Cases in primary care laboratory medicine: testing pitfalls and summary of guidance on sex hormone testing

doi:10.1136/bmj.39038.614317.AE

BMJ 2007;334:91-94 (13 January), doi:10.1136/bmj.39038.614317.AE

Practice

Cases in primary care laboratory medicine

Cases in primary care laboratory medicine: testing pitfalls and summary of guidance on sex hormone testing

W Stuart A Smellie, consultant

¹ Clinical Laboratory, General Hospital, Bishop Auckland DL14 6AD

Correspondence to: W S A Smellie info@smellie.com

Sex hormone testing in women is difficult to interpret, andto produce valid conclusions tests must be timed correctly andfollow a rational sequential testing strategy

The first 150 words of the full text of this article appear below.

Introduction

Laboratories see large differences in the useof tests to investigate subfertility. The use and interpretationof tests for the female sex hormones can be problematic; althoughpopulation reference data exist, values change markedly withinand between the different phases of the menstrual cycle, andvalues outside of quoted reference ranges often provide verylimited information and can be misleading. This is particularlytrue for women with cycles that are irregular or atypical inlength. Good examples of this can be seen in both menopauseand subfertility.

Summary points

Hormone testing has very limiteduse in diagnosing the menopause

Monitoring patients on hormone replacement therapy relies onclinical response in most situations

Early investigation of subfertility is recommended onlyin specific groups of patients

A detailed menstrual history is essential to interpret gonadotrophinresults

A luteal progesterone concentrationabove 20-30 nmol/l seven days before onset of menses effectivelyexcludes endocrine related subfertility; . . . [Full text of this article]

Case 1

Case 2

Discussion

Case 1
Case 2
Box 1: Who should be investigated for subfertility testing?

Questions and answers: learning points

Box 2: Recommended initial tests for investigation of subfertilityin men and women
What tests should be used to investigate subfertilityin men?
Whattests should be used to investigate subfertility in women?
Box 3: Investigation of secondary amenorrhoea
When should secondaryamenorrhoea be investigated?
Whattests should be used to investigate secondary amenorrhoea?
What are the sources of evidence?
Useful websites