By Ann Marie McQueen
I don’t think anything illustrates how messed up the menopause “medical” space is right now more than the announcement this week that P&G’s Clearblue – the fertility and pregnancy test people – has released a Menopause Stage Indicator.
In one corner, you have the test:
• buy the kit (US$29.99 Amazon, Walgreens and Rite Aid) and download the free app
• do 5 urine tests every other day over 10 days to determine levels of follicle stimulating hormone (FSH), info that is combined with cycle history and age to unlock your menopause stage
• combine the above with six weeks of symptom tracking, and get a report to take to your healthcare provider
FSH FYI FROM CHAT GPT (which BTW calls FSH ‘one piece of the puzzle):
FSH is a hormone produced by the pituitary gland that plays a role in regulating the menstrual cycle and stimulating the ovaries to produce estrogen. During menopause, as the ovaries become less responsive to hormonal signals, FSH levels tend to rise. Elevated FSH levels can indicate a decline in ovarian function.
A few issues off the top:
- As you can see on the box, Clearblue puts you in four stages. But if you think about it for a minute, you know you are in postmenopause when you haven’t had a period in 12 months, and you know you are in premenopause too, because things haven’t gotten weird yet. They really, most of the time, do not need any testing.
- Building on the work of endocrinologist Professor Jerilynn Prior, Lara Briden helpfully outlines four stages within perimenopause in her book Hormone Repair Manual.
- The FSH-levels-indicating perimenopause issue is debatable. It’s generally accepted that they rise after menopause, but again, we don’t need a test for that.
- There are only 19 symptoms available to track on the Clearblue app, and we know there are dozens more than that – as many as 100+.
As for FSH, on one side you have the behemoth that is P&G and Clearblue Menopause Stage Indicator’s new spokeswoman, Dr Heather Hirsch. She tells FemTechInsider: “The menopause transition can lead to an array of different and frustrating symptoms that can make women feel confused, but having a diary log of symptoms, cycle history, and the results from the FSH tests will certainly help clinicians make a more accurate diagnosis and start the dialogue of safe and available treatment options if appropriate.”
Sounds fantastic: This is groundbreaking because it will help women be less confused and doctors to be more accurate.
Except that on the other side you have Dr Stephanie Faubion, medical director for The Menopause Society and director of the Mayo Clinic Center for Women’s Health – no affiliation with Clearblue – telling Time magazine a key piece of the argument is flawed.
“Lab levels of hormones like FSH are fluctuating all over the place by the day,” Dr Faubion told Time magazine. “I don’t understand what the benefit would be.”
Need a second opinion? Dr Samantha Dunham, co-director of the center for midlife health and menopause at NYU Langone Health (also not affiliated with Clearblue), also in Time: “The diagnosis of menopause and its stages are clinical diagnoses, and we treat by symptoms. So I’m unclear about the utility of the test.”
For more clarity, let’s turn to the Australasian Menopause Society:
- Perimenopause is usually diagnosed clinically on the basis of new onset vasomotor or other symptoms and a change in the pattern of menstrual bleeding. Menopause is diagnosed 12 months after the final menstrual period.
- The average age of menopause is 51. Early menopause is defined as menopause occurring between 40-45 years and premature ovarian insufficiency (POI) prior to age 40.
- Measuring estradiol or FSH is generally not indicated because of marked daily fluctuations.
- A symptom score sheet can be helpful in measuring the severity and impact of symptoms and assessing response to any intervention.
Tell this to all the doctors who continue to try and test for perimenopause. Take the super-healthy 48-year-old nurse I just met, who is experiencing terrible periods and a slight thickening around the middle; both driving her crazy. Her ob-gyn ‘tested her for perimenopause’, told her everything was normal and she wasn’t in it.
That’s crazy-making. But it happens all the time.
One thing that is for sure? We don’t have nearly enough options for this stage of life. According to Clearblue brand director Leah Wood, menopause has 10 times more searches than fertility, but only makes up 25 percent of the conversation size. They found that 2/3 of women feel unprepared and 45 percent believe they don’t have enough information.
We have to remember most doctors are also winging it when it comes to peri/menopause. (And even worse than someone winging it is someone winging it with certainty.)
So until the medical profession closes the “menopause gap” Dr Faubion herself has talked about – the one where no one is really equipped to treat us in this all-systems transition – we are kind of on our own.
After ruling out any other problems, I think the first question any woman in the age range who facing a bunch of strange symptoms needs to ask is this: ‘What about this am I resisting and how can I begin to wrap my head around it?’
Find out more about Ann Marie’s work at HotFlash Inc.