What is the significance of a 50-year-old female's menstrual irregularity, with periods occurring every 2 weeks, in the context of her laboratory results: Luteinizing Hormone (LH) 2.9 milli-international units per milliliter (mIU/mL), Prolactin 8.33 nanograms per milliliter (ng/mL), Follicle Stimulating Hormone (FSH) 7.3 mIU/mL, and Estradiol 119 picograms per milliliter (pg/mL)?

From the Guidelines

The lab results for this 50-year-old female with irregular periods occurring sometimes every two weeks suggest perimenopause, and management options should focus on regulating cycles and alleviating symptoms. Her hormone levels (LH 2.9 mIU/mL, FSH 7.3 mIU/mL, estradiol 119 pcg/mL, and prolactin 8.33 ng/mL) are within normal ranges for a cycling woman, but the pattern of frequent periods indicates hormonal fluctuation typical of perimenopause 1. Some key points to consider in the management of this patient include:

• Hormonal therapy, such as low-dose combination oral contraceptives (e.g., 20-35 mcg ethinyl estradiol with progestin) or cyclic progestin therapy (e.g., medroxyprogesterone acetate 10 mg daily for 10-14 days each month), to regulate cycles 1.
• Non-hormonal options, such as NSAIDs like ibuprofen 600 mg every 6 hours during heavy bleeding, to alleviate symptoms.
• Lifestyle modifications, such as regular exercise and stress reduction, to help manage symptoms.
• Monitoring for anemia if bleeding is heavy, and considering further evaluation with endometrial biopsy if bleeding becomes very heavy or prolonged 1. It's essential to note that the patient should understand that these irregular cycles are expected during the transition to menopause, which typically occurs around age 51, and that management options should prioritize alleviating symptoms and regulating cycles 1.

From the FDA Drug Label

Breakthrough bleeding, spotting, and amenorrhea are frequent reasons for patients discontinuing oral contraceptives. In breakthrough bleeding, as in all cases of irregular bleeding from the vagina, non-functional causes should be borne in mind In undiagnosed persistent or recurrent abnormal bleeding from the vagina, adequate diagnostic measures are indicated to rule out pregnancy or malignancy. The patient's lab results show:

• Luteinizing Hormone (LH): 2.9 mIU/mL
• Prolactin: 8.33 ng/mL
• Follicle Stimulating Hormone (FSH): 7.3 mIU/mL
• Estradiol: 119 pcg/mL Given the patient's complaint of periods sometimes every 2 weeks, the lab results do not directly indicate a cause for the irregular bleeding. Key points to consider:
• The patient is still having periods, which suggests that she is not menopausal
• The FSH level is 7.3 mIU/mL, which is within the normal range for a premenopausal woman
• The Estradiol level is 119 pcg/mL, which is within the normal range for a premenopausal woman
• The patient's symptoms of irregular bleeding should be investigated further to rule out pregnancy or malignancy 2

From the Research

Hormone Levels

• The patient's hormone levels are as follows:
  • Luteinizing Hormone (LH): 2.9 mIU/mL
  • Prolactin: 8.33 ng/mL
  • Follicle Stimulating Hormone (FSH): 7.3 mIU/mL
  • Estradiol: 119 pcg/mL
• These levels can be compared to those found in studies on oral contraceptive users, such as the one by 3, which showed that basal LH, FSH, and estradiol levels were significantly suppressed in women taking oral contraceptives.

Menstrual Cycle

• The patient is experiencing irregular periods, with menstruation sometimes occurring every 2 weeks.
• This irregularity could be related to the hormonal changes caused by oral contraceptives, as seen in the study by 4, which found that hormone levels followed a cyclic pattern during the 21/7-day oral contraceptive regimen, but decreased during the extended regimen.

Ovulation Inhibition

• The studies by 5, 3, and 6 show that oral contraceptives can inhibit ovulation by suppressing LH and FSH levels, and thus preventing the release of an egg from the ovary.
• The patient's LH level of 2.9 mIU/mL is lower than what is typically seen in ovulating women, suggesting that ovulation may be inhibited, as found in the study by 7, which examined the ovulation-inhibiting effect of various orally administered estrogen-progestin combinations.

Prolactin Levels

• The patient's prolactin level is 8.33 ng/mL, which is within the normal range.
• The study by 3 found that prolactin concentrations were unchanged in women taking oral contraceptives, while the study by 6 found that prolactin levels were unchanged in women receiving new oral contraceptives containing ethinyl estradiol plus levonorgestrel or desogestrel.