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

Doctor, am I experiencing Perimenopause? Am I experiencing Perimenopause?   Am I experiencing Perimenopause? What should I expect from HRT? What should I expect from HRT?

Doctor, Are these symptoms of Menopause?

Q:  I am 47 years old, Caucasian, and generally in good health. I plan to have a hysterectomy for grapefruit-size fibroids, which are causing general discomfort and frequent urination. Is there any value to natural menopause over surgical menopause, assuming the ovaries are not diseased?  I think this would be an easier decision for someone who is post-menopausal. I have had about half a dozen hot flashes over the last year and seem to be experiencing more joint pain than usual. My menstrual cycle has been a predictable 25 days for several years.  A: Do not remove normal ovaries. With surgical menopause (removal of both ovaries), a sudden decrease of estrogens occurs with a lot of vasomotor complaints and more bone loss than with natural menopause. Also the ovaries produce androgens, and androgens are important for libido. The production of androgens is maintained until very old age. Postmenopausal ovaries are still functioning organs.

Q:  My wife and I are both 52.  She went through menopause 3 years ago, but we are still concerned about the possibility of getting pregnant.  Could you refer me to some information on this issue? A:  3 years after menopause the possibility of getting pregnant is essentially zero. When still menstruating after 50 the possibility of getting pregnant is extremely small.

Q:  I am 56 years old and have always had "normal" periods. This past Dec. I had my last period. I do not get hot flashes or any other menopause symptoms. However, I have cramps, not severe but a pressure feeling and cramps. I keep thinking I am getting my period. Is this normal for this time of life? A:  I suppose that there is still hormonal activity from your ovaries and you are aware of the effect on the uterus. Maybe a new bleeding is coming.

Doctor, am I experiencing Perimenopause?

Q:  I am a 41 year old women who has experienced changes in her period for the past year, some short some long, however 5 weeks ago I started my period and it was light for 2 days then heavy for about 5. It then continued in a light flow for another 2 weeks. Then it stopped for exactly 1 week and started again, it was very heavy for the next 7 days, I was changing a super plus tampon every hour, for several days then it slowed a bit. I also experienced lower pelvic pain as well as lower back pain, typical of a period but became bothersome after the first week. Total I had a period for 3 weeks straight stopped one week and started for a total of 4  out of 5 weeks of menstrual flowing. My period has stopped for 2 weeks, however I am still experiencing some pelvic pain as well as lower back. Any ideas or suggestion as to what may be happening? A:  This is certainly an unusual menstrual pattern that deserves further attention. This is not a perimenopausal pattern. Please check-out this great article on your question called, "Perimenopausal Bleeding - what's normal?" by Paul D. Indman, MD, OBGYN.net Editorial Advisor.

Q:  I am 49 with hot flashes, periods about every 3 months, and my hypertension is fairly well controlled most of the time.  My doctor has given me some low dose pills but I am afraid to take them for fear that they will raise my blood pressure.  Is there any chance I could take HRT at this point?  I think that the lower dose of estrogen will be less of a problem with my blood pressure.  I don't have a need for contraception.  What do you think? A:  Low dose BCP are excellent in this phase of life. The risk of increasing blood pressure is very low with the low dose pill and it occurs in the first 3 months, so it is easy to detect. An other possibility is HRT. But in this phase of perimenopause with HRT bleeding problems are seen often. Especially with continuous combined HRT. The best is sequentially combined HRT: continuous estrogens and 10-14 days each month progestagens. When cycle is not perfect with this form of HRT, usually the amount of progestagens has to be increased somewhat.

Q:  I am 48 years old and have had irregular periods for 2 years.  When I was 42 I had my left Fallopian tube and ovary removed due to cysts and tumor.  I have not had a period since Nov. Last week I was treated for a vaginal bacterial infection, and the following week for urinary tract infection.  I experienced palpitations, chills, sweaty, and severe anxiety, with stiffening of feet and jerky body movements.  The physician's assistant said I should see a psychiatrist for anxiety disorder--I am on Prozac and take Zanex. When I came home from the doctor's office, I needed to use the toilet and lo and behold I have a period.  I feel like I'm going crazy, I can't remember anything.  Any comments or suggestions?  Thanks! A:  This is a normal pattern of bleeding in perimenopause.

Q:   It has been one year since my last regular period and over six months since I last spotted.  I know that I am in menopause, although I have not had any blood analysis to show such.  I have had hot flashes, like most menopausal women for about four months or so.  The problem is that when I have a hot flash, I experience a racing feeling in my chest.  My husband has been checking my heart rate and blood pressure each time I have a hot flash.  Each time my heart rate is elevated to approximately 120 whereas it typically runs about 84 for me.  Also, my blood pressure drops to about 95/50 whereas it typically runs about 125/70.  I am very concerned about this.  Are these just typical hot flashes or should I be concerned that it is something more serious? A: These symptoms are typically for hot flush. The vasodilatation results in tachycardy and drop of blood pressure. No signs of heart disease.

Q:  I had my last period in April. It is now late in May and I still haven't got my period. I am 44 years of age. Last week I went on the 12th and had a urine pregnancy test from my GYN. It was negative. I'm wondering if it is still possible that I am pregnant? I usually had my period every 3 weeks, to the tee. But, I have to say that the last period was almost a week late, so are my concerns warranted? I have been experiencing symptoms of peri-menopausal for several years now. I have tenderness in the breasts, but otherwise I feel okay.  The only thing that concerns me is the lack of menses and that now I am not experiencing the hot flashes as much. Is all this normal? A: The modern pregnancy tests are very sensitive. A negative test is almost certainly proof of no pregnancy. On this age ovulatory disturbances are frequently seen and this is probably the case.

Q:  My wife just turned 50. She is perimenopausal. She has had a diminished interest in sex over the last year, yet on the rare occasions we do have sex she has little trouble reaching orgasm and seems to enjoy our lovemaking. The fact that she enjoys sex on one hand yet avoids it on the other seems to me to be a contradiction that points away from her perimenopausal condition as a major factor in her avoidance/lack of interest in sex. Or is it possible for a woman to experience a diminished desire for sex due to her perimenopausal condition while at the same time showing no decrease in sexual satisfaction? A:   Perimenopause does not influence sex drive. But maybe she is tired, or somewhat depressive. That will influence sex drive, but not sexual satisfaction.

Q:  I am a 32 year old woman. In the past few months my periods  have been intermittent - one month normal, the next month, all the symptoms but no period.  I have also been experiencing incredible hot flashes, mood swings, loss of sex drive & irritability.  Am I too young to be perimenopausal? A:  Never too young, but very unlikely. Just an annovulatory cycle I suppose.

Q:  I read an answer you gave to a person stating she suddenly developed panic anxiety and muscle aches and stiff neck, etc. I am also 48 and suddenly these same symptoms came on along w/ irregular periods which started first prior to panic, anxiety. Don't you agree that the mind and physical are connected therefore, hormone fluctuations at perimenopause affects physiology and the brain? I was taking ativan for panic and haven't taken meds for two months because my anxiety subsided along w/ other symptoms. I don't believe my anxiety or panic would just disappear by itself if I truly had nothing more than a psychiatric disorder. Too many women on message boards have suddenly developed panic anxiety muscle aches, etc in their 40's. This certainly could be perimenopause correct? A:  I disagree. Panic attacks and anxiety can mimic all climacteric symptoms. But they are not climacteric symptoms themselves. Perimenopause can aggravate these problems, but again panic attacks and anxiety are not perimenopausal symptoms and are not cured by taking estrogens.

Q:  When / how much should I worry about memory loss? Is it normal to start losing some short term memory when one is 41 years old? I am very healthy; had two weird period cycles (very short) last year and am now back to normal.  During the last year or so I find myself searching for words, using wrong words--I have never had a problem with this before.  Also I often can't remember simple things like what I did yesterday or what I had to eat yesterday- without thinking a bit on it (I have to think longer than I used to, before I come up with the answer). I'm worried about early menopause and early Alzheimer's (one grandparent on each side apparently had Alzheimer's).  Is there anything I can do to improve short term memory? I am a legal secretary, keep track of a lot of details there, and I have a very busy life.  My mother thinks I'm just too busy and under too much stress.  I am basically happy, and I sleep and eat well and try to exercise 2-3 times a week.  I figure as long as my job performance is not affected, the memory losses are probably not a problem - right? A:  No one can predict the future and there is no way to predict future memory. In your story nothing indicates early menopause. Maybe, your mother is the wisest.  And your busy job is the cause. Alzheimer on an early age does exist and when there are really signs of is, you have to consult a specialist in neurology. But most people experience periods of bad memory without any linkage to Alzheimer.

Q:  I am 43 years old, and was wondering what happens to a woman's sexual drive after 40?  I use to feel like I had a high sex drive and longed to have sex regularly.  But now, I don't feel urges.  What do you suppose is happening health wise? A:  Nothing changes with sexual drive when a woman passes the age of 40 years. You could be experiencing relational troubles. And a change in sex drive is largely determined by your relationship. Consultation of a sexuologist can be helpful. Or maybe a relational therapist.

Q:  Have plant estrogens and progestins been shown to mimic human estrogens/progestins? Can you describe the similarities, differences, benefits, and side effects in contrast to one another?  I am 45 and have just started spotting before my period, which until now are still regular.  I am also having night sweats, hot flushes, with some dizziness, fatigue, and nervous flashes.  Where in the perimenopausal spectrum do you suppose I might fall?  A:  Hormones derived from plant sources are not different from hormones made in a factory. The structure of the compound is the only relevant item. A compound, has the same effect and side-effects regardless of the source. Some plant derived compounds are not characterized very well and the effects are not entirely known. This is the problem with unpurified plant extracts as in herbal medicines. Your situation is an early phase of perimenopause with ovulatory disturbances. Enough estrogens are produced by your ovaries, but progesterone is lacking sometimes.

Q:  I am 46 years old and had a partial hysterectomy 3 years ago.  My uterus, cervix were removed, however I still have my ovaries.  My annual check up this year, I was told my ovaries are about the size of tiny grapes.  Could these ovaries still be functioning and if so for how long?  My Dr. seems to think I could be starting menopause.  How would I know?  Then he said my ovaries can still function for a few more years.  I doubt this due to their size. I would really like to get the facts.  I greatly appreciate any information you can help me with, as I am very concerned. A:  Ovaries can contain functional cysts. That kind of cysts do produce estrogens. Cysts are often seen after hysterectomy mainly because of less blood supply to the ovaries. They can function very well during a long time. You will not know about their function as long as you have no complaints. Without complaints there is no need to worry about function of the ovaries. Wait and see what will happen.

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.