to the hormonal output of the ovaries, and it begins to react when the ovaries fail to pump oestrogen and progesterone into the bloodstream. Indeed, the pituitary gland is not at all ‘happy’ with the failure of the menopausal woman’s ovaries. The pituitary gland quickly responds by pumping out large amounts of a hormonal messenger called Follicle Stimulating Hormone (FSH).
FSH travels from the pituitary gland, via the bloodstream, to the failing ovaries to try to stimulate them back into action.
Alas, this does not work; the ovaries have ‘closed up shop’ forever, and despite the hormonal pleas and wooing from the pituitary gland the ovaries remain inactive. Meanwhile, the pituitary gland cannot comprehend that the ovaries are unable to respond to its advances, and in a futile attempt to reawaken them it continues to pump ever-increasing amounts of FSH into the bloodstream. This achieves nothing as far as the ovaries are concerned, but it does provide a useful diagnostic test for your doctor to determine if you are menopausal. Typically the blood FSH levels are quite high if you are menopausal, and will be greater than 30 U/L, and may reach up to 300 U/L. In other words, you will have continually elevated levels of FSH, and this is the most accurate test for the menopause. Obviously all women who are wondering if they are menopausal will want to know what their FSH level is, because if they are truly menopausal they no longer have to worry about contraception. They will also know if it is the failure of their ovaries that could be responsible for any unpleasant symptoms that they may be suffering with.
If you are on the oral contraceptive pill, you will need to stop taking it for several months before having a blood test; otherwise your blood tests for the menopause will be inaccurate. The oral contraceptive pill makes the results of blood tests for hormone levels totally meaningless. Women on the Pill will always show very low levels of both FSH and their own naturally-produced hormones, because the Pill suppresses the production of hormones from the pituitary gland and the ovaries. I am often amazed that women are sent for testing of their hormonal levels while they are still taking the Pill!
Symptoms of the Menopause
Some women will not experience any menopausal symptoms and may get a shock to discover that their blood tests show menopausal levels of hormones!
Other women may experience unpleasant symptoms, ranging from mild to severe, such as:
Hot flushes
Aches and pains – sometimes called fibromyalgia
Vaginal dryness and discomfort
Vaginal shrinkage
Painful sexual intercourse
Bladder problems such as urgency and incontinence
Loss of sex drive
Shrinkage of the breasts
Mood changes, which may be severe enough to result in a clinical depression
Low self esteem
Anxiety and panic attacks
Memory problems
Poor concentration
Dry and ageing skin
Hair loss
Sleep disorders
These symptoms may come on gradually during the perimenopausal years, or may come on quite suddenly. Understandably they can be very distressing, especially if you do not understand what is causing them.
To assess your level of oestrogen and progesterone deficiency, blood tests and/or salivary tests are very accurate.
You can also take a minute to fill in the questionnaire below, which is known as ‘Your Oestrogen Level Score Chart’.
If your total score for all of these symptoms is 15 or more, then it is likely that you are suffering from a deficiency of oestrogen.
If your score is 30, your body is probably crying out for oestrogen. This can be confirmed or refuted by a simple blood test to check your levels of oestrogen and follicle-stimulating hormone (FSH).
It is an interesting exercise to score your symptoms of oestrogen deficiency before and after starting HRT. Computing your score every three to four months provides a useful self-check to see whether your hormone replacement therapy is adequate. However, you should not decide to alter your dosage based on the results of this questionnaire without first consulting your doctor.
OESTROGEN LEVEL SCORE CHART
| Symptom | Your Score | |
| Depression and/or mood changes | _________ | |
| Anxiety and/or irritability | _________ | |
| Feelings of being unloved or unwanted | _________ | |
| Poor memory or concentration | _________ | |
| Poor sleeping patterns | _________ | |
| Fatigue | _________ | |
| Backache | _________ | |
| Joint pains, arthritis | _________ | |
| Muscle pains | _________ | |
| Increase in facial hair | _________ | |
| Dry skin and/or sudden development of wrinkles | _________ | |
| Crawling, itching and/or burning sensations in the skin | _________ | |
| Reduction in the sexual desire | _________ | |
| Frequency of or burning sensation with urination | _________ | |
| Discomfort during sexual intercourse | _________ | |
| Vaginal dryness | _________ | |
| Hot flushes and/or excessive sweating | _________ | |
| Lightheadedness or dizziness | _________ | |
| Headaches | _________ | |
| TOTAL SCORE | _________ |
The symptoms that are characteristic