Ask The Expert

Ask The Expert

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


Doctor, Are these symptoms of Menopause?  

Question: I am in very early stages of menopause and am experiencing hair loss. Will this continue and is there any supplement I can take that will slow the hair loss down?

Answer: Hair loss is a tricky issue in the menopause. It likely is in part related to estrogen depletion but also has a genetic component to it. Often there is no treatment for it although there are some medications available that may improve this. Treatments like minoxidil cream may be helpful. Secondary illness need to be evaluated such as thyroid disease also. You should consider HRT, which may slow down hair loss.  This however is often genetically determined.  

Question: I've read several chat boards where women indicate they are also sick during menopause. Is it common for one to have bouts of nausea during menopause - I mean is that a symptom also like hot flashes?

Answer: This is not a common complaint as a woman transitions to menopause. However, it would not be inconceivable to think that the stresses of this transition on the body could be manifested as nausea. It would be important to investigate other causes of nausea such as gastric reflux, gallbladder disease, peptic ulcer disease, etc.

Question: I am 40 years old. Over the last several years, I have noticed that about one week prior to the beginning of my period, I start to have heart palpitations. They last up through the third or fourth day of my cycle, and then begin to diminish until the next month. Have you ever heard of anything like this? I also notice extreme fatigue during this time.

Answer: PMS has many manifestations. Arrythmias are not, however, a common manifestations. It is plausible that the hormonal fluctuations throughout the cycle and especially premenstrually can cause fluid shifts that may make the heart work harder. In addition the prostaglandin concentration rises which can cause vascular effects that may stimulate palpitations.

Question: I am a 54 year old female and I have excessive hot flashes. My doctor has changed my medication three times to no avail. I have to take three or more baths per day to feel clean. Is there anything maybe organic I can take or how do you feel about soy in my diet?

Answer: Often women resort to alternative treatments in this setting. High doses of vitamin C & E can help. Herbals available, although expensive, can help. These include black cohash, blue cohash, dong quai, chasteberry, evening primrose oil, ginseng, soy, wild yam root. Wearing loose cotton clothing, avoiding extremes of temperature, stressful situations, wines, hot drinks can also help. Certain medications cause hot flushing such as prozac and similar types. Some women do not absorb well oral estrogens. Blood estradiol levels sometimes shed light on the inability to control hot flushing.

Question: I am 50 years old and had both ovaries removed in Dec.99 (due to large cysts). I seemed to recover fast and with no complications. On March 17th I began to have what I am assuming were classic hot flashes. Rushing feeling of my blood from head to foot, down arms. Heavy sweating in feet and hands, extreme anxiousness, heavy chest. I did go to a doctor (not my own I was out of town), and they also found my blood pressure to be high. When I got home I went to my family doctor (couldn't get in to see my obgyn until next week), and he seems to be quite puzzled. He has increased my Estrace from 1MG to 2Mg, and I am taking a relaxant (Ativan .5mg). I am also on Atenolol 50MG for the High Blood pressure.  I was relieved to read that my symptoms seem to match those of hot flashes, however mine are quite severe as I am unable to function normally when I get these feelings. Just for background, I had a hysterectomy in 1977 for cervical cancer but my ovaries were left. I never had any side effects from that procedure. I have always been in great health. Any observations? Any input would be greatly appreciated.

Answer: Surgical menopause is very complex and often difficult to control the subsequent symptoms. It sounds as if you are having typical hot flushes. Often oral HRT is not well absorbed and often one needs to consider patch HRT. It may be wise to consider an estradiol level to help assess your absorption status. Also, typically speaking, HRT does not take away every hot flush. The cause of your hypertension needs to be evaluated as their are conditions which can cause this and also create hot flushing such as pheochromocytome, hyperthyroid.

Question: I am 36 years old, have had normal periods all of my adult life and I have really bad problems with PMS. My gyno put me on Prozac a few years ago though it seems to not be helping. This month, I had my usual PMS symptoms but no period, and I am having night sweats on a regular basis. I spoke with my pharmacist this morning and he suggested that I try soy isoflavones and black cohash. I have had 4 pregnancies, two of which ended in miscarriages due to lack of progesterone and had to use suppositories for the first 3 months with both of my children. Could this have something to do with menopause symptoms occurring early?

Answer: This is a PMS story. And Prozac is the only objectively proven cure for many women. No other proven medication exists. There is no scientific documentation about the use of black cohash or isoflavones in PMS. But you can try it. I am not aware of serious side effects of black cohash. And also soy is harmless.
Answer provided by Ronald Barentsen, MD, PhD

Question: I am 50 years old and stopped bleeding for 8 months and resumed periods after 8 months of no bleeding. Is this normal for menopause symptoms?

Answer: Yes, it is. All kinds of cycle irregularity are seen. It is possible that after 8 months of amenorroea, an episode of even regular periods follows. But usually it remains irregular. It is only after 12 months of no bleeding that the possibility of new periods is so small that we can tell you that we do not expect them anymore.
Answer provided by Ronald Barentsen, MD, PhD

Question: I had a blood test in December and the doctor said I was NOT menopausal had been having regular periods, but extremely heavy flow and cramps.  My last period was January 4,2000. I am 55yrs. What could be going on? I have had a laparoscopy. Any info you can share would help

Answer: Menopause by definition is no menses for 12 months.  The perimenopause is an undefined period of time prior to that.  It is heralded by irregular menses with variable degrees of menopausal symptoms.  Heavy menstrual flows suggest an anatomic problem with the uterus.  Perhaps you should have an ultrasound to look at the endometrium and architecture of the uterus.

Question:  I had a TAH/BSO on Dec. 2/99, I was on Levothyroxine at the time, and was placed on Premarin .625 in the middle of January/2000.  Been feeling terrible and have been seen by Gynaecologist, Endocrinologist, Family Doctor, all my blood counts are out of whack.  The Thyroid seems to have now gone into a hyperactive state, I was told by my Doctor to immediately STOP the Thyroid medication until next Monday when we will re-evaluate this again.  Why does there seem to be an interaction with the Premarin and levothyroxin?  I am reading conflicting reports out there on this subject and am searching desperately for some clarification on it. Any comments on this?

AnswerSurgical menopause can be very difficult to treat for the occasional women.  Often issues related around the thyroid and its metabolism are impacted by this "imbalanced" hormonal state.  Premarin can impact thyroid replacement by impacting its digestion in the liver.  Estrogens also increase thyroid binding globulin and can reduce active thyroxine available.  In the occasional person with an underactive thyroid (partially functioning) once estrogens are started a compensatory hyperthyroid state can result requiring adjustments in medication. 

Doctor, am I experiencing Perimenopause?  

Question: I am 37 and feel that I may be perimenopausal. My symptoms range from drying skin, to missed menses and the swelling and soreness of breasts with occasional depression. Are these signs of perimenopause and, should I get this checked out?

Answer: 37 seems a bit young for the perimenopause.  Remember many of the symptoms of the perimenopause are generic and can be related to PMS, stress, other diseases (thyroid). Again most of these complaints need further evaluation before labeling them as perimenopausal.

Question: I just turned 38 April of 2000 and have one daughter, age 1 1/2. I have a VERY LARGE fibroid tumor. Approx. 10 centimeters. We've been trying to get pregnant for the last 6-7 months. I went to the gyno this month for my yearly exam (thyroid and anemia and pap smear tests all came back normal) and she said I was ovulating so I went home and had relations with my husband. Now I'm 6 days late with my period and 2 separate pregnancy tests say I'm not pregnant. I'm not stressed so I don't think this is the reason. I have never missed a period. (Unless pregnant) Friends think I'm being ridiculous when I mention it might be perimenopause. Should I call the doctor or just wait to see if the period comes? How can I tell if it's perimenopause? I have had some sleep problems but not drastic. And occasional forgetfulness but nothing that's abnormal. And, I'm extremely moody. I also had all the symptoms that a period was coming - bloating, lower back pain, PMS but then nothing.

Answer: The average age of menopause is 51.4 years. Typically the perimenopause is some timeframe prior to this usually 2-3 years and is often associated with very irregular menstrual cycles and subsequently other menopausal symptoms. The climacteric refers to the timeframe associated with the transition from reproductive ovarian function to menopause and encompasses for most women the decade of the 40's. In your setting it would be important to repeat the pregnancy test at some point in time. If again negative then it would be equally important to observe what happens to the menstrual cycle. Many factors affect regularity. If you are not pregnant than most likely the proliferative phase of your cycle (that part prior to ovulation) was not truly 2 weeks and therefore the irregularity. At 38 it would be highly unlikely (but not impossible) for you to be perimenopausal.  

Question:  I am 43 years old. I used to have extremely heave periods to the point of hemorrhaging. I had something called an ablation about 3 years ago. Although my periods did not stop they have been much lighter. For the last six month, however, my periods have been longer somewhat irregular. This past month my period was almost 18 days long. In the middle of my period it stopped for a couple of days and then started up again (not heavy but still there). I have bloating, breast tenderness and the who works. My period ended last week and now just today, I could feel my breasts becoming tender, my stomach feeling bloated and low & behold I am now spotting! I talked to my GYN he says see what happens in the next couple of months. My last pap test was normal when I had my ablation he did an endometrial biopsy and it was fine. My GYN said maybe I should have another ablation biopsy or perhaps I should think about a hysterectomy. I feel that I am too young for a hysterectomy. I just read that irregular bleeding is NOT part of perimenopause. I thought that it could be. I actually thought many of my bleeding problems were hormonal. I am going crazy here. Any input would be greatly appreciated. Thanks.

Answer: Irregular bleeding is the most common complaint in the perimenopause. After an ablation it can be difficult to reconcile symptoms. Several problems can occur after an ablation. Not uncommonly a person will get a hematometra which can present as spotting through the month associated with cramping. A pelvic ultrasound/sonogram will help with that. Erratic bleeding needs to be evaluated. Usually one considers an endometrial biopsy and ultrasound/sonogram as first line. Often hormonal attempts to control erratic bleeding are tried prior to recommending surgical options.

Question: I would like to know if you associate dizziness/vertigo with perimenopause? I have had this for almost two years now and been to all the doctors and all the tests and no cause can be found. Was told it was all in my head and must be depressed. I have found A LOT of women on the internet with the same thing?

Answer: Dizziness and vertigo have many causes. Occasionally they can be associated with hot flushes.

Question: I am 35 years old and the mother of four. Approximately six years ago I had a tubal ligation.  About two years ago, I started to have an average of about a 25 day cycle.  Ovulation has become extremely painful.  I have become depressed, very fatigued, have insomnia that not even prescription medication has been able to help.  Within the past six months, I have skipped an entire month with no period, and then later had three periods within a six to seven week time frame.  I am constantly sore and achy.  Doctors are constantly telling me that short of a hysterectomy or the pill, there is basically nothing they can do, yet no one has ever really put a diagnosis on me.  I recently came across a brief  article about perimenopause.  In you opinion, does it sound like I could be going through this?  I would like something to tell my doctor.  Sometimes I feel like they just think I am crazy.

Answer: You probably are too young to be perimenopausal. Occasionally tubals disrupt the hormonal concentrations to the uterus and can change the menstrual cycle. Your complaints have many possibilities. A thorough physical exam with information on healthy living may be helpful.

Please be sure to check out new information at the Endometriosis Pavilion, PCOS Pavilion, and Chronic Pelvic Pain Sections concerning your symptoms.

Question: I am 49 and going through perimenopause. My main problem is "memory loss". Is this memory loss permanent with women or does it get better after menopause? If you can answer me, I sure will appreciate it. Thanks!

Answer: Memory loss is a common complaint in the perimenopause/menopause. It tends to improve as do most symptoms of menopause. You can help this by practicing memory techniques. Some herbals are purported to help with this. Hormone therapy nearly uniformly improves memory loss related to menopause.

Question: Can changing hormone levels during perimenopause also cause a change in bowel habits?

Answer: A change in bowel habit has many causes and implications that I would not want to label it completely as a perimenopausal phenomenon. This needs to be evaluated further.

Question: I have been displaying the symptoms of perimenopause for several years. Recently I've experienced severe aches in my joints, i.e., elbows, wrists, knees, etc. In the past these symptoms often indicated the oncoming of a flu-like bug, but I haven't become ill. I have recently noted an increase in my moodswings and night sweats; could these joint aches be associated with the perimenopausal process?

Answer: These are common perimenopausal symptoms but can also be related to other illnesses. If you are in the 45-55 years age group it would be more plausible. You don't mention your age. With the vague complaints you need to consider a full physical exam and evaluation prior to making any conclusions.

Question: I am a 43 year old woman. For the past couple of years, my menstrual cycles have been between 21 - 23 days and last anywhere from 4 -5 days. I also spot 1 -2 days prior. I have never missed any periods. I experience PMS the week before I start and am very crabby and can't control it. In the past couple of months, I have been waking up with night sweats and am just drenched. Could I be starting pre-menopause?

Answer: It appears that you may be experiencing symptoms related to the climacteric. This is approximately the 10 years prior to the menopause. Often I see worsening PMS with occasional other symptoms that mimic menopause.  Menopause tends to be a genetically determined event.  It would be helpful for you to know when your mother, grandmother, etc. went through the menopause.  This will be a rough estimate for you.

Question: In June 1999 I had a pelvic sonogram which showed a thickening of the lining of my uterus. In Aug. 1999 I had a biopsy, it was negative. During a follow-up sonogram in March 2000 I was told the lining had increased even more. My doctor wants to do a D&C . I have now experienced bleeding, I have not had a period in two years, I am 54 years old. I am experiencing severe anxiety at the thought of having a D&C. What options do I have ? I have never been told to have a blood test to see what my hormonal level is.

Answer: Thickened endometrium in the menopausal women is significant. The biopsy, although reassuring may not necessarily define the problem. Often thickened endometrium in this age group suggest an endometrial polyp. the usual evaluation of this includes a sonohysterogram in which a small amount of sterile saline is instilled in the uterus and a sonogram is performed at the same time. This will nearly always define a problem in the endometrial cavity. If something is present a hysteroscopic evaluation of the endometrium is generally recommended. This involves putting a telescope-like device in the uterine cavity and visualizing the endometrium. Problems can be specifically addressed.

Question: How irregular does your period get during perimenopause? What is the normal range between periods?

Answer: Often it is irregularity of the menses that first causes the perimenopausal patient to seek out assistance. In generally, the menses can take on any nature during the perimenopause. It can come twice per month followed by skipping months. the menses can be absent for many months and then all of a sudden appear. Only 10% of women experience cessation of menses without irregularity. Usual menstrual cycles can vary from 21-42 days.

Question: I am 43 years old. What are the symptoms of perimenopause, and when will I be entering menopause.

Answer: The average age of menopause is 51 years. Several years prior to this will be the time of perimenopause. during this time most women experience very irregular cycles followed by hot flushing. A woman is considered menopausal when she has stopped menses for 12 full months and is at the appropriate age.

Question: My wife is 45. About 6 months ago, she stated she was becoming depressed when around me. Further, she began making statements totally untrue about me, our marriage, our children's relationship with us, that had me completely baffled. A friend told me that perimenopausal women can become depressed, and the mind "attempts" to heal itself, and can quite literally "create" the reasons for the depression. Hence, the "false" statements about me, the marriage. Is depression possible in perimenopausal women? Is the depression chemically caused by decrease in hormones? Can depression be "cured" by the brain and it's attempts to create "false" images as described above?

Answer: The brain has estrogen receptors just as most tissues of the body. A women can easily experience mood swings and depression in the perimenopause especially as she approaches the complete cessation of her menses (the menopause). During the perimenopause there can be significant fluctuations in the levels of estrogen/progesterone/testosterone. Some people call this hormone imbalance. However you may be dealing with marital discord for which you may be unaware.

Question: Is it normal to have lower back and abdominal pain during ovulation while going through perimenopause? Also, getting a UTI?

Answer: Perimenopause is usually accompanied by less ovulation because the cycles are very irregular. Mittleschmerz, ovulation pain, is common in many women but not all. If your pain is midcycle, about 12-14 days prior to your next menses and goes away within 48 hours it may be mittleschmerz. Perimenopause would not be a factor that impacts mittleschmerz or significant abdominal pain. UTI are often related to poor drinking habits, not toileting often enough, and perintercourse. In the menopausal women with a lack of estrogen, UTI can be more frequent. Generally speaking, perimenopause is not a significant cause of UTI.

Question: I am 51 yrs old, am on the pills to alleviate hot flashes, insomnia and other symptoms of perimenopause. I have recently been experiencing heart palpitations, (they never occur during exercise) and they most often occur when I am lying down to sleep. I have been under some stress and have been diagnosed with MVP but all of this was under control until just lately. Are palpitations one of the symptoms of Menopause?

Answer: Palpitations are a symptom of the perimenopause/menopause and in part are related to vasomotor instability.

Doctor, am I experiencing Perimenopause?  

QuestionLast year I began experiencing dramatic symptoms including extreme fatigue, muscle and joint pains, painful intercourse, at least one bout of vasculitis, etc. Most of my symptoms seems somewhat consistent with RA, but I don't have the factor. These symptoms lasted for 8-9 months. About 5 months into this episode I stopped taking birth control pills when they had begun to give me high blood pressure (I always had 110/70 average before that time period, but the b.c. pills had caused it to fluctuate with highs over 160/110). My period did not come and I began to have hot flashes. A gynecologist ran a hormone blood test and said I was absolutely post-menopausal. He began me on estrogen therapy and my symptoms went away but my periods kicked in when they shouldn't have and ultimately I was taken off hormone therapy and put back on b.c. pills.

Answer few months ago I went off the b.c. pills, again because of my blood pressure. I am having periods, but they are not as regular as they used to be. 31 day cycle, 13 day cycle, 31 day cycle, 36 day cycle, with spotting in between. I am beginning to get a lot of pain with intercourse again even with use of Astroglide. The fatigue has returned as well and seems to be getting worse by the day, although is not nearly as bad as it was last year when I had to take to the couch by 2 PM. (Normally I am an over achiever and have lots of energy).

Last year I saw over a dozen doctors, particularly specialists, and no one was able to diagnose my problem in particular, although my gynecologist believes I am in perimenopause. But nothing seems to explain this life-altering fatigue. Otherwise, I am in good health, but do have lymphodema which is under control.

I want to know if I should expect that the fatigue in particular, as well as painful intercourse which is not mitigated by use of lubricants, is to be expected for perimenopause, or if there might be something else going on. Is there another type of specialist that I should see--or should I assume that these symptoms are what I need to put up with on my road to menopause. If my blood work so certainly proclaimed me "post-menopausal" is that normal or a signal of something else that should be looked into?

AnswerThis is a very complex set of symptom some of which can be perimenopause related but are not necessarily the average or normal set of complaints. I think it would be important to have a full physical exam and appropriate lab work done. The more common complaints in the perimenopause are irregular menstrual cycles with hot flushes. It is not uncommon to have an FSH elevated in the "menopausal" range and yet periodic ovarian function occur. This is the defining mark of the perimenopause and is responsible for the irregularity of cycles. It would be important to have your thyroid evaluated as often thyroid dysfunction occurs during the perimenopause.

QuestionI am 37 years old. I have had my period since I was 10. Lately I've noticed some changes that have me concerned. I feel hot and cold constantly, have mood swings to the point I blow up over every little thing, I've been having trouble sleeping and wake up at 3 or 4 in the morning and can't get back to sleep. I am still getting my period. My grandmother was in her 50's when she started menopause, my mother had a hysterectomy at age 45 and didn't go through any symptoms. Are these symptoms of menopause or could it be something else?

AnswerRemember menopause is defined as the cessation of menses for 12 months. Typically the onset of menopause is genetically determined. It is important in your setting to look at other reasons for your symptoms.

QuestionI am forty-four years old, healthy and active. I have had a regular, 26 day cycle for about 30 years but now I'm sometimes skipping periods altogether. I am not on any medication, I do not take the Pill. I had a tubal ligation a year ago. My doctor says that the blood test I had last week does not show that I am menopausal. If I am indeed perimenopausal, would that show up in the blood tests?

AnswerNormal FSH tells us a lot about ovarian function. But it is important to know that it reflects mainly the actual situation of today. Usually we take a sample on day 3 of the cycle to have an impression of ovarian function. High levels of FSH can be followed by completely normal levels during long cycles in perimenopause. Actually, FSH gives not much information.
Answer provided by Ronald Barentsen, MD, PhD


Question I'm 52 yrs old and I experience uncontrollable bleeding and huge clots. I also have fibroids. When the bleeding finally stops I'm so exhausted from the loss of blood, I think, I can hardly sweep the floor without resting. I normally walk briskly for about 4 miles per day. I am not on any type of HRT and have tried to pill for control of the bleeding which only made me bleed continually for 3 months. Is my only resolve surgery?

AnswerThe medicinal treatment options include progesterone, BCP, danazol, in an attempt to try to control the bleeding issues, iron is important also. If these treatment options are unsuccessful than only surgical options remain. If your uterus is of normal size and has no submucosal fibroids you could consider endometrial ablation. If the fibroids are the cause of the bleeding myomectomy (removing just the fibroids) is an option. Hysterectomy is the definitive option. An emerging treatment in your setting is uterine artery embolization. This is not offered everywhere.

Question My Dr. believed my (cycle day 3) FSH level of 43 was not a sign of perimenopause but a "reverse hormone feed back problem" due to the fact I am 80 pounds overweight. I have two questions please...Do you believe this theory? Does this mean if I lost weight my FSH level would go down and I could possibly conceive a child?

AnswerMy understanding is that a day 3 FSH > 20mIU/ml suggests impending ovulatory failure.  This needs to be correlated with age, symptoms, etc.   

Question 47 and experiencing insomnia with mild flashes, any suggestions?




Doctor, What should I expect from HRT?  

Question: I first took Prempro, but had problems with irregular bleeding and long periods, so my doctor switched me to premphase. I've been taking Premphase for 2 years and seem to be doing fine. I have very regular spotting after 8 days of the progesterin phase. My doctor seemed unconcerned that I was not having spotting after the full 14 days, I think because I am so "scheduled".

I recently moved to a new location and started seeing a new OB/GYN. My first visit was for a small complaint but after reviewing my history this new doctor seems very concerned about my "regular" spotting, saying that it should come after the full 14 days. She has ordered a sonogram which of course I'm hoping will be normal. But she's also talking about biopsies. I can't seemed to find literature about when spotting or periods should occur while taking Premphase. Can you send me guidelines? Thanks.

Answer:  Generally speaking, it is acceptable to begin bleeding about 3 days prior to when it is likely to happen taking premphase.  Very occasionally this premenstrual spotting suggests the need for more progesterone.  In the past, we prescribed 10 mg of provera.  Only recently that has changed, and now we prescribe first line 5 mg of provera.  This is the amount of Premphase. An ultrasound/sonogram is a good idea to rule out the possibility of an endometrial polyp. An alternative to immediate biopsy is to consider increasing the provera to 10 mg.  An endometrial biopsy is a reassuring method of determining the hormonal affects on the endometrium.

Question:  I had  a hysterectomy at 45 years old and am on 1mg of estrace which alleviates many of the symptoms. However, I still suffer from mood swings and depression. Any suggestions?

Answer: Often hrt is not adequate to improve mood swings and depression. Make sure you are living a healthy lifestyle.  that includes regular daily exercise which can improve the mood naturally. Eat properly and take vitamins, minerals, and antioxidants. Sleep regular hours, control stress, think positively. All things considered an occasional person needs assistance with an ssri such as prozac. Are there other reasons other then estrogen depletion that may be the underlying cause of the mood issues?

Question: I am a 37 year old female mother of twins through IUI using metrodin and lupron.  Took Ortho Novum to regulate menses which have never been regular for 4 to 5 years. Stopped taking in August because of headaches, pains in lower abdomen and raised cholesterol levels which I felt were caused by pills. Headaches and other pains lessened dramatically. Cholesterol levels returned to normal. Began getting periods with 36 to 42 day cycle for 3 consecutive cycles once off pill.  Now at day 77, no signs of pregnancy, home test confirmed negative, feeling very bloated, irritable and tired.  Also feel weight gain and have been trying to watch diet.  Would like to know some options before called GYN and immediately going back on pill. Any ideas?

Answer: It sounds as if you are anovulatory. The causes of anovulation are many: thyroid, prolactin, weight, stress, exercise (too much), etc. If this was your problem prior to IUI than it will not resolve without assistance. If one does not like the pill than progesterone only is an option. There are very few things you can do short of medicine to assist in menses regulation. 

Question: I am pre-menopausal and I have a family history of breast cancer, my sister died at 34 years old. I have heard that since my GAIL assessment is 2.9 I should go on something for prevention of breast cancer, someone mentioned Evista since I will not be getting the estrogen, how true is that? I know Evista has not been proven for breast prevention of breast cancer, but the data is promising. What do you think?

Answer: Unfortunately Evista is not approved for perimenopausal management. Also there is alot of controversy yet about the application of Tamoxifen in your particular situation. My best advice is to consult with an oncologist about your risks and the application of preventative management as understood with today's science.

Question: I am currently taking Premarin and would like to change because of the controversy surrounding its actual make up. My current gyn says that all hormones are alike. Is this true? I have had a complete hyst (ovaries, cervix, uterus, tubes removed).

Answer: There are myriads of estrogen preparations. Now that we know more about the estrogen receptor and its complexities, it is more and more apparent that not all estrogens are alike. The interesting point of premarin is that it has 10 different estrogens with the principal estrogen being estrone. As we learn more about the different effects of these estrogens at the receptor site in tissue, it may become more apparent that compounds with different types of estrogens my prove to be more beneficial. All of this, at this time is conjecture. Cinestin is a premarin like compound made from yams grown in Mexico. Estratab is an esterified estrogen made from plants. Estrace is estradiol synthesized.

Question: I have been taking Estrace for a few years after a hysterectomy. When I do not take the medicine for a few months I begin to experience debilitating and excruciating pain in the bones and joints throughout my whole body. Could you tell me what could be the cause for this pain? Is this a typical concern or complaint in menopausal women?

Answer: We do not completely understand this phenomenon. However, simplistically speaking all tissues of the body have estrogen receptors. In particular, synovial linings in joints have receptors. It is conceivable that a lack of estrogen decreases joint fluid causing them to be "creaky".

Question: I had a hysterectomy with removal of ovaries and uterus six years ago at the age of 48. I began 1.25 Estratest a few says after. About a month after starting HRT, I woke up feeling as if I had a terrible kidney infection.  For two years I saw two different doctors who tried to "adjust" my HRT, while I battled migraines, diarrhea, overall pain, and fatigue. At least 8 different brands of oral HRT were tried in different doses. Then the patch with different doses. Finally, injections were tried. All of this "adjusting" usually made me feel worse physically, and sometimes I would have to go to bed for 2 days to recover. I did not want to continue HRT because I felt it was causing or, at the very least, exacerbating my mysterious symptoms. Indeed, when I would stop HRT even for a few days, the symptoms seemed to dissipate; however, my doctors' answer to that was Prozac or Paxil, both of which robbed me of sleep and increased my pain (since the hysterectomy, I seem to be supersensitive to meds. For instance, now I can only take half a Sinutab, when I used to take 2 every 4 hours.)

In 1996, after 2 years of wondering what was wrong with me, I went to a highly thought of rheumatologist who ran some tests and diagnosed fibromyalgia. I asked him then if HRT could exacerbate my symptoms (migraines, diarrhea, overall pain, and fatigue), and he said he had never heard of that, though he did tell me that women with fibromyalgia who still have menstrual periods have a harder time between ovulation and start of menses.

About a month ago, I decided to stop taking HRT and see how I felt. I reasoned thusly: If fibromyalgia worsens for a woman once she ovulates, the condition must be sensitive to those hormonal changes. I wondered if my body was sensitive to the HRT pill I took every morning and its diminishment over the next 24 hours. It was a rough first week, but after that, I felt markedly better. The stiffness that had plagued my right side from the toe to under my armpit disappeared, and my daily backaches disappeared. It was the first time (in the winter) that I could bend over to pick something up and not wince. I also feel more clear in my mind and less fatigued.

Yesterday my doctor insisted I resume to HRT, despite the fact that it has reduced my chronic pain and fatigue by at least 75%. He says he will work with me until we find the right dosage.  I feel as if I am the only woman in the world with this problem.

Answer: You have a very complex and difficult problem. It seems that two things occurred at once in the setting you described. First you were made surgically menopausal. Secondarily, you developed fibromyalgia. It is unfortunate because the combination can make management of either more difficult. I think that you have done an empiric trial and have found that HRT doesn't make you feel better. The conclusion to that, in my mind, is that it is not for you. I don't believe that all women need to be on HRT. I believe you prove the point. There are other ways of managing the dilemmas of menopause (osteoporosis, heart disease, Alzheimer's, macular degeneration, etc.) Some people in your setting seek out alternative therapies which are abundant today. I would recommend that you seek out assistance from someone who is willing to listen to your concerns and past experience and create alternative approaches to deal with the issues of menopause in your setting.

Question: I am a 31 year old female who has recently been put on HRT following a total hysterectomy for endometriosis and I can not seem to find any information about the treatment I have been put on. It is called Ortho-Prefest. I would like to know what the side effects, drug interactions are and anything else that I should be aware of while taking it?

Answer: Ortho Prefest is a new formulation of HRT. It is a combination of 17 Beta Estradiol and Norgestimate (the progestational agent). The medication is made by Ortho-McNeil Pharmaceutical, Inc located in Raritan, NJ 08869. I would recommend contacting them or request from your doctor the package insert which reviews all of your questions.

Question: I have been on Prometrium TID for nearly 18 mos. I am 48 yrs old and have no symptoms of estrogen deficiency yet such as hot flashes, insomnia, etc. I was put on the Prometrium for heavy, prolonged menstrual cycles that rendered me anemic. I tolerated this med well, most meds I do not. The past few months I have noticed a period of 24-72 hrs of vague nausea and having a very quesy stomach at the onset of my period. One or two days into my period the nausea goes away. The feeling is much like that of "morning sickness" at the onset of pregnancy. I have had this symptom for the past 5 cycles, but did not think it could be due to hormone imbalance until recently. Reducing the Prometrium to BID or even QD this past cycle and extending to 10 days instead of the 7 days I take it 2 weeks after my last period began did not help. My MD had tried me on a low dose birth control pill prior to trying the Prometrium. I developed this same felling of nausea the first month and quit using them. What do you think?

Answer: This is a common complaint with progesterone supplementation. Prometrium TID is a high dose and can give this side effect. There are pills that address nausea such as estrostep. Often taking the pill at night can improve this symptom.

Question: I am 48 and have been experiencing perimenopausal symptoms for a few years. My periods became regularly closer together over the last few years although about twice a year I skip one and a few times have had extended periods lasting over 14 days.  I see my dr. regularly and had a pap last Sept.  At that time he prescribed the lower dose of the Combi-Patch which I used as directed for 3 months.  After being on it for approx. 3 weeks I began spotting, which I thought was a period starting, but it didn't end.  I spotted for 6 weeks and during that time had two 3-4 day time periods where the spotting became heavier and more like a regular menstrual period.  I also had extremely tender breasts.  Actually this was a new dr. I saw as my previous dr. relocated.  I tried in vain to get a call back from this dr. to no avail - his nurse said "just continue with the patch - your body needs time to adjust to it".  After 6wks I called my internist and she suggested I just go off the patch.  I was spotting from mid November until Jan 13th.  It is now the beginning of April or approximately 11-12 weeks since the spotting stopped and I have not had a period - should I be concerned or is this possibly just my "new" menopausal cycle?  Do you feel that it is necessary for me to see the dr. re this or it is o.k. to just wait and see? Thank you very much in advance for your help!

Answer: I think it is important to see your doctor.  there are many ways to accomplish HRT and you have only tried one.

Question: My mother is 45-years-old. She recently got her uterus removed. What medicine or hormone she should take to balance all the hormones after the removal of uterus?

Answer: Your mother will only have a hormone deficiency if her ovaries were removed at the time of hysterectomy.  If that is the case she would need estrogen to replace what her ovaries made.


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.

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