Study of Elevated Levels of FSH Rarely cause Specific Symptoms Menopause, Diagnosis and Management

Abstract

Emphasis is made on the importance of explaining to women about the stages and many on sequences of the menopause, which extends beyond flushes and sweats and includes psychological symptoms, musculo-skeletal, vaginal, bladder and sexual effects, as well as long term effects on bone and cardiovascular health. Note is also made of the need for contraception during the perimenopause and the importance of providing appropriate information for women who are about to undergo treatment which may lead to menopause. Much work is needed to provide this information in many formats such as websites, leaflets, magazines, as well as traditional face to face consultations. According to this article, to provide advice for healthcare professionals and women regarding the menopause and the way symptom relief can be achieved.

Introduction

I. INTRODUCTION

All women are different and respond differently both to estrogen deficiency and in their response to treatments. Decisions have to be made on an individual basis, taking into account symptoms, past history, family history, diet and lifestyle and individual preferences and concerns. Blood tests are rarely required to diagnose perimenopause or menopause in women aged over 45 and should not be taken. While measurement of FSH has often been used in the past to diagnose perimenopause or menopause, the level fluctuates significantly and bears no correlation with severity or duration of symptoms or to requirement for treatment. Reducing inappropriate use of testing FSH levels will produce savings in terms of cost of test, time for further consultation to discuss the results and will reduce delay in commencing agreed management.

Blood tests are rarely required to diagnose perimenopause or menopause in women aged over 45 and should not be taken. While measurement of FSH has often been used in the past to diagnose perimenopause or menopause, the level fluctuates significantly and bears no correlation with severity or duration of symptoms or to requirement for treatment. Reducing inappropriate use of testing FSH levels will produce savings in terms of cost of test, time for further consultation to discuss the results and will reduce delay in commencing agreed management.

Follicle-stimulating hormone (FSH) is a hormone produced by the anterior pituitary in response to gonadotropin-releasing hormone (GnRH) from the hypothalamus. FSH plays a role in sexual development and reproduction in both males and females.

Normal FSH level?

Before puberty: 0 to 4.0 mIU/mL (0 to 4.0 IU/L) During puberty: 0.3 to 10.0 mIU/mL (0.3 to 10.0 IU/L) Women who are still menstruating: 4.7 to 21.5 mIU/mL (4.5 to 21.5 IU/L) After menopause: 25.8 to 134.8 mIU/mL (25.8 to 134.8 IU/L) Symptoms of high FSH levels:

Symptoms can include: Irregular periods or no periods. Hot flashes and/or night sweats. Skin and hair changes.

II. PROVISION OF INFORMATION

Diet and lifestyle advice should be considered, particularly smoking cessation, weight loss, alcohol reduction and increasing exercise to help general health and well-being and all treatment types should be discussed.

For vasomotor symptoms such as flushes and sweats, HRT should be offered after full consideration of benefits and risk, since it was shown to be the most effective treatment with minimal risks. The type will be determined by whether or not the woman has had a hysterectomy, whether perimenopausal or postmenopausal, past medical and family history, other medication and individual preferences. Clonidine or antidepressants should not routinely

be offered. Of the non-hormonal therapies, isoflavones or black cohosh have been shown to be helpful but consideration should be given to the fact that not all preparations contain the same amount or quality of product. For low mood due to menopause, HRT should be considered rather

than antidepressants, and Cognitive Behavioural Therapy can be helpful. For low sexual desire, testosterone can be considered if HRT alone is not sufficient.

A. Symptoms After Breast Cancer

Women who have had breast cancer or who are thought to be at high risk of breast cancer and who have menopausal symptoms should be offered a discussion about all treatment options. Of the non-hormonal options, St John’s Wort may be used but it should be noted that it may interact with other medications. The antidepressants Fluoxetine and Paroxitene, which have been

often used in the past for vasomotor symptoms, should not be

• Bleeding or bruising easily.
• Frequent infections.
• Fatigue.
• Fever.
• Night sweats.
• Unexplained weight loss.
• Bone pain (in myeloma)
• Painless swelling of lymph nodes (in lymphoma)

B. Breast Cancer

Breast cancer is when breast cells mutate and become cancerous cells that multiply and form tumors. Breast cancer typically affects women and people assigned female at birth (AFAB) age 50 and older, but it can also affect men and people assigned male at birth (AMAB), as well as younger women. Healthcare providers may treat breast cancer with surgery to remove tumors or treatment to kill cancerous cells.

C. Overview

Breast cancer tumors develop when breast cells mutate and grow.

1) What is breast cancer?

Breast cancer is one of the most common cancers that affects women and people assigned female at birth (AFAB). It happens when cancerous cells in your breasts multiply and become tumors. About 80% of breast cancer cases are invasive, meaning a tumor may spread from your breast to other areas of your body.

Breast cancer typically affects women age 50 and older, but it can also affect women and people AFAB who are younger than 50. Men and people assigned male at birth (AMAB) may also develop breast cancer. 

2) Breast cancer types

Healthcare providers determine cancer types and subtypes so they can tailor treatment to be as effective as possible with the fewest possible side effects. Common types of breast cancer include:

• Invasive (infiltrating) ductal carcinoma (IDC): This cancer starts in your milk ducts and spreads to nearby breast tissue. It’s the most common type of breast cancer in the United States.
• Lobular breast cancer: This breast cancer starts in the milk-producing glands (lobules) in your breast and often spreads to nearby breast tissue. It’s the second most common breast cancer in the United States.
• Ductal carcinoma in situ (DCIS): Like IDC, this breast cancer starts in your milk ducts. The difference is DCIS doesn’t spread beyond your milk ducts.
• Less common breast cancer types include:
• Triple-negative breast cancer (TNBC): This invasive cancer is aggressive and spreads more quickly than other breast cancers. 
• Inflammatory breast cancer (IBC): This rare, fast-growing cancer looks like a rash on your breast. IBC is rare in the United States.
• Paget’s disease of the breast: This rare cancer affects the skin of your nipple and may look like a rash. Less than 4% of all breast cancers are Paget’s disease of the breast.

3) Breast cancer subtypes

Healthcare providers classify breast cancer subtypes by receptor cell status. Receptors are protein molecules in or on cells’ surfaces. They can attract or attach to certain substances in your blood, including hormones like estrogen and progesterone. Estrogen and progesterone help cancerous cells to grow. Finding out if cancerous cells have estrogen or progesterone receptors helps healthcare providers plan breast cancer treatment.

Subtypes include:

• ER-positive (ER+) breast cancers have estrogen receptors.
• PR-positive (PR+) breast cancers have progesterone receptors.
• HR-positive (HR+) breast cancers have estrogen and progesterone receptors.
• HR-negative (HR-) breast cancers don’t have estrogen or progesterone receptors.
• HER2-positive (HER2+) breast cancers, which have higher than normal levels of the HER2 protein. This protein helps cancer cells to grow. About 15% to 20% of all breast cancers are HER2-positive.

D. Symptoms and Causes

Common signs of breast cancer and what to look for.

1) What are breast cancer symptoms?

The condition can affect your breasts in different ways. Some breast cancer symptoms are very distinctive. Others may simply seem like areas of your breast that look very different from any other area. Breast cancer may not cause noticeable symptoms either. But when it does, symptoms may include:

• A change in the size, shape or contour of your breast.
• A mass or lump, which may feel as small as a pea.
• A lump or thickening in or near your breast or in your underarm that persists through your menstrual cycle.
• A change in the look or feel of your skin on your breast or nipple. Your skin may look dimpled, puckered, scaly or inflamed. It may look red, purple or darker than other parts of your breast. 
• A marble-like hardened area under your skin.
• A blood-stained or clear fluid discharge from your nipple.

2) What causes breast cancer?

Experts know breast cancer happens when breast cells mutate and become cancerous cells that divide and multiply to create tumors. They aren’t sure what triggers that change. However, research shows there are several risk factors that may increase your chances of developing breast cancer. These include:

• Age: Being 55 or older.
• Sex: Women and people AFAB are much more likely to develop the condition than men and people AMAB.
• Family history: If your parents, siblings, children or other close relatives have breast cancer, you’re at risk of developing the disease.
• Genetics: Up to 15% of people with breast cancer develop the disease because they have inherited genetic mutations. The most common genetic mutations involve the BRCA1 and BRCA2 genes. 
• Smoking: Tobacco use has been linked to many different types of cancer, including breast cancer.
• Drinking beverages containing alcohol: Research shows that drinking beverages containing alcohol may increase breast cancer risk.
• Having obesity.
• Radiation exposure: If you’ve had prior radiation therapy — especially to your head, neck or chest — you’re more likely to develop breast cancer.
• Hormone replacement therapy: People who use hormone replacement therapy (HRT) have a higher risk of being diagnosed with the condition

E. Early stages of cervical cancer

Early stages of cervical cancer don’t usually involve symptoms and are hard to detect. The first signs of cervical cancer may take time to develop.

Signs and symptoms of Stage I cervical cancer can include:

• Watery or bloody vaginal discharge that may be heavy and can have a foul odor.
• Vaginal bleeding after sex, between menstrual periods or after menopause.
• Pain during sex (dyspareunia).
• If cancer has spread to nearby tissues or organs, symptoms may include:
• Difficult or painful urination, sometimes with blood in urine.
• Diarrhea, or pain or bleeding from your rectum when pooping.
• Fatigue, loss of weight and appetite.
• A general feeling of illness.
• Dull backache or swelling in your legs.
• Pelvic/abdominal pain.

If you experience abnormal bleeding, unusual vaginal discharge or any other unexplainable symptoms, you should contact a healthcare provider.

1) What causes cervical cancer?

Most cervical cancers are caused by HPV, a sexually transmitted infection. HPV spreads through sexual contact (anal, oral or vaginal) and can lead to cancer. Most people will get HPV at some point in their lives and not realize it because their bodies fight the infection. But if your body doesn’t fight the infection, it can cause the cells of your cervix to change to cancerous cells.

2) Symptoms of high levels

Elevated levels of FSH rarely cause specific symptoms.

In females, elevated levels may be a sign of menopause, which can cause symptoms including:

• Hot flashes
• Weight gain
• Vaginal dryness
• Irregular menstruation
• Sleep disturbances
• Emotional changes
• Bone losstrusted source

A rare pituitary condition called ovarian hyperstimulation syndrome (OHSS) can cause high FSH levels in females. Most cases of OHSS are the result of fertility treatments. Doctors will regularly monitor people undergoing these treatments for any signs of OHSS.

Symptoms include enlarged ovaries and the accumulation of fluid in the abdomen, leading to pelvic pain.

3) Symptoms of low levels

In children, low levels of FSH may be a sign of delayed puberty. Symptoms of low FSH levels include:

• limited sperm production
• infertility
• delays in sexual development

Conclusion

According report will focus on the evaluation and management of secondary amenorrhea. We will also review the advantages of employing a digital strategy to improve access to menstrual cycle education, integrated care, clinical research, translational research and as a means to gain deeper insights into the relevant basic science. First, however, we describe the normal menstrual cycle and its value as a vital sign of general health. The normal menstrual cycle The first day of menstruation is defined as Day 1 of the menstrual cycle. The interval between successive menstruations, and therefore the cycle length, typically ranges from 21-35 days. 1). During the first half of the menstrual cycle, termed the follicular phase, the major steroid secreted by the ovary is estradiol and this hormone results in growth and thickening of the inner layer of the uterus known as the endometrium. During the second half of the cycle, the luteal phase, progesterone is also secreted by the ovary and together with estradiol prepares the uterus for the implantation of a blastocyst (multi cell ball-like structure derived from a fertilized egg should it enter the uterus. Preparation of the uterus for pregnancy involves a thickening of the endometrium with a marked increase in its blood supply. If pregnancy does not occur, the luteal phase terminates after approximately weeks, progesterone and estradiol secretion fall to low levels and stimulation of the uterus by these steroid hormones is withdrawn resulting in a breakdown of the endometrium. The resulting transient uterine bleeding, together with cellular debris shed from degenerating endometrial tissue, comprises the menstrual flow.

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Copyright

Copyright © 2024 Dr. Chilakalapudi Meher Babu. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.