From the Guidelines
For a 50-year-old woman with irregular menstrual cycles occurring every 10 days, I recommend a comprehensive laboratory workup to assess for perimenopausal changes and rule out other causes, starting with follicle-stimulating hormone (FSH) and estradiol to evaluate ovarian function, as elevated FSH (>25 mIU/mL) with low estradiol suggests perimenopause 1. To evaluate hormonal imbalances in this patient, the following laboratory tests are indicated:
- Follicle-stimulating hormone (FSH) and estradiol to evaluate ovarian function
- Thyroid-stimulating hormone (TSH) and free T4 to rule out thyroid dysfunction, which commonly affects menstrual patterns
- Complete blood count (CBC) to assess for anemia from frequent bleeding
- Prolactin levels to exclude pituitary adenomas
- Luteinizing hormone (LH) to evaluate the FSH:LH ratio
- Comprehensive metabolic panel to assess overall health status
- Hemoglobin A1C to screen for diabetes, which can affect menstrual regularity These tests will help determine if her symptoms are due to normal perimenopausal changes or other conditions requiring specific treatment, allowing for appropriate hormone therapy if indicated 1. It is also important to consider the PALM-COEIN classification system, which describes uterine bleeding abnormalities in women of reproductive age, including structural and nonstructural causes 1. Given the patient's age and symptoms, it is essential to rule out other potential causes of irregular menstrual cycles, such as polycystic ovary syndrome (PCOS), hypothalamic amenorrhoea, and hyperprolactinaemia, as suggested by the study on reproductive dysfunction in women with epilepsy 1. However, the most recent and relevant guideline for managing abnormal uterine bleeding associated with ovulatory dysfunction is from 2014 1, which prioritizes medical treatments, such as progestin-only contraception and combined hormonal contraception, and considers surgery as an option if medical treatment fails.
From the FDA Drug Label
PATIENT INFORMATION Progesterone Capsules, 100 mg and 200 mg Rx only What is progesterone capsules used for? Treatment of Menstrual Irregularities Progesterone capsules are used for the treatment of secondary amenorrhea (absence of menstrual periods in women who have previously had a menstrual period) due to a decrease in progesterone When you do not produce enough progesterone, menstrual irregularities can occur.
The FDA drug label does not answer the question.
From the Research
Laboratory Tests for Hormonal Imbalances
To assess for hormonal imbalances in a 50-year-old female with irregular menstrual cycles, the following laboratory tests may be indicated:
- Follicle-stimulating hormone (FSH) levels to evaluate ovarian function 2
- Estradiol (E2) levels to assess estrogen production 2
- Progesterone levels to evaluate luteal phase function 2
- Luteinizing hormone (LH) levels to assess ovulation 2
- Thyroid function tests (TSH, free T4) to rule out thyroid disorders that may be contributing to menstrual irregularities
- Prolactin levels to evaluate for hyperprolactinemia, which can cause menstrual irregularities
Rationale for Testing
The patient's irregular menstrual cycles, occurring every 10 days, may be indicative of hormonal imbalances, particularly changes in estrogen and progesterone levels 3. The menopausal transition is characterized by irregular menstrual cycles and unpredictable hormone levels, including dramatic swings in estradiol (E2) 2. Evaluating the patient's hormone levels can help determine the underlying cause of her menstrual irregularities and guide treatment.
Associated Conditions
Menstrual irregularities have been associated with various diseases and medical conditions, including metabolic syndrome, coronary heart disease, type 2 diabetes mellitus, and rheumatoid arthritis 3, 4. The patient's irregular menstrual cycles may be a marker for underlying cardiometabolic conditions, and further evaluation and screening may be necessary 4.