by Tony Scialli, MD and Adriane Fugh-Berman, MD
'Measure, Track and Plan Your Mid-Life Transition' says the advertising on the feminine pink and white box. If only it were so easy! The newly marketed Menopause Home Test by Physicians Laboratories claims to provide a means for midlife women to monitor their hormonal status in much the same way as a home pregnancy kit: with a urine sample and a plastic indicator.
If the pretty packaging doesn't lure you in, as the company hopes it will, the box also comes complete with dire warnings for the sceptical consumer: 'Undiagnosed menopause can devastate your health, family, and social/sex life'.
Their website http://www.MenopauseHomeTest.com further trumpets the alarm: 'It's your health -- it is an 'emergency!' And in a parody of self-empowerment, the manufacturers claim that their test will provide women 'control and power' over their midlife transition.
Consumers are advised to use the test every six months from age 35 at an incredibly hefty $59.95 US per pack (each pack holds 2 tests). Considering the average woman does not reach menopause until her early-fifties, the company is banking that the baby boom generation is very naïve indeed, with each woman willing to dish out around $1200 to affirm her menopausal status.
That's assuming that FSH tests make a contribution to the health of mid-life women. They don't.
The traditional blood test to diagnose menopause is a measurement of FSH (follicle stimulating hormone) in the blood. FSH is a hormone that is consistently elevated many years after a woman's last menstrual period.
However, during the years before the last menstrual period and during the early years after the last menstrual period, FSH levels regularly bounce up and down. An elevation of FSH may mean that a woman will never have another menstrual period, and therefore is menopausal, but it may also mean that this hormone is in its normal bouncing-around phase, perhaps years before a woman's periods will have finished.
Like the blood test, the new urine test sold in the Menopause Home Test measures FSH. And like the blood test, the urine FSH test would not be expected to diagnose menopause with certainty until many years after a woman has had her last menstrual period - in other words, when a diagnosis of menopause would not require any testing at all.
FSH tests, however, may be useful for women who are having trouble becoming pregnant. An FSH result on day 3 of a spontaneous menstrual cycle can predict whether a woman's eggs have aged beyond the likeliness of successful pregnancy and birth. FSH levels should be at their lowest in the early part of a woman's cycle. Women with elevated FSH values on day 3 are unlikely to become pregnant (or, if they do become pregnant, they are unlikely to carry the pregnancy very long). An elevated FSH reading can be disappointing, but it can also save a woman from spending large sums of money on assisted reproductive technologies that will not likely be successful. However, this urine kit is not designed to pick up the subtle increase in day 3 FSH that will help with fertility prediction, so don't waste your money on it.
The woman who is having an increase in the variability of her menstrual cycles in her 40s or early 50s is almost certainly a normal healthy woman with age-appropriate changes in ovarian function. The presence of other symptoms, such as hot flashes, breast tenderness, or mood changes, may be due to these natural hormone fluctuations or may be fortuitous, due to aging or to life circumstances. No FSH test, either blood or urine, will add information of any use to the health or well-being of women in this age group.
The implication by the makers of Menopause Home Test that the elevation of FSH in a woman's body represents a disease requiring immediate medical attention and therapy is misleading and insulting. The makers of the Menopause Home Test are preying on our society's fear of aging and hoping to turn a quick profit from the medicalization of menopause, a natural and perfectly normal transition for the midlife woman.
Tony Scialli, MD, is Professor, Department of Obstetrics and Gynecology, Georgetown University Hospital, and Director of the Reproductive Toxicology Center in Bethesda, Maryland.
Adriane Fugh-Berman, MD, is Assistant Clinical Professor, Department of Health Care Sciences, George Washington University School of Medicine, co-author of The Truth About Hormone Replacement Therapy (Prima 2002), and a board member of the National Women's Health Network (202.347.1140), a U.S. membership-supported advocacy group that takes no money from pharmaceutical companies or medical device manufacturers.
This article first appeared in A Friend Indeed (May/Jun 2002), the newsletter for women in menopause and midlife.
