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I am wondering if the below sequence of tests can be used to…

Hi, I am wondering...

Hi, I am wondering if the below sequence of tests can be used to confirm pregnancy for a 46-yr old woman who may not have yet reached perimenopausal condition. 1) Quantitative HCG, 2) Complete Blood Wor

Doctor's Assistant: In general, how has your health been lately?

2) Complete Blood Work (CBC) 3) TSH 4) FSH and finally Transvaginal Ultrasound after a week.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

No. I have otherwise been a healthy woman all my life and keep fit health-wise.

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Customer reply replied 1 month ago
I would appreciate if the doctor could also let me know if the above combination of tests would exclusively be used ONLY to detect if a person is Pregnant or, if these (in the stated sequence) could also be used to diagnose other conditions such as PCOS (which I thought needed a Biopsy as well), or Excessive Bleeding (Friboids) or PeriMenopausal confirmation (but doesn't that typically NOT include FSH?). So I wanted to confirm what Condition the above combination of tests would mostly likely be used to diagnose? Thanks.
Customer reply replied 1 month ago
Just to Clarify, Sequence of Lab Tests I listed above are... 1) Quantitative HCG Blood Test 2) Complete Blood Count (involving WBC, Haemoglobin, Hematocrit, RBC, RDW, MCH, Platelets,) 3) TSH 4) FSH and TVUS a week later.
If you need my earlier values for the above, let me know. thanks.
Answered in 20 minutes by:
3/18/2018
Dr. Muneeb Ali
Category: Medical
Satisfied Customers: 9,222
Experience: MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
Verified

Hi,

Welcome to JA and thanks for this question. Actually, these tests can be used to diagnose a variety of conditions, I will describe what each test can diagnose below,

1) Quantitative hCG - this is primarily used to diagnose pregnancy and in some situations tumors like choriocarcinoma or other forms of hCG producing tumors. But its primary role is to diagnose pregnancy

2) CBC - this is a general test which would not confirm a perimenopausal condition or pregnancy but rather it can tell us about an infection in the body, anemia, low platelet counts because of infections, hematological disorders etc. It is a general test which gives us an idea about a number of conditions but NOT perimenopause, pregnancy, PCOS or fibroids for that matter. It can indicate anemia secondary to possible fibroids if you are bleeding a lot however it won't confirm the diagnosis of fibroids

3) TSH - will ONLY tell us about the presence or absence of a thyroid disorder and nothing else, it would, however, explain any abnormalities in the periods as thyroid disorders are a very common cause of the sudden absence of a period or excessive bleeding.

4) FSH - this can tell us about perimenopause, menopause and ovarian failure. In almost all of these conditions, the FSH would be raised. It would also be raised in the tumors of the brain which produce excessive FSH. In case of PCOS, the LH FSH ratio would be raised and the levels of FSH would still be in the normal range

5) Transvaginal ultrasound - this would actually help in diagnosing a pregnancy, fibroids, PCOS (PCOS does not need a biopsy, a hormonal blood panel with an ultrasound is diagnostic for the condition),

Now as far as the sequence of tests is concerned, I think an hCG level alone would be enough to confirm or exclude a pregnancy. The other tests would be done to determine other conditions depending on what your symptoms are. Usually, this combination of tests is advised to determine what can be the cause for a patient who has absent periods or has irregular periods or has excessive bleeding.

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Customer reply replied 1 month ago
Ok, so if someone had a missed period and suspected they were pregnant and the HCG came out low (2 miU), CBC values looked Normal (within range), but the FSH came out High (> 60), would the Transvaginal Ultrasound done a week later be used to diagnose Pregnancy (look for Gestational Sac or confirm Ectopic Pregnancy) OR to confirm other suspected conditions such as PeriMenopause or Ovarian Failure.? Thanks in advance for your excellent explanation!
Customer reply replied 1 month ago
One more... if the HCG was Low, FSH was High, the TVUS could be used to not just detect Pregnancy but possibly MisCarriage also, isn't it? If not, please explain. Many Thanks.!
In this situation the high fsh can indicate perimenopause or ovarian failure but given the age perimenopause is the likely cause. The ultrasound is not to detect a gestational sac etc because even if there was miscarriage the hcg levels take time to settle down and they are usually elevated for 4 weeks following a miscarriage. The hcg levels here indicate that there was no pregnancy to begin with if the missed period was within the last 4 weeks.
In short the ultrasound here is to detect menopause or ovarian failure.
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Customer reply replied 1 month ago
Just to confirm again... I read somewhere that the HCG Levels could be Low (< 5 mlU) if the Quantitative HCG was done early (within a few days of conception) AND if the embryo was in the Fallopian Tube instead of Uterus (which could lead to Ectopic Pregnancy), then the Low HCG value would NOT be conclusive indicator of Lack of Pregnancy, therefore the Ultrasound would be used to confirm the actual condition. Is this not possible? If you're sure of this is not possible, please let me know so I can rest assured it can ONLY likely be a Perimenopausal condition.
Customer reply replied 1 month ago
Another related question... Without the possibility of Conception (Non-Pregnant), can the HCG level in a Normal Perimenopausal woman be 2 miU soon after a missed period? ( I thought HCG is typically ONLY produced as a result of conception and not otherwise. i.e, >= 2, but not very high, which could be the result of possible pitutary tumors). In other words, a Non sexually active woman of 46 would NOT have a HCG level of 2miU in her blood. Is this correct?

hCG levels can be low if the test is done early but that is VERY early on in the course of the pregnancy, usually within the first couple of days. Secondly, even if the embryo was in the fallopian tubes, the level would be higher than 2 mIU. This is what happens in 99.9% of the pregnancy, the possibility of a pregnancy being missed based on the hCG alone is present but it is highly improbable that this is the case here. When we talk about possibilities in medicine, we would always consider the more likely scenarios rather than those which occur very RARELY. So while it is possible it is HIGHLY unlikely in this scenario.

Regarding hCG, you would have small amounts of hCG in your body even if you are not pregnant. You won't have ZERO hCG in your body, hCG can be present in very small amounts in normal nonpregnant individuals which is why the normal range is under 5 mIU and not zero. Small amounts are normal, so a nonpregnant woman of 46 CAN and usually WOULD have a hCG level under 5 in normal situations.

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Customer reply replied 1 month ago
I am sorry to have forgotten to rate you.. you Absolutely deserve a 5-Star Rating. Let me run the scenario to ground to be absolutely sure... Said differently, if the 46-yr old woman had a missed period and immediately suspected pregnancy but wanted to know the cause for sure, and got these tests done within a couple of days, and the follow on TVUS after a week, how would you say the cause is Most Likely Perimenopause and NOT a failed pregnancy (i.e, how would you absolutely Rule Out the possibility of a failed pregnancy besides the low HCG value?). If you need any of the other test values (HCG 2mlU, TSH 1.026, FSH 71, CBC all within normal ranges and the values fall in the ranges for both Non-Pregnant and First-Trimester women).

The only way a low hCG level may have missed a pregnancy in this scenario would be if conception took place 1-3 days before the test was conducted and it is possible that at that time the hCG levels did not rise. However a repeat hCG after a week would confirm the absence of a pregnancy if it came back as low again. Secondly if the ultrasound came back negative as well then i would be sure that this is perimenopause rather than pregnancy.

A low hCG level along with a negative ultrasound together would rule out a pregnancy definitively. And if there is any doubt then a repeat hCG can be done to rule out the slim possibility of the levels not rising because the test was done too early.

But in this situation we are not talking about an active pregnancy but rather a failed pregnancy and in case of a failed pregnancy, the hCG levels should have risen as soon as implantation took place whether it was in the fallopian tube or the uterus. Since they did not then there was no pregnancy to begin with.

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Customer reply replied 1 month ago
if the going in position was just a Missed Period (and not presumption of possible pregnancy), given the age, would typical diagnosis/testing still involve a HCG Test initially or just the other CBC, TSH, FSH and TVUS testing? I am wondering since you said initially that HCG is primarily used to test for pregnancy, so if an OBGYN knew the patiebt was 46-yrs old and the Missed Period as the only given facts, would an HCG test still be administered to rule of possible Pregnancy?

It would involve a hCG test, a missed period would always be considered a pregnancy (if the patient was not post menopausal) until proven otherwise (via a hcg test). Women can bear children even at age 50, so age alone is not an indication that a woman cannot get pregnant. A hCG test would be administered always in pre menopausal patients.

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Customer reply replied 1 month ago
Thanks a Bunches for the excellent explanations and answers! I am quite clear about this matter now. Have a nice day!

You are welcome, best of luck.

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