Blog of the Society for Menstrual Cycle Research

A New Blood Test to “Predict” “Menopause”? Is this What Women Really Want?

June 28th, 2010 by Elizabeth Kissling
Collage by Merlinprincesse | Creative Commons 2.0

Collage by Merlinprincesse | Creative Commons 2.0

Guest Post by Heather Dillaway, Wayne State University

I keep seeing news articles about a “new Iranian study” that hopes to better predict “age at menopause” for women, and the authors of this study supposedly discovered a “blood test” that will be able to “predict menopause” within the next few years. It is touted as a way to judge when women will be “done” or be at the “end” of “menopause” and also to predict by default when they will be at the “end” of their “fertile” years (so that maybe they can know when they have to pop out that first or last baby). After seeing so many references to this study over the last week and having studied how women feel about the “beginning” and “end” of menopause for the last ten years myself, I can’t just sit back and not critique the underlying assumptions that are part of this study and air some of the concerns that I have about this impending blood test.

First, there is an assumption that the cessation of menstruation (as biomedical researchers define it) is the defining moment of “menopause.” Thus, what these scientists are trying to predict is the age when women might reach “menopause” (or 12 months past their last menstrual period). Yet, not all women judge the “end” of menstruation as the most important aspect of their menopause experience, in fact many women are much more concerned about when other signs and symptoms of “menopause” will begin and/or how long they will last, for instance, irregular bleeding or heavy bleeding in “perimenopause” or hot flashes, night sweats, etc. Can a test predict when irregular bleeding might start and how long it might last? And if a test predicts that a woman might reach her “age at menopause” right after her 54th birthday, will that make a 45-year-old woman with irregular bleeding feel assured that she has only 9 years left? In addition, can a test predict how soon a woman might start experiencing hot flashes and how long they might last, if that is instead to be her most worrisome sign or symptom?  If a test predicts that a woman’s age at menopause will be around age 49, will that woman feel assured about her hot flashes at age 48, having no idea how long those hot flashes will last but maybe hoping that they’ll end right alongside her last menstrual period? While the authors of this study (like most other biomedical studies) want to continue to uphold the definition of “menopause” as the official “end” of menstruation and ultimately the “end” of fertility, and hold this up as the most important part of menopause that we should know about, I beg to differ. Women want to know more than just their “age at menopause” or the final end to their fertility.

Second, continuing to define menopause primarily through the cessation of menstruation as this study does means that those women who do not menstruate regularly before menopause (e.g., pregnant women, breastfeeding women, women with amenorrhea before menopause, serious athletes, women with eating disorders and other health conditions, intersexed women, women on Depo-Provera or Seasonale, women with partial hysterectomies, women on hormone therapies, etc.) continue to be defined as abnormal and even infertile, if we follow through with the mindset of the authors of this study. In my mind, this study seems not to be written for those groups who haven’t been menstruating regularly before their “age at menopause” or who might even have been defined as “infertile” before menopause. The assumption is that all women menstruate regularly and are fertile before menopause and, therefore, menopause can mean the end of menstruation and fertility, but so many women’s experiences negate this assumption and reality. Even women who have simply been on the birth control pill for ten years or women who had a tubal ligation negate the idea that “menopause” is the end of fertility. There are so many factors that interrupt “normal” “menopause” or “normal” “fertility,” and this study does not explain any of that. If women have not been faced with a regular menstrual cycle earlier in their lives and have not been “fertile” before menopause, how are they supposed to interpret this study’s definition of “age at menopause” or fertility? Does this calculation still work for them? Presuming it does, what should they assume when they reach that predicted age at menopause? Should they just assume they’re done, and take the authority of the blood test as fact, that they are indeed “menopausal”? And should women who have experienced troubles with fertility before menopause wait to think that they are infertile until after the predicted age of menopause? This blood test leaves me with many questions and few answers, especially when I start to think about all of the supposed causes of age at menopause and infertility, and all of the women who are left with unexplained experiences if we rely on this blood test to give us the answers.

Third, the idea that this blood test essentially predicts time to failure/time to the “end” of fertility is problematic for those interested in promoting women’s health, in my opinion. The study is praised already for its potential ability to predict “early menopause” and allow women to know when (not if, but when) they should switch gears and begin to have those children they always wanted to have (assuming they wanted them, of course – there is no room for “childfree” women from the perspective of researchers touting this blood test).  As this study is praised for its ability to predict when women should start worrying about their fertility (and might want to have that baby before it’s “too late”), what does the predicted “age at menopause” do for a woman? Does it help her figure out when she might start having trouble getting pregnant, or when she should start trying to have that first or last baby? Does it help the woman trying to decide whether she really wants children or not?

If we are truly to promote positive gender identities, a healthy view of both menstruation and menopause, a healthy view of women who either decide to have children or decide to be child-free, and the women who delay childbearing until their forties, the idea that this study predicts the “end” of fertility (read: the end of women’s delay of childbearing now that she can plan “well”) could be problematic, if it is couched in terms of “time left” and (essentially) time to system failure. Ultimately, does that mean that, if you don’t plan well and end up childless that it’s your fault? Does that mean that if you are still concentrating on your career with only 5 years left until age at menopause that you are not scheduling your time well? Does that mean when you get to the “end,” you should maybe think of yourself in a different way? And should you worry if your blood test says you only have a year left of regular menstruation?

Or what happens if you get to your appointed cessation time and you don’t stop menstruating? And do we really want to let women think that if they reach their appointed age at menopause, then they don’t need to use birth control anymore? Furthermore, this study’s researchers admit that their new blood test can predict within a 4 month window but, from my calculations, that might leave women guessing whether they have hit their “age at menopause” within an 8-month period (4 months on either side of the predicted time, best case). And the authors of the study admit that the margin of error could be as much as 3-4 years off at the current time (but of course they’re hoping their estimations will be improved by the time that this blood test is approved and marketed).

How are women supposed to feel about all of this? I don’t know, but I worry about the extra anxiety that individual women might feel if they received this “simple blood test.”  I realize we all want to plan well and plan more, and that our entire society is geared towards planning when exactly that tornado will hit, that market will fall or recover, that housing market will get better, that weight will come off, that baby will be born, or that illness will be gone, but are we really truly better off and less anxious with all of this planning and prediction? And, at the bottom of it all, is this what women actually want? I’m left more anxious just thinking about the repercussions of this “simple blood test,” and I wonder what women really would rather know. And even if they did want to know their predicted age at menopause, is that the most important thing to them, and will this actually lessen their fertility concerns?

  

15 Responses to “A New Blood Test to “Predict” “Menopause”? Is this What Women Really Want?”

  1. Meghan says:

    This is an Iranian study. I’m not surprised that nothing other than fertility is discussed; does anything else even matter? (sarcasm)

  2. Heather D says:

    Of course, you’re right, nothing else matters. :)

  3. Heather D says:

    Okay, I have been thinking more about this: Even though the national/cultural/religious context for this study matters significantly (and I do thank you, Meghan, for pointing that out!), the way this study is being described in international news is that it will be very helpful for women everywhere who might want to know how fast their biological clocks are ticking. So, despite the contexts behind the research project that might have instigated the focus on fertility, the effects are potentially wide-reaching for women/healthcare providers elsewhere. Also, the questions I posed in the original post still stand: how should women actually think about this predicted age at menopause? Even if women were using this blood test to pinpoint the end of fertility, how would the results of this test shape their thoughts and actions over the 10 or 20 years before this test? To me, pinpointing a “sell-by date,” as a commenter on another article about this study termed it, is dangerous and anxiety-ridden for women. At least in my opinion.

  4. I’m highly sceptical that there is any validity to the supposed test. Can someone point me to the article so I can assess it myself?
    Thanks,

  5. Re: CONCLUSIONS: Of every 10 women in late reproductive age with AMH levels greater than 0.39 ng/mL, only one will reach menopause status within the next 6 years.

    So, does this mean women with low AMH can take AMH in pill or patch form, and thereby delay menopause?

    There’s a list of AMH studies at wikipedia: http://en.wikipedia.org/wiki/Anti-M%C3%BCllerian_hormone

    Weenen C, Laven J, Von Bergh A, Cranfield M, Groome N, Visser J, Kramer P, Fauser B, Themmen A (2004). “Anti-Müllerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment” (abstract). Mol Hum Reprod 10 (2): 77–83. doi:10.1093/molehr/gah015. PMID 14742691. http://molehr.oxfordjournals.org/cgi/content/abstract/10/2/77.

    Visser J, de Jong F, Laven J, Themmen A (2006). “Anti-Müllerian hormone: a new marker for ovarian function”. Reproduction 131 (1): 1–9. doi:10.1530/rep.1.00529. PMID 16388003. http://www.reproduction-online.org/cgi/content/full/131/1/1.

    • Heather D says:

      Re: the conclusions in that article I posted — I think that the results being touted now from a larger, expanded sample of 266 women may be saying that more women might reach menopause with low AMH levels, but I’m not sure. I can’t find the print version of the presentation that is in the news. I like your questions about this. It does lead to all kinds of holes in their results, or at least gaps in our knowledge about what to do with these predictions.

      • Another thing that comes to mind (maybe someone has already mentioned it) – could there be some idea to circumvent menopause altogether? An elixir of eternal youth kind of thing – assuming there’s one thing women hate more than menstruation, it’s menopause…from a marketer’s point of view…

        I can remember when botulinum toxin was a deadly poison, and only a deadly poison – but now it’s got that elixir of youth thing going for it…I’m just picturing in my mind a scenario, similar to that greeting the book “Is Menstruation Obsolete?” – a big followup sequel: “Is Menopause Obsolete?” How to keep those ovaries functioning forever. Maybe they already know how to do this, and I’m just not up to date on things.

        • Heather D says:

          Maybe we can bottle the AMH hormone and give women injections akin to Botox…the possibilities are endless!

  6. Laura Wershler says:

    What continues to astound me with these predictive “let me tell you about your body” approaches to mentrual cycles in general, and issues like fertility and menopause in particular, is that we don’t need them. All women are capable, with instruction, of acquiring the LIFE SKILL of menstrual cycle charting so that they may clearly understand the status of their fertility throughout their reproductive years. A woman can monitor her fertile signs and recognize if anovulatory cycles, long or short cycles, reduced cervical mucus, shortened luteal phases, etc might interfere with her desire or effort to become pregnant. This knowledge might then lead women to simple interventions that can enhance fertiltiy, before the requisite invasive infertility approaches kick in. (As a starting point, I know that much infertility is more complicated than this, I’m not talking about this kind of infertility.)

    As for transition to menopause, having a date in mind is really quite useless. What we need to know and understand, again something we can only do if taught to chart and interpret cycle events and perimenopausal sypmtoms, is how our transition to menopause is unfolding. Are we at risk from too much estrogen and not enough progesterone? Are we are risk for osteoporosis from years of inconsistent ovulation? These are the things that body literacy and menstrual cycle awareness can tell us. A test like this is more likley to promote anxiety and confusion, than anything else. The key message: Know thy own body.

  7. [...] at re:Cycling, Heather Dillaway explores some of the complicated questions that are too often ignored when it comes to medical treatments or [...]

  8. Heather D says:

    So, I guess this article appearing in the Washington Post today is a nice parallel to the fact that there may be a “simple blood test” to predict menopause in the next few years. If anyone is interested, here is the link:

    By freezing embryos, couples try to utilize fertility while delaying parenthood
    By Gillian E. St. Lawrence
    Special to The Washington Post
    Tuesday, July 6, 2010
    http://www.washingtonpost.com/wp-dyn/content/article/2010/07/02/AR2010070204597.html

  9. [...] hope my colleague Heather Dillaway feels at least at little vindicated when she reads this: A new study in the Journal of Health [...]

  10. [...] hope my colleague Heather Dillaway feels at least at little vindicated when she reads this: A new study in the Journal of Health [...]

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Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.