Ask The Expert
Ask The Expert
Q: My gynecologist tried to give me an endometrial biopsy as I had experienced some extremely small spotting between periods. I am 55 & beginning perimenopause (according to blood tests my gynecol. took). I have no symptoms of any kind or any other problems gynecologically or related to menopause. I am in very good health. He was unable to do the procedure as my cervix is narrow (I had one childbirth by C-section at age 38). Sometime later he scheduled a saline ultrasound and what he was able to see was fine but he once again couldn't see everything for the same problem of narrow cervix. He now wants to do a D&C. Unfortunately, I have had very bad experiences in hospitals, plus had 2 relatives die unexpectedly after going in them. I know you can't give advice but do you think I should get this procedure as I am afraid that it will involve cramping (as I have always had extremely severe cramping after other procedures such as a hyserosalpingogram years ago). Whenever I have been told a procedure is painless, I have found that to be not true in my particular case. I am an educated health professional who has undergone many tests in my lifetime, which on looking back seem needless as to the emotional and physical stress involved. Thank you for reading this. Your input will be appreciated.
A: Intermenstrual bleeding or spotting are signals for further analysis especially in the age of 50+. Vaginal echoscopy, endometrial biopsy and saline infused sonography are the easiest way to come to a diagnosis. But in about 5% of all women, these procedures are impossible because of a narrow cervical canal. Hysteroscopy under local or general anesthesia is the next step. Another way, with somewhat less certainty, but acceptable, is to test the endometrial situation with adequate amounts of cyclic progestagens. With progestagen (2.5 or 5 mg norethindrone or 10-20 mg MPA) in the second half of the cycle (day 15-24 or 26) one can regulate the periods. When intermenstrual bleeding is over with such a regimen, the likelihood of endometrial pathology is extremely low. With persistent intermenstrual bleeding in such a regimen, a hysteroscopy and D&C is absolutely necessary.
Q: I am a 33 year old woman. I discontinued birth control pills 10 months ago hoping to try to conceive. I have not a period since that time. I have however been diagnosed with hypothyroidism and currently am being treated for about two months. I had an MRI which showed a small mass in my pituitary gland. The doctor said it was small and I should come back in three months to make sure it was not a tumor. My estrogen tests have also been low. I have tried Prometrium and Premphase to induce withdrawal bleeding, but they did not produce periods. What should I do next?
A: This is not a question of menopause. This is an endocrinological disease, probably an adenoma in the pituitary gland. The treatment for desired pregnancy depends on the several hormonal systems involved with a pituitary disorder. Please consult a gynecologic reproductive endocrinologist/fertility specialist.
Q: I am 35 and have experienced changes in cycles such as over the past few years have noticed a great decrease in men. cycle. Within the last year have developed adult acne, some weight gain, night sweats(1 or 2 days a month, especially right before my cycle or at ovulation.) Also hot flush feelings at times. My cycles are only a length of about 36 hours or so. And within my last cycle only 2 weeks later I began to spot some, which I have NEVER done before. I'm starting to wonder if I could be showing signs of perimenopause? I just had a complete physical and all is well. I also wondered does menopause have anything to do with heritage?. My mom was in full menopause by the age 42. Thanks.
A: The menopause (date of last menstrual period) is determined mainly (for 85%) by genetics. With your mother in early menopause, it is likely that you will experience early menopause too, but it is not absolutely certain. Many women experience changes in their periods long before perimenopause starts.
Please check-out this article related to your question, "Perimenopausal Bleeding - what's normal?" by Paul D. Indman, MD
Q: I have been suffering from a severe vaginal inflammation. I am 66 and have had this for several years but not this severe. No discharge but severe vaginal burning. Is this part of being old?
A: This symptom is probably caused by atrophy. Local estrogens can be helpful in this condition. Burning without discharge can also be a symptom of several diseases, as lichen sclerosus or VIN (vulvar intraepihelial neoplasia). If the symptoms persist with the use of estrogens further analysis is necessary.
Q: I have panic and anxiety disorder for which I take lorazepam (3 mgs daily). I've recently had a hysterectomy (TVH/BSO) and am finding that my anxiety is much worse. Is this directly related to the hysterectomy?
A: The reason for hysterectomy, and the circumstances around the hysterectomy can also be important for the reaction. Maybe it is the bilateral oophorectomy and the estrogen deficiency when BSO was performed before menopause. But usually panic and anxiety disorders has to be treated accordingly and not with hormones.
Q: Last month I was diagnosed as having premature menopause, at the age of 35. My estrogen level was 43, FSH also very low, can't remember what it was. My last normal period was October 6, 2001. I have an eleven year old daughter and had a miscarriage five years ago. I did see an endocrinologist following hormone level tests, and will see him again in January to discuss the results of more elaborate tests I had done and also to discuss hormone replacement therapy. If I were not going through menopause, my period would have been due last week.. I am now experiencing lots of pelvic cramping, fatigue, and most significantly, nipple tenderness--to the point that it wakes me up at night. Are these symptoms that are part of the perimenopausal phase, or is it possible that I could be pregnant?
A: Low FSH is NOT compatible with menopause. You experience a so called hypogonadotropic hypoestrogenic condition. Your endocrinologist will certain look at several systems for the cause. With menopause very high FSH levels are observed.
Q: I am a 41 year old woman and think I may be experiencing menopause symptoms. Many women in my family went through menopause between the ages of 38 and 45. My question is, can fever be a sign of menopause? I have had a fever for almost two weeks between 99.2 and 99.6 degrees- the first week before my period and the week of my period. Can this extended fever be associated with menopause?
A: No, it is not.
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.