Detection of perimenopause or postmenopause human chorionic gonadotropin: an unnecessary source of alarm

OBJECTIVE: The normal pituitary production of human chorionic gonadotropin alongside luteinizing hormone, measurable in menopausal serum and urine was initially reported over 3 decades ago and has been described in numerous subsequent publications. Unfortunately, delays or cancellations of important medical procedures and use of needless chemotherapy still occurs because of the finding of human chorionic gonadotropin in perimenopausal and postmenopausal woman. We describe the problem and a concise approach to this management dilemma in menopausal women. STUDY DESIGN: This is an outcomes study of 36 cases of perimenopausal and postmenopausal human chorionic gonadotropin evaluated in cases referred to the USA hCG Reference Service. RESULTS: By report of the provided records, in 6 of 36 cases, unneeded chemotherapy was given for assumed recurrent gestational trophoblastic disease. In 9 cases, surgery was cancelled or postponed and in 3 cases renal transplantation was cancelled at the time of locating a matched donor kidney. In all cases the measured human chorionic gonadotropin was due to menopausal production of pituitary human chorionic gonadotropin. The average human chorionic gonadotropin detected in perimenopausal cases was 6.4 +/- 3.2 IU/L, and in postmenopausal cases was 11.6 +/- 7.0 IU/L or significantly higher. In 24 cases, therapeutic doses of high-estrogen birth control pill were used to confirm pituitary origin with 23 cases demonstrating successful human chorionic gonadotropin suppression. CONCLUSION: Low levels of human chorionic gonadotropin production in the perimenopausal and postmenopausal state is a normal physiologic phenomenon. Provider education is warranted and management protocols are suggested in all health-related fields to clarify the normality of low level pituitary human chorionic gonadotropin production. Understanding this physiology will avoid delays in necessary therapies such as organ transplants, and will limit the misadventure of prescribing unnecessary treatments for presumed gestational malignancy.