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Limitations of follicle-stimulating hormone in assessing menopause status: findings from the National Health and Nutrition Examination Survey (NHANES 1999-2000)*

Henrich, Janet B. MD; Hughes, Jeffery P. MPH; Kaufman, Steven C. MD, MS; Brody, Debra J. MPH; Curtin, Lester R. PhD

doi: 10.1097/01.gme.0000198489.49618.96
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Objective: We used data from the National Health and Nutrition Examination Survey (NHANES 1999-2000) to: establish new population-based estimates for follicle-stimulating hormone (FSH) and luteinizing hormone (LH); identify factors associated with FSH; and assess its efficacy in distinguishing among women in the reproductive, menopause transition, and postmenopausal stages.

Design: Nationally representative sample of 576 women aged 35 to 60 years examined during NHANES 1999-2000.

Results Levels of FSH and LH increased significantly with reproductive stage. (Geometric mean FSH levels for successive stages: reproductive, 7.0 mIU/mL, SE 0.4; menopause transition, 21.9 mIU/mL, SE 3.7; and postmenopause, 45.7 mIU/mL, SE 4.3). There was considerable overlap, however, among distributions of FSH by stage. Only age and reproductive stage were significantly associated with FSH in multivariable analysis. FSH cutoff points between the reproductive and menopause transition stages [FSH = 13 mIU/mL, sensitivity 67.4% (95% CI 50.0-81.1), specificity 88.1% (95% CI 81.1-92.8)] and between the menopause transition and postmenopause stages [FSH = 45 mIU/mL, sensitivity 73.6% (95% CI 60.1-83.7), specificity 70.6% (95% CI 52.4-84.0)] were neither sensitive nor very specific.

Conclusions Age and reproductive stage are the most important determinants of FSH levels in US women; however, FSH by itself has limited utility in distinguishing among women in different reproductive stages.

In this nationally representative sample of US women, only age and reproductive stage were significantly associated with follicle-stimulating hormone (FSH) levels. Geometric mean FSH levels for successive stages were: reproductive, 7.0 mIU/mL; menopause transition, 21.9 mIU/mL; and postmenopause, 45.7 mIU/mL. Receiver-operating characteristic curveYderived FSH cutoff points between the reproductive and menopause transition stages (FSH = 13 mIU/mL), and between the menopause transition and postmenopause stages (FSH = 45 mIU/mL), were neither sensitive nor very specific.

From the 1Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; 2The Orkand Corporation, Falls Church, VA; 3Contraception and Reproductive Health Branch, Center for Population Research, National Institute of Child Health and Human Development, National Institutes of Health; and 4Division of Health and Nutrition Examination Statistics, Centers for Disease Control and Prevention, National Center for Health Statistics.

*This article was presented as a poster at the Society of General Internal Medicine national meeting in Chicago, IL, May 2004. This project was supported by the National Institute of Child Health and Human Development, National Institutes of Health, and by the Centers for Disease Control and Prevention, National Center for Health Statistics. Dr. Henrich performed part of the work on which this report was based while participating in an Interagency Personnel Agreement with the National Institute of Child Health and Human Development.

Received February 13, 2005; revised and accepted June 14, 2005.

Address correspondence to: Janet B. Henrich, MD, Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208025, New Haven CT, 06520-8025. E-mail: janet.henrich@yale.edu.

© 2006 by The North American Menopause Society.