ASK THE EXPERT Questions answered by Ronald Barentsen, MD, PhD, Netherlands Chairman of the OBGYN.net Menopause Advisory Board

Are these symptoms of Menopause? Page 1 Am I experiencing Menopause? Page 2 What should I expect from HRT? Page 3

Doctor, Are these symptoms of Menopause?

Question:  I had a hysterectomy 3 yrs. ago due to endometriosis, primarily.  I have still been having symptoms of a premenstrual type, such as headaches, irritability, etc.  These symptoms have presented themselves at the same time every month.  My Gynecologist says that this is not possible.  I guess he feels that it is all in my head.  My husband is the one who made the connection of the dates and symptoms.  I have been on Premarin, 1.25mg  once a day and Wellbutrin, 150mg 2 times a day.  Can you give me any insight or direct me to someone who can? Answer:  I suppose that your ovaries are removed also. Because with hysterectomy only, the ovaries are retained and all cyclic variations are maintained. Without ovaries, a cyclic pattern is not possible because of hormonal changes. But I have heard this observation several times. My hypothesis is that somewhere in the brain a cyclical pattern is still working. But there is no literature about that.

Question:  At my yearly exam I asked my doctor to do an ultra-sound as a screening device.  She discovered the lining of the uterus was a "9" and should be a "5".  She did a biopsy.  I do not take HRT.  Should I be concerned about uterine cancer? Why the biopsy and what will happen if the biopsy shows only normal cells? Answer:  The endometrial thickness in postmenopausal women with bleeding has to be less than 5 mm for reassurance. With more than 4-5 mm endometrial biopsy or other investigations are advised. For women without bleeding no "normal" thickness is known. Usually the lining is thin, but not always. Maybe a polyp exists (as in 10% of women). No therapy required for non-bleeding polyps. So with normal cells no need for further diagnosis.

Question:  I had a complete hysterectomy in May of last year.  My doctor started me on Estrace.  After about a month, I started having pains in my legs and arms and severe headaches.  I called my doctor who switched me to Cenestin.  I no longer have the hot flashes but do have some mood swings and absolutely no sex drive.  I have been on them for about five months.  Also, my elbows seem to ache a lot since I have been on Cenestin.  Not in the joint, but in the soft inner part of the elbow  I stopped taking them for about two weeks and was so moody my husband was threatening to leave me.  I also got extremely depressed when I was off of them about a week. It got gradually worse and I was afraid enough to start taking them again.  I could not wait to get older with grown children so I could enjoy the things I always wanted to do.  Now I feel bad all the time and do not want to do anything.  Do I need to contact my doctor about changing them yet again? Answer:  With removal of the ovaries, also androgens decrease. Your problems (lack of well-being, loss of libido) are probably related to an androgen deficiency. With oral estrogens like Estrace and Cenestin (and with Cenestin more than with estrace) Sex Hormone Binding Globulin (SHBG) rises. This will bind the available androgens even more. Solution: transdermal estrogens will induce no rise in SHBG. second solution: extra androgens together with estrogens as in Estratest.

Read Past Ask The Expert Topics 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.