Question: When can I discontinue using contraceptives for birth control??

At what point during the phases of menopause can I discontinue using contraceptives for birth control?

Answer:

Always a problem. What is the age of this woman? Pregnancy after age 50 is seldom seen. Pregnancy after age 53 is very very seldom and natural occurring pregnancy after age 56 is never described.

How large a risk is acceptable? Sometimes one wish to know more details and measuring FSH and estradiol after one week off the BCP will give a rather good impression of residual ovarian activity. But low dose BCP are very good for climacteric complaints, and for bone mass too.

I am 41, suffered from endometriosis all my adult life. In Nov. 1997 I had extensive surgery, with the removal of 1 ovary and tube. The remaining ovary was "functioning" in as much I was having mid cycle bleeding and heavy monthly bleeds. Prior to going on HRT, I experienced severe headaches, the pressure in the head type. I had never suffered from headaches before. My libido was severely affected. I went onto HRT for a year and for wanting to pursue the natural option, I have recently taken myself off it.

I am back to severe headaches and no libido at all. What natural option do I have that will help the headache and the libido? Which hormone is the "culprit" for this? The estrogen or progesterone?

Thanks !

Answer:

I cannot give an answer to this question. Why HRT was started a year ago, while the remaining ovary was still functioning? HRT is not a cure for severe headaches, nor it is for libido. Now after stopping HRT, are there still periods? When amenorrhoea exist is this because an early menopause?

Is there a hormonal reason for headaches? It should be investigated by a neurologist. When hormones have anything to do with libido, androgens have to be investigated. So there are a lot of questions around this problem.

Question: What is Kraurosis Vulvae?

My mom has asked me to look up some information about kraurosis vulvae on the internet. She told me that it deals with white patches on the vulva. I have been unsuccessful in finding information. She is 52 yrs. old and has had this condition for about a year. She also told me that it must have something to do with post-menopausal women. I have looked all over the place and can't find any information on it. If you could help me out with this I would be grateful. Any web site or information that you could pass on would help her. She got me concerned when she started talking "malignant". Thank you for taking the time to read this. We appreciate it.

Answer:

Kraurosis vulvae is an older name for a disease now called "Lichen sclerosus". You have to look at those words in the literature or internet. It is a disease that can occur at every age even in newborns, but usually the problems is seen in older women. The chance of malignancy in lichen sclerosis is very small, less than 1%. Not all white lesions are lichen sclerosis. Sometimes the skin looses pigmentation (so called vitiligo). Lichen sclerosis has to be diagnosed by biopsy. There is no cure for it, but complaints like itching can be influenced by corticosteroid creams. Without complaints there is no need for medication.

I started 1mg of Estrace about 6 months ago and have noticed some hair thinning within the last 3 or 4 months.I was placed on Estrace because my gynecologist said I was estrogen deficient since my hysterectomy(ovaries were left) 2 years ago.I was just wondering if it is possible to get to much estrogen? Could too much or too little cause hair thinning?

Answer:

With oral estrogen without progestogens there is a rise of sex-hormone-binding-globulin. And therefor it is possible that androgens (produced in adrenal cortex and in the ovary) are bound somewhat more. We expect more a decrease in androgen activity than an increase.

Loss of hair is mainly determined by (an excess of) androgens. Estrogens are not involved with that. Hair thinning is not a manifestation of to much estrogens. To much estrogen is possible, but usually mastopathy is the first sign.

I have been told I need to have a major surgical hysterectomy because of a fibroid cyst (about size of a lemon) at or near the uterus. No ovarian involvement observed in ultrasound. I am on HRT for about 5 years. No cysts were present at last yearly exam. No symptoms, no bleeding, no pain.

Are there alternatives? Or is this considered high risk because I am post-menopausal. I am 54, never had children.

Answer:

This question gives some problem for interpretation. A fibroid is not a cyst. Fibroids without any complaint is not a reason for an operation, certainly not after menopause. After menopause it is extremely seldom that fibroids will cause any problem.

With cysts another question arises. How large is the cyst and what are the characteristics in ultrasound. With small cysts (less than 5 cm) and no signs of suspect malignancy, I usually perform a second ultrasound after 3-4 months. With growth an operation is indicated. Otherwise we follow this with ultrasound yearly.

Question: Vaginal atrophy and bleeding?

I am a 63-year-old woman with this problem.The vagina is almost sealed shut. I am inserting Estrace cream.The doctors would like me to take Estrogen, but my experience caused bleeding after 3 months of it. I am worried if I try Prempro and would bleed, will this blood be able to come out???

Answer:

It is unusual that the vagina is almost sealed by atrophy. Although it is possible. But is the correct diagnosis made? Or are there signs of lichen sclerosus? This disease will not cured by estrogen cream. If it is only atrophy, the vagina will not be closed completely (I suppose that there was no radiation therapy for cancer) and when bleeding with Prempro it will come out.

I am 46 years old, birthed 4 children, of that 1 C section. I had my
tubes ties 10 years ago and have NO history of cycle problem. I have 5 to 7 day period, not major discomfort and have been regular as clock work. Two months ago, I suddenly missed my period. I had the bloaty and heavy feeling most of the month, but still no show. The next month, I started my cycle as scheduled but I have not stopped bleeding and it is now 26 days. I have been going through one tampon and a pad every 90 minutes along with some very large clots. It has at times slowed down, only to become very heavy within a day.

I went to my MD, because my OB/GYN was not available, he put me on Provera 10 mg., 1 per day and Doxycycline 1000mg for infections
as a pre-caution. This was when I had been bleeding for 21 days. The Provera has slowed the bleeding down, but if I go any longer that 20 hours between pills, I have start bleeding heavy again.

My test have not showed a reason for this and I am beginning to think that I will bleed to death, before I get results. I tried to see another doctor, but they did not want to get in the middle of my current doctors treatment. What could cause all this bleeding?

Answer:

This is a pattern that looks like so called dysfunctional bleeding. This is usually a disturbance in the ovulatory process and not uncommon in perimenopause. The cure is a course of progestogens and when 10 mg provera is not stopping the bleeding maybe 20 or 30 mg is. You have to see your doctor again and discuss the problem again. So there is not a lot of reason to be anxious.

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.