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The following ‘Ask the Experts’ questions were sent in to The Menopause Exchange by our members, the answers were provided by our ‘Ask the Experts’ panel and included in issue 87 (winter 2020/21) and issue 88 (spring 2021) of The Menopause Exchange newsletter.  If you would like to read the questions and answers in the latest issue of The Menopause Exchange newsletter sign up for FREE emailed newsletters.

What do follicle-stimulating hormone (FSH) levels indicate, and what are the normal levels for women in the perimenopause, at the menopause and after the menopause?

Mr Nick Panay, consultant gynaecologist, replies:

FSH is a hormone made by the anterior pituitary gland in your head. It triggers the release of oestrogen from an ovary. When oestrogen levels fall at the menopause, FSH levels start to rise by a mechanism called “negative feedback” to try to make more oestrogen. But, because the follicles that make oestrogen (and eggs) eventually run out, oestrogen levels remain low. FSH levels remain higher than normal for many years but eventually start to drop. FSH levels vary during your normal menstrual cycle so it’s important that the timing of your blood test is recorded according to the day of your cycle. FSH levels usually remain below 10 International units per litre (IU/L) except at ovulation when levels can increase to more than 20 IU/L. In the perimenopause, FSH can change in a more exaggerated way, although levels usually remain below 40 IU/L. At the menopause, FSH levels are typically more than 40 IU/L and can even be more than 100 IU/L. After the menopause, FSH can remain higher than normal for many years, although eventually levels fall to below 10 IU/L due to the loss of the negative feedback. In the past, FSH was measured to confirm the diagnosis of menopause, but the NICE Menopause: diagnosis and management guideline published in 2015 advised that an FSH test wasn’t required to confirm menopause in women aged 45 years or higher once their periods have stopped and they are experiencing typical hot flushes and sweats.

I found your recent article on workplace menopause policies and guidance (issue 86) really interesting. You mentioned having a menopause champion or ambassador. Who would be the best person for this role?

Norma Goldman, founder and director of The Menopause Exchange, replies:

You could choose an employee going through the menopause or someone with an interest in the menopause. This could be a learning and development manager, an equality, diversity and inclusion officer or a health and wellbeing manager. It could also be someone working in the PR or occupational health departments.

I am 47 and taking thyroxine tablets for hypothyroidism. I’m thinking of going on HRT to help my hot flushes and night sweats. Will HRT affect my thyroxine?

Dr Sarah Gray, GP, replies:

HRT may interact and slightly reduce the effectiveness of the thyroxine. Thyroid replacement can reduce the activity of both your own hormones and of replaced hormones. This interaction is kept to a minimum by using oestrogen replacement delivered through your skin. I tend to use this option for women who take anything other than very low doses of thyroxine.

I’m prone to sinus problems and always feel congested. A friend has suggested I cut out dairy foods to see if this helps, but I’m worried about my risk of osteoporosis. What advice can you give me?

Angie Jefferson, consultant dietitian, replies:

Dairy causing excess mucus production and congestion is a well-established myth. According to ENTUK, the professional body representing Ear, Nose and Throat specialities, there’s no proven link between having dairy foods and making excess mucus. Dairy allergy doesn’t typically cause sinus symptoms on its own, so unless you have any gut-related symptoms when eating dairy foods you’re probably fine to carry on eating them. My recent article (Issue 86, Autumn 2020) on Nutrition & Immunity gives some tips on eating habits to help maintain a healthy immune system and stave off infection – so make sure you’re eating oily fish every week, including lots of colourful fruits and vegetables in your diet, and choosing wholegrains and high fibre foods. And don’t forget good hydration as without enough fluid, mucus tends to be thicker.

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