Evaluation of Menopausal Status in Women Taking Alesse

Introduction to Menopausal Status Evaluation

The American College of Obstetricians and Gynecologists recommends that hormonal levels should not be measured in women taking combined oral contraceptives (such as Alesse) to evaluate menopausal status, as exogenous hormones completely suppress the hypothalamic-pituitary-ovarian axis, making interpretation impossible 1

The North American Menopause Society suggests that combined oral contraceptives suppress FSH and LH through negative feedback, making these markers uninterpretable for evaluating ovarian function 1, 2
The Society of Obstetricians and Gynaecologists of Canada recommends that menopausal status cannot be determined while taking oral contraceptives, similar to GnRH agonists 1

The American College of Obstetricians and Gynecologists recommends stopping Alesse for at least 4-6 weeks before any hormonal evaluation to allow recovery of the hypothalamic-pituitary-ovarian axis 1
During this period, barrier contraception should be used if necessary 3
For women aged 60 or older, no laboratory tests are necessary, and age alone is sufficient to confirm postmenopausal status 1
For women under 60, wait 12 months after stopping Alesse for amenorrhea, then measure FSH and estradiol together (not FSH alone) in the early follicular phase if oligomenorrheic 1
FSH in the postmenopausal range (>35 IU/L) and low estradiol confirm menopause 1, 2

The North American Menopause Society suggests that for severe perimenopausal symptoms under Alesse, consider alternative treatments, such as venlafaxine, paroxetine, or gabapentine, as non-hormonal alternatives 5
The Society of Obstetricians and Gynaecologists of Canada recommends that low-dose oral contraceptives (20-30 mcg of ethinyl estradiol) may effectively relieve climacteric symptoms while providing contraception 4, 3