Question: Are fatigue and dizziness symptoms of perimenopause?

I am 45-years-old and have had three children, my last at age 38. For quite a number of years now I have experienced very heavy bleeding, but my period has only lasted 4 days in the cycle. Last January I experienced stomach upset a week before my period was expected and then started having extreme anxiety, low blood pressure, fatigue and dizziness. This went on for four weeks. I saw an internist and just about every test was done. My period resumed like clock work every 20/21 days. Two weeks ago I came home from work very dizzy. I laid down and had extreme vertigo. The next day I had terrible lower back pain and it continued into the next day. I went to the clinic and they checked the urine for blood and determined I must have a UTI. They put me on Ceftin tabs, I reacted to the first pill. I went back to the clinic and the next day they started me on another antibiotic, I reacted to it as well. The doctor had told me to stop the med. He checked my back further and concluded that I must have injured my back at work....but truthfully I don't think I did. I had back pain (which feels much like back labor) for a week and a half. I am experiencing fatigue and dizziness, hot flashes, night sweating and very moody. I was to get my period about 3-4 days ago, but haven't gotten it yet.....though it's always been there like clock work. I am wondering if I am experiencing pre-menopause and would like suggestions in what to do about this. There is heart problems and diabetes in the family and I did have gestational diabetes. Thank you.

Answer:

This case history is not typical for climacteric complaints. It is essential to realize that in this story no change in the menstrual cycle has occurred. Perimenopause starts by definition with menstrual irregularity. Of course it is possible that perimenopause starts in this woman on this very moment, but that is no reason to attribute all symptoms as perimenopausal.

After a total hysterectomy for endometrial cancer, at age 56, my wife says she is losing her pubic hair. It appears so, is this normal? Can anything be done about it? Her libido is also greatly diminished. Can anything be done about that?

Answer:

Pubic hair can become very thin, but this has nothing to do with menopause. It is a manifestation of aging. I have no idea what to do about this, probably nothing, it is not a disease. Loss of libido can be a matter of loss of androgens, especially if bilateral oophorectomy is performed. Sometimes Estratest (with testosterone) will help to solve the problem. But loss of libido can occur because of many other (mainly psychological) reasons, and then androgens will not cure the problem

Question: Frequent bleeding, leg cramps on Premarin?

I am having leg cramps almost every night. I'm on Premarin, but I'm still having them. Also, why am I having a period every other week or so? Thanks.

Answer:

I have no idea regarding the leg cramps. But bleeding every other week is not the rule. You are on Premarin, but also bleeding. So you still have a uterus. Then you have to combine the estrogens with progestogens in some way. Please ask your doctor for a combined regimen of estrogens and progestogens (either sequentially combined or continuous combined). Such a bleeding history needs further investigation.

Are herbs the only alternative treatment for menopausal symptoms besides estrogen replacement therapy? How about medications following hysterectomy with a strong family history of breast cancer and heart disease?

Answer:

Progestogens can be helpful and sometimes a low dose of clonidine can help. The new medicament tibolon (Livial) is not blamed for inducing breast cancer, but a definitive answer is not available for that. But it is excellent help for hot flashes.

I am 50 years old, have 5 children and am in good health. I had a hysterectomy during the summer. For a month now, I have been waking up sweating in the night -- hot flashes? Is there urgency (in the sense of immediate or within a year) to get estrogen replacement? By the way, my mother got breast cancer in her 70's, but was treated and is OK now. Thank you.

Answer:

There is no urgency to start HRT. In this stage of life estrogen levels are usually not too low. But why postpone the start of HRT? It can prevent night sweats and sleep disturbances.

Question: Can black cohosh cause hair loss?

I am 48 and in menopause. I am not on HRT due to the fact I had a blood clot from taking the birth control pills. I take vitamins and also black cohosh for my hot flashes. Can the black cohosh cause me to lose hair? Thank You.

Answer:

The problem with nearly all herbal medicines, and also with black cohosh, is that the product is not tested like normal drugs and no one knows about side-effects.

I'm interested in beginning HRT prior to menopause. I'm 48 years old. Should I have FSH testing to determine if I should begin? I've heard FSH results vary month to month - should one have multiple tests?

Answer:

Why to start HRT when your ovaries produce enough estrogens? There is no reason for HRT when you are still regularly menstruating. Unless you have hot flashes or night sweats. In that case you can start HRT for the cure of your complaints. For preventive HRT you can wait until periods stop. FSH testing has no meaning for estradiol levels.

My mother is an active 52-year-old women and is still having periods. She has seen several doctors and they both have told her the same thing; they do not know why her ovaries are still working at her age. She is told that this is not good and there could be an underlying problem, but they don't know what it is. She has had many tests and the doctors still couldn't give her an answer. Please, if you have any information on this condition, it would be most appreciated to hear from you. Thank You.

Answer:

Still having regular periods at the age of 52 is completely normal. Mean age of last menstrual period is somewhere between 51 and 52, but at least 10% of all women are still menstruating at 56, some of them regularly. After 60 periods become a rare event.

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Note: Opinions expressed here are for educational purposes only and, as such, do not constitute and should not be interpreted as initiation of a physician-patient relationship. This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.