FSH Testing for Women Aged Over 45 years with Perimenopausal Symptoms in a General Practice Setting

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Sarah L Adams, Gaunt E, Shepherd G, Wilding R and Armour C

University of Cambridge, UK
Chesterfield Drive General Practice Surgery, Ipswich

: Androl Gynecol: Curr Res

Abstract

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Background: Many women present to primary care when experiencing perimenopausal symptoms seeking symptom relief and confirmation of reproductive status. NICE guideline NG23 states that perimenopause in healthy women over 45 should be a clinical diagnosis. Follicle-Stimulating Hormone (FSH) testing is not recommended due to large and rapid fluctuations in this age group. Despite this, it is estimated that 640,000 tests are thought to be ordered inappropriately in England each year. At £15 each, guidance adherence could save the NHS £9.6 million a year. Objective: We set out to determine the number of FSH tests carried out in women over 45 who presented with perimenopausal symptoms to a primary care Centre in England. Method: A closed-loop audit was performed. Data was collected from computerized records over a 6-month preintervention, and a 4-month post-intervention period. FSH tests ordered for indications other than perimenopausal symptoms were excluded. The intervention included presentation of NICE guidelines and supporting evidence to all medical staff at the primary care Centre. Results: See table 1. Accounting for cycle length, there was no significant difference in the number of FSH tests ordered postintervention. However, documentation of symptoms and an increase in ‘adamant patient request’ was noted. Conclusions: Despite FSH testing being an unreliable indicator of reproductive status in women over 45, it is ordered frequently in primary care. Many of the women were unsatisfied with clinical diagnosis. It is likely that the intervention was not effective as it required clinicians to spend more time counselling patients about the inappropriate nature of testing and menopause. This is challenging given the time-restricted context and impact of symptoms on quality of life. Authors suggest undertaking a further cycle to assess the impact of patient intervention leaflets on the diagnosis of menopause.

Biography

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Sarah L Adams is currently studying in her penultimate year of Medicine at the University of Cambridge. She intercalated in Genetics during her 3rd year, graduating with a 1st Class in 2016. She aspires to be an Academic Obstetrician Gynecologist and has a interest in global women’s health and the genetics of fetal development. In her spare time, she enjoys learning to fly with Cambridge University Air Squadron.

E-mail: e: sa708@cam.ac.uk