Confused with labs

[llle]

I posted a question on 6/11 "Premenopause/Menopause".  This is a followup. I am confused and wondering if you could shed some light.  I called my OB/GYN with the complaints I had (see previous post).  He did not want to see me but instead drew my labs (including all the ones you suggested) and started me on Vagifem tabs once nightly and Premarin 0.9/day orally and wants to see me in Sept.  Within 24-48 hours, my symptoms were virtually gone.  I have had almost no irritation/dryness, no night sweats, etc.  I assumed that when the labs came back, it would confirm that I was heading into menopause.  However, 8 days later my doc's office called to tell me all my labs were "within normal limits" with the FSH on the upper limits of normal.  How can I go from being extremely symptomatic to asymptomatic after starting those two meds and yet my labs are "normal"?  No one can give me a definitive answer as to why this is?  I thought maybe you could give me your two cents.  Wouldn't my labs be abnormal with the symptoms I had and why would I recover so quickly after the meds? Could it be that the results may be "within normal limits" but its not within normal limits for me?  I don't have a baseline since this is the first time I have had these labs drawn.  Thanks for your response and thanks so much for this wonderful website.  It is very much appreciated.

[Machelle Seibel, MD]

A. Perimenopause is a transition from normal reproduction to an end of reproduction.  But it is not linear.  Lab values fluctuate up and down daily so at any moment you could have “normal” labs or “upper normal” labs or even abnormal labs and a few hours later they are normal.  

The change is not in the range of any given lab but in the trend.  Like the stock market.  The Dow Jones can be going up or down over a year but on any given day it can be normal.  That is how the labs work.  If your FSH was upper limits of normal, it means your body was already working harder by making more FSH so that your body could produce a lower normal amount of estrogen from your ovaries.

All of this is very typical of Perimenopause/Menopause.  The fact that your symptoms are gone with the estrogen is the empiric proof as well. Glad you are feeling so much better.
Machelle M. Seibel, MD

[llle]

Thank you for the response.  It seems logical and makes perfect sense.  This answers my questions and I appreciate it.  And I'm am also very glad I have had relief with the estrogen.