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

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

Doctor, Are these symptoms of Menopause?

Question: When menopause starts after you have had a tubal ligation (10 yrs ago) can it feel the same as a pregnancy? As in no periods and spotting when you lift something heavy or have sexual intercourse? Answer:  No it cannot. Spotting after intercourse needs further investigation. What are the pregnancy signs? Breast tenderness? That can occur in perimenopause especially with high estrogen levels as in anovulatory cycles. Tubaligation has nothing to do with perimenopausal signs and symptoms.

Question:  I am 56. For the last 5 years I have irregular bleeding: from 6-7 weeks intervals to 17 - 18 days intervals. sometimes spots in between. Volume of bleeding is less and less but for sometimes the periods getting longer, 7-8 days. I had minor hot flashes 6 - 7 years ago.  I have hypoteroiditis for the last 15 years, I receive Eltroxyn, a pill a day and I am a little overweight. What are my chances to have cancer? Answer: The changes to have cancer are low. Only 1 in 1000 women per year will have endometrial cancer. Your history is one of perimenopausal bleeding pattern. But for certainty it is wise to perform an endometrial biopsy especially because of the intermenstrual spotting. At the age of 56, 10% of all women still have their periods.

Question:  My FSH blood test was 67.  My doctor says that it is perimenopausal. Is there any other medical condition that could make my FSH blood test high or is it just strictly menopause? Answer:  It is the main sign of ovarian failure. There are no other conditions with such high FSH.

Question:  I am 42 years old and have always had a fairly normal menstrual cycle. My only concern is that for the last 3 or so years, I have been experiencing large blood clots during my cycle.  The cycle lasts about 6-7 days as usual, but for about a 24-48 hour period of it I experience blood clots.  Sometimes worse than others.  If this is a normal part of aging for me, I can handle it. But I would like to hear it from an expert that this does happen to others.  Should I be concerned?  The only other symptoms I experience are an occasional head ache and bloating.  I don't have any pain or cramps. What do you think? Answer:   The amount of blood loss increase with aging. As long as no anemia occurs, there is no reason for concern.

Question:  I am a 33 year old female. I had a hysterectomy when I was the age of 27. I have been experiencing some problems lately concerning , hot flashes, major mood swings, depression and fatigue. Is this menopause and can it happen to me? Answer:  It can always happen. But it is extremely rare. Ask your gynecologist to test your FSH. With high FSH and low estradiol, premature ovarian failure can be diagnosed with important consequences. Normal FSH excludes premature menopause.

Question: Over the last year since I had my second child I have been experiencing night sweats, hot flashes, memory loss, weight gain, bloating, diarrhea/constipation, and menstrual periods every 3 months. I would hazard to guess that I am perimenopausal but I just turned 28. My mother says that she was around my age when she started having symptoms similar to mine and that eventually she was started on HRT to stop early menopause. Is it possible that I am perimenopausal? I have always had abnormal periods and didn't even start menstruating until I was 14. They found nothing wrong with my hormones at the time the sample was taken. Is it necessary to have hormonal samples taken throughout your cycle to get an accurate result? What should I do? I am a senior nursing student and I need my memory! Also my husband and I would like to know where we can find my libido? Answer:  With the test performed, premature ovarian failure is excluded (I suppose that normal hormones means also normal FSH). Loss of libido can have many reasons. This is the field of sexuology. Consult a sexuologist for that type of problem. As regard your complaints: psychological problems can mimic perimenopausal complaints. Menstrual periods only every 3 months is unusual unless you are still breastfeeding your child. Does your gynecologist have an explanation for this?

Question: I am 50 years old, with a history of fibroids (that were never a problem) and have not had a period for about 2 years.  I have been on HRT (first Prempro, but had breakthrough bleeding, then Prometrium and Estratab, then back to Prempro) since April 1999.  About 4 weeks ago, I started bleeding.  Went to my gynecologist who did an endometrial biopsy and removed a cervical polyp.  Biopsies were negative.  Two days after the bleeding ended, I started bleeding again.  I went back to my doctor, who doesn't really feel it is anything to be concerned about, but is sending me for a vaginal sonogram and a sonohysterogram.  Is this the course you would recommend or is this overkill at this point? Answer:  Half of the women with continuous combined hormone replacement therapy as in Prempro will experience bleeding. Usually it stops again and the longer the treatment is continued the less bleeding occurs. But in some women the bleeding problem will continue. For diagnosis a sonohysterogram and a biopsy is sufficient to rule out serious troubles. There are two methods to continue with HRT: switch to a sequential combined scheme (such as Premphase) and accept regular withdrawal bleeds every month as is seen in 90% of women on Premphase. Or try a continuous combined regimen with less estrogens. The breast tenderness points to a relative high dose.

Question: In August of 1999, I stopped taking birth control pills, based on the fact that I had been on them for nearly ten years and thought I would give my body a "break" from them.  I hadn't been too worried about the fact that I hadn't been on my period since that time, until recently.  I am 27 years old and have noticed outrageous mood swings, dizziness, nausea, mild & infrequent hot flashes, disrupted sleep, vaginal dryness, lowered libido, heart palpitations, and headaches.  I know it is uncommon for women my age to go through this; but should it be considered? Answer:   It is quit unusual to have no periods after stopping birth control pills. Premature ovarian failure on your age is extremely rare, but other endocrinological problems like hyperprolactinemia or polycystic ovary syndrome are seen frequently in such situations. It deserves further medical attention. Please check-out the OBGYN.net PCOS Pavilion for more information about this question.

Question:  I am a 50 year old woman and I have been taking estrogen therapy since I was 39.  Presently I am taking Prempro.  I have not had a period for at least 6-8 years.  Do I still produce an egg monthly and would it be possible for me to become pregnant?  Answer:  You can never say never. But pregnancy with this history is extremely rare, but there are observations of pregnancies many years after the last period.

Question:  Six years ago I experienced all the signs of perimenopause at age 35. My doctor prescribed Premarin and Provera. My cycle, hot flashes, and severe anxiety attacks then stopped. Everything was good for a few years, now I'm back to irregular or no menstrual cycle. The hot flashes have also returned. How much longer will I have to go thru this till menopause? Answer:   No one can predict the duration of perimenopause. It can stay for a very long time during many years and it can pass without notice at all. Some women are more lucky than others in this respect.

Question:  My mother went through menopause at 36 years old. I am wondering what are the chances of her four daughters going through menopause this early? And if chances are high, how far before the age of 36 could we experience perimenopause? Answer:  You are at risk for a premature ovarian failure because of your mothers history. But no one can tell you if this will happen indeed. A risk is not a prophecy. Maybe you will experience menopause at the age of 56. It is possible, but unlikely. The mean duration of perimenopause is 4 years. But there is a wide variation.

Question:  I have read a lot concerning menopause.  Many women mention moodiness and unable to cope as emotionally as they had in the past.  Most responses from your column and others has seemed to mention this lack of present coping has nothing to do with menopause.  I think it has to be directly related to menopause.  I still have regular periods, but have skin dryness, fatigue & other symptoms.  Any suggestions to help get me back on track with more energy and positive coping skills? Answer:  No suggestions, because I do believe that coping problems have nothing to do with menopause. The perimenopausal period is a period with greater vulnerability. During this phase of life the reaction on serious life events can be exaggerated, much more than earlier. But without life events, no emotional disturbances are seen.

Question:  I am 41 years old, over the course of the last year, I have lost my job, have lost complete interest in all outside activities, with the exception of the computer. My period which have never been normal, I would go a full year without it, have become regular, and are occurring every 3 weeks. I have lost my libido, I have severe mood swings, which can get extremely hostile, I am depressed most of the time, and have alternate periods of insomnia with periods of sleeping all the time. Do I need to see a gyn or do I need to see a psychiatrist? Could I be going through menopause? Answer:   Your need is certainly a psychiatrist. All signs of depression are present. This e-mail is a promise that help will be useful.

Question:  I am a fifty-one year old women,  who has not had a period for about a year and a half. All of a sudden this month I have a period, with all the same cramps and back ache and sore breast  that I had experienced in the past. I have put on weight in the last year, about fifty pounds. Is it normal to start a period after not having one for so long? Answer:   It is not normal to start again with periods. But it happens sometimes. But before you can conclude that periods restart you have to be certain that no endometrial lining problems like hyperplasia exist. An endometrial biopsy (or at least a transvaginal ultrasound) are necessary in postmenopausal bleeding. Please check-out the article "Postmenopausal Bleeding and Its Significance" by J. Glenn Bradley, MD

Question:  I am 54 years old.  I had a pituitary tumor removed in 9/74 (I had Cobalt radiation in 1970).  As you may know, I've been on hormone therapy since then.  The problem that I have at this time is an acute pain in both sides of my pelvic area, which I assume where the ovaries. I develop the pain when I am sexually aroused or at the time of having an orgasm.  My gynecologist indicated that it was fibrosis, but a scan didn't show any fibrosis.  Lately I've been thinking about having a hysterectomy to solve my problem and also to discontinue having my period. Could you give me any advise regarding my situation? Answer:   I have no idea of the cause of your pain. This complaint is completely unknown to me. Because it is only present with sexually arousal and orgasm, perhaps a sexuologist can advice you better. Without diagnosis choosing for a hysterectomy is not such a good idea, because it is a major surgery with a possibility of  complications and with the possibility that the same complaints will stay after the hysterectomy.

Question:  My mother is 71 years old and still gets her period monthly, sometimes twice a month.  What can be done to stop her periods, if anything? Answer:   This is very unusual. A thorough gynecological examination is necessary. Hormone levels are necessary to diagnose functioning ovaries. When ovaries are not functioning properly (and that is very likely) the cause of bleeding has to be searched for. Periods will stop only after proper treatment of the cause. Please check-out the article "Postmenopausal Bleeding and Its Significance" by J. Glenn Bradley, MD

Question:  I am 41 year old woman. Last year had surgery to remove an ovary and still have one.  I was dizzy or weeks following surgery and 6 weeks afterward had an attack of vertigo.  I have since had about 10 vertigo spells.  I asked my doctor if this could be related to a decline in hormones, she did only one FSH test and said it was normal.  Could the vertigo have anything to do with the removal of this ovary? Answer:  No, it can not.

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. 10/00