[NP-Clinical] Perimenopause

[Ellen Vander Galien]

Have two endocrine questions for all of you

1. How useful do you find the measurement of FSH and estradiol during the perimenopause? I do not routinely use these test rather look at patients age, signs and symptoms and make a clinical diagnosis. May on occasion rule out thyroid problems or diabetes if clinical situation dictates. My physician colleague does FHS and estradiol routinely and they are always normal even in the women with a clear picture of perimenopause. 

2. How do you all monitor adequacy of thyroid hormone replacement. I was taught to use the TSH and what I have read supports this. My physician colleague on the other hand,monitors only Free T4. He believes that as long as the free T4 is within normal range increasing the thyroid hormone replacement is justified if the patient continue to complain of fatigue and inability to lose weight even if it results in a "undetectable" TSH. I was taught that the was oversuppression and a subclinical hyperthyroidism that could result in osteoporosis or atrial fib. 

Any thoughts appreciated. Thanks

Ellen Vander Galien *usually lurking"
Family Nurse Practitioner
Beaver Dam. Wisconsin
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