Ask The Expert

Ask The Expert

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

Doctor, am I experiencing Perimenopause?   

Question: I am 53 years old.  I have regular periods every 25 - 28 days, lasting 3 days (since I was 13), but the last two to three months I've been spotting before and after my menses.  I have mood swings and cry easily, no hot flashes. Any ideas?

Answer: Maybe it is perimenopause. The change of your periods could be explained by anovulation. Mood swings are, as you know, often seen during the change. When spotting is disturbing you, this kind of bleeding problems can be cured by a cyclic course of a progestagen on days 14-26 of each cycle. When spotting occurs without any relation to menstruation, a gynecologic investigation is necessary.

Question:  Is it possible at 47 and having menopause but now getting periods back again to conceive?

Yes it can. The possibility of pregnancy is present as long as there are periods. But with irregular periods the change is low. But also low changes are real. Use contraceptives until 12 months of amenorrhea to become certain.

Question:  I was wondering if thyroid levels can change due to perimenopause. And can thyroid levels fluctuate due to perimenopause? Is breakthrough bleeding common in mid-cycle?

Answer:  Thyroid levels are not influenced by perimenopause. Breakthrough bleeding in mid-cycle is uncommon. Sometimes we observe a spotting just before ovulation in midcycle because of the decrease of endogenous estradiol on that time. But that is not breakthrough bleeding.

Question:  I'm almost 39 years old, mother of a 15 year old, and a heavy smoker.  I've been experiencing mood swings and water retention for the past year.  Recently (past 3 months) I've been having "hot flashes" during the day, about once every other week, which leave me drenched and then dizzy (and occasionally nauseous).  My period came a week early this month, which is a very unusual event for me, and the "night sweats" have begun.  I've always had problems with arthritis, but, this too, has been more of a problem lately.  My mother started having similar symptoms at age 40.  I had felt that I was too young to be going through perimenopause, so I've been ignoring these symptoms.  I'm also extremely nervous, especially before my periods.  Should I call my doctor?  What kinds of tests can he do to determine if I'm perimenopausal?

Answer: An increase of FSH can be a sign of perimenopause, but FSH levels can fluctuate enormously. At the age of 39, the start of perimenopause can be completely within the normal range. It is early, but not too early. In some women perimenopause can last for 10 years. And because of your mothers history, you have to deal with this possibility. Also anxiety problems can provoke night sweats and that has nothing to do with perimenopause. You have to talk about this with your doctor.

Question:   I am 39 years old and have a long history of problems with my periods, prolapsed uterus etc. I have had hot flashes, night sweats, for years and my period was very heavy. But for the last 6 months I have had very mild periods, from 5-7 days down to 3 maybe 4 and very light. And the night sweats have gotten worse, as has the emotional rollercoaster I have been on. My Dr. doesn't think I am old enough to be in perimenopause, but all the females in our family had a history of early onset menopause, and most had a hysterectomy by 40. During my last pap my Dr. thought I had an enlarged uterus. Although I felt fine. And sent me for an ultrasound test. They did find some small fibroids. And I feel heavy in the uterus, similar to being pregnant. I haven't had any midcycle or severe bleeding. My weight dropped from 156 to 145, my hair is shedding and that concerns me. Am I entering perimenopause? And should I go ahead and have a hysterectomy. I don't want to worry about recurrence and more procedures later on. I've had enough problems with my female anatomy already!  I had gallbladder surgery a year and a half ago, and have had chronic diarrhea, and take Questran light every day. Luckily my gyn found colitis and put me on antibiotics that cleared it up. Now this! Is there any connection to the Questran and colitis and now fibroids?  Thank you so much for this site and your help.

 Fibroids are very common. About 20-25% of white women have one or more fibroids at the age of 40. Sometimes fibroids cause complaints: heavy bleeding and/or heavy feelings low in the abdomen. Only the complaints are an indication for hysterectomy, not the presence of fibroids per se. But with a prolapsed uterus and abdominal complaints maybe a hysterectomy is indicated. You have to discuss that with your own gynecologist. It is not possible for me to advise on hysterectomy. Questran has nothing to do with fibroids. I do not recognize perimenopause in your story.

Question:  I am 47 1/2, have had normal periods occurring every 21-23 days. I missed a period in dec 99 for the first time. I Jan I had a period that lasted 6 weeks. This brought me to the gynecologist. He gave me 5 days of Depo-Provera. The following month was normal then I missed again and had a 3 week period of various flow and colors. I went back to the gyno who drew fsh and estridiol levels. The results showed that I was not in menopause (fsh a little elevated estridiol normal) and he said that there was no need for hormone therapy. Now I am having another heavy period almost 2 weeks now. Should I worry about this? at least 6 woman I know so far in my age range have had hysterectomies for heavy bleeding, I prefer to keep my uterus but am worried about this heavy bleeding. Is it an expected occurrence in perimenopause?

Answer:  This kind of bleeding is called dysfunctional bleeding. A shortage of progesterone and not of estradiol is the cause. Because the cycle is anovulatory no progesterone is formed. The condition can be made better (regular cycle, less bleeding) with regular courses of progestagens in sufficient dose. Taking Provera (at least 10 mg, maybe more; in Europe we have a lot of better progestagens for this condition such as norethisterone) monthly from day 15 to 26  (the first day of the bleeding is day 1) will regulate your cycle with a withdrawal bleeding 1-2 days after stopping the progestagens as long as your ovary produces estrogens. When no estrogens are produced (after menopause) no bleeding will occur after the progestagens.

Question:  I have been on hormone med. at least 15 years I am 44 years old, also had complete hysterectomy do I have to stay on hormone medication for ever?  I would like to stop due to weight gain.

Answer:  Estrogens do not cause weight gain. During the 40s the basal metabolism needs less calories than earlier (a little bit less). With the same diet and the same amount of exercise you will have a little bit more calories than your needs and weight gain occurs. And many women are not as active during their 40s than before, and usually they consume the same. Without ovaries it is important to continue the use of estrogens at least until the age of 50 i.e. the median age of menopause. Early menopause without estrogens places you in an extra risk for cardiovascular disease.

Question:  I am 47 years old who had a stoke at the age of 40. I am unable to take any estrogen product. I have just started to experience night sweats, irregular periods, mood swings and exhaustion. I work 50 - 60 hours a week at 2 different jobs.  I get enough exercise and I eat well, what else can I do to make this transition more comfortable?

Answer:  What kind of stroke was here? There are to kinds: thrombotic stroke or hemorrhagic stroke. Estrogens can cause thrombosis in women with inheritant coagulation disorders. But otherwise there is no reason to abstain from hormonal therapy. Clonidin can diminish flushes. Also Prozac can be helpful according to some experts but this effect is never published. Regulation of your menstrual cycle by taking progestagens from day 15 to 26 will also diminish climacteric complaints. But there are some doubts to use medroxyprogesteroneacetate (Provera) for that. Other progestagens, like norethisterone or megestrolacetate are excellent in that respect. And progestagens are not blamed for thrombosis.

Question:  In May I experienced burning mouth syndrome.   Since I was experiencing stressful times and conflicts within my family, I began to take Prozac as I had done in the past.  I had been off Prozac for about a year and proceeded to take 40mg/day.  I had never dosed this high, as my body seemed to respond well to 20mg.  Up until this point in time my periods were sometimes scant and sometimes heavy with flushing.  I never really knew how each month would play out.  Since the onset of the burning mouth (3 months ago) my periods stopped.  I am also experiencing a loss of libido. My problems with depression and OCD have lessened, although I continue to experience thought disturbances and distortions.  I am wondering if this cornucopia of symptoms is indicative of menopause?  I am 48 years old and began periods at 10 years of age.  I have three children and have had recurrent periods of depression/OCD for the past 20 years.  Thanks very much for your guidance and expertise.

Answer:  Burning mouth is a difficult problem. There is a possibility that low estrogen levels have something to do with that. Maybe it can be checked by your doctor. When your estradiol level is low, you can try hormone replacement and determine if it cures your mouth problem. With adequate estradiol level, this cause is ruled out. Burning mouth can also have psychological causes.

Question: I am a 47 year old woman who was recently diagnosed as being perimenopausal. For months prior to this I have experienced extreme fatigue, memory loss, slurred speech, memory loss.  My first approach was a neurologist who suggested it was due to stress and perhaps my cold turkey approach to coming off aspartame after over 25 years of strong addition to diet coke.  I am on paxil which has addressed some of the system and my OB/GYN has put me on a birth control pill specifically for perimenopause.   My question is about "brain burn".  Sometimes my entire brain felt as it was on fire.  The only relief was sitting with a fan at my head.  My entire head was wet with sweat (dripping wet) by was not I was not sweating anywhere else!  This was accompanied by strong fatigue and a lot of crying for no reason I could determine.  Since then it seems to be just portions of my brain and usually bilateral, both fronts, or back or sides.  This is truly frightening.  Could this be a system of perimenopause and if not, do you know of any other leads I could pursue.?

Answer:  This symptom is quit unusual. It is not on my list of symptoms. And I am afraid that I cannot help you. Perimenopausal problems are usually completely cured by birth control pills as your OBGYN advised. And when that symptom still exist, it is almost certain that it has nothing to do with perimenopause.

Question:  Is fatigue a symptom of pre-menopause?  I get about 8 or 9 hours of sleep each night and I can't seem to get going.  My periods have been erratic.  I am 49 years old?

Answer:  Are you sure that it is not anemia because of heavy bleeding? With good sleep there is no reason to blame perimenopause other than by bleeding problems. There are a lot of causes of fatigue. Consult your doctor.

Question:  I am 45 years old. For several months, my periods have grown a couple of days further apart and lighter. But, this month it grew heavier and was relentless for days and days. An M.D. gave me Ortho-Novum to see if my system would respond to birth control bills. He said he suspects  that I am perimenopausal. He advised me to take 4 pills the first day, 3 the next, then 2, and finally take one pill a day for three months. He said it should regulate me. The doctor told me that if the bleeding continued that he would do a biopsy (I had a negative pap smear less than a year ago). How long should the bleeding last? I am taking Ibuprofin for Arthritis, Buspar, glaucosamine, and Furosimide for blood pressure?

Answer: This story is typical for anovulatory bleeding and this is seen very often during the forties. The  treatment with Ortho-Novum is also a good one and you can expect that it will control the problem. When spotting continues. Stop the Ortho-Novum for a few days. A withdrawal bleed will occur and start again with one pill a day. Either for a month like the normal way for birth control pills or for three months.

Question:  I am 52 have been told that I am in early menopause.  I didn't have a period for several months, then had 2 in one month, next month was a normal period for me, but this month was 5 days of spotting followed by 7 days so far of a heavy period.  Is this normal?

Answer:  Yes, this is a normal pattern. You can expect all kinds of bleeding patterns during the climacteric.

Question:  I am turning 36 years old this fall.  Though there is no history of perimenopause in my family I have plagued will irregular cycles recently.  I have the occasional hot flashed and the mood swings.  I spotted the entire month of July, thought I had a normal 5 day cycle in starting August 13th and have just found myself beginning another cycle on August 24th.  I have not been tested for perimenopause. Do these sounds like symptom's or could I just be having a series of irregular cycles?

Answer:  This pattern is not normal nor perimenopausal. Between 13th and 24th of August there are only 11 days and that is not compatible with a normal cycle. Consult a gynecologist for further diagnosis.

Question:  I'm 42 and for the past two years have had several (10) cases of vertigo.  Could this be related to perimenopause or menopause?  I have been to a neurologist and an ENT and they have found nothing to explain the dizziness. The other day I had 12 women (ages 36-45) at my house for a meeting and someone mentioned having a bad case of vertigo the week before.  Once the subject came up there were five of us that had periodic cases of vertigo and all of us started having the symptoms sometime after the age of 38.  Our cases range from mild to severe.  Until this conversation I thought it was just me - now I'm wondering about all the other women who are experiencing this and how much it is related to age and the aging process.  Any thoughts?

Answer:  No idea. It is not possible to have an idea on an isolated symptom. Especially as a neurologist and a ENT specialist has found nothing at all. And vertigo is absolutely a neurological symptom.

Doctor, am I experiencing Perimenopause? 

Question:  What is the difference between menopause and perimenopause?  I am suffering from hot flashes, night sweats, heart palpitations, dry eyes, irritability and sensitivity, crying for no reason, dizziness, etc.  Of course, not all of these symptoms are constant, they come and go.  Answer blood test showed that I have the estrogen level of a "post-menopausal" woman.  What is going on?

Answer:  Menopause is the last menstrual period and is diagnosed in retrospect after 12 months of amenorrhea. Perimenopause is the period around menopause, starting with irregular periods and ending 12 months after the last menstrual period.

Please check-out "Menopause, Perimenopause & Postmenopause:  Definitions, Terms & Concepts" by Peter Kenemans, MD, PhD

Question:  I just turned 40 and for about the last year I have had noticeable health changes.  My periods were coming anywhere from 3 to 5 weeks apart and lasting only 3-4 days.  Now they are back to about 4 weeks apart, but last only 2-3 days.  Also, I was having significant abdominal bloating a few days before my period and also extreme breast tenderness.  Those symptoms continue, but now start earlier in my cycle and last longer.  I have been taking Wellbutrin for about 3 1/2 years for depression, but in the last year I also started having about 1 day of severe moodiness and nearly uncontrollable rage a few days before my period.  My psychiatrist has started me on an extremely low dosage of Zoloft (12.5 mg) (in addition to the Wellbutrin) to counter the rage and it seems to be working.  I frequently wake up at night feeling either uncomfortably hot or cold and I have feelings of abdominal pressure or nausea when I lie down at night.  Do these sound like symptoms of perimenopause?

Answer:  This symptoms are a part of the premenstrual tension syndrome, not perimenopause. The cause is probably a disturbance of serontonin. Serotonin reuptake inhibitors do help.

Question:  Are there specialist who deal only with menopause and symptoms?  I have been to doctor after doctor and taken antidepressant and different estrogen replacements. I had thyroid surgery last fall and went on hormone replacement several months before.  I have spent the last year bouncing around from Ob-Gyn to endocrinologist to psychiatrist and feel worse than I have ever felt with mood swings, crying episodes.  Any suggestions would greatly be appreciated.

Answer:  Every gynecologist has to be familiar with (peri)menopause, but some are more familiar than others.

Please check-out "How to Find Doctor Right!" by Aniruddha Malpani, MD

Question:  I am 42 years old.  7 years ago I was treated for Graves Disease.  I have been hypothyroid for almost 6 1/2 years and am currently taking synthroid and cytomel.  Having a normal level of thyroid has not been easy for me over these years.  Suddenly this month my periods changed....and I started again today for the 3rd time this month.  I have noticed that I am overheated at times, but that can occur with thyroid issues.  Can this be perimenopause?

Answer:  There are lot of reasons for bleeding problems and bleeding three times a month needs further investigation. Consult your doctor.

Question:  At age 38 my doctor said I was perimenopausal.  I am now 42 and have not had a period for 1 year, but fsh test show that I am still in perimenopause.  What could be making me not have a period for so long? I still have mood swings  and I am tired most of the time. I feel like I have PMS all the time.

Answer:  Maybe high prolactin or other endocrinological disorders.   What is the perimenopausal FSH level? What is the level of estradiol?

Question:  I have had 2 miscarriages in the last 6 months and I am 38 yrs. old. I had an endometrial biopsy done & it indicated I have a luteal phase defect and then I had an FSH level of 35 on day 9 of my cycle. Could I be entering menopause and if so what are my chances of having another baby?

Answer:  FSH can vary enormously. A day 9 level is not the proper one for diagnosis. We prefer a day 3 level for pregnancy prognosis. The change for miscarriages increases with age. High FSH on day 3 makes the change for a new pregnancy low, but it happens from time to time.

Question:  I am a 48 year old Caucasian female, married 8 years, no children.  My menstrual cycle has recently shortened from a consistent 27 days to 25 days.  I understand this could be the beginning of the perimenopause phase of my life.  I have been experiencing periods of memory loss.  Is this part of perimenopause?  I am also experiencing unevenness in my disposition or mood.  Is this part of perimenopause? After an extraordinary 30 + year sex life I now have diminished (or no) libido.  Is this part of perimenopause?  I am also experiencing frequent insomnia.  Is this part of perimenopause?  Could this be diminished testosterone?  Do you have suggestions regarding these perimenopause questions that I can present to my health care provider?

Answer:   You have many questions at a time, but there is no reason to consider a decrease of testosterone as a cause of a changed sex life. Testosterone will remain at a constant level until far after menopause. Also memory loss is a questionable symptom. Your mood swings are compatible with perimenopause.

Question:  I am a 30 year old experiencing changes in my monthly cycle that have been worsening since age 28.  I have extreme mood swings in a matter of moments.  My periods are heavy with clotting for two days, stop completely for 1 to 2 days, then begin heavily again (cramps and all).  Sometimes this occurs more than once during my period, extending the menstrual cycle up to 12 days.  During ovulation week, I am nauseated with unusually painful cramping.  I have virtually no sex drive, which is a major change for me.  I am on no medications except for Prevecid (for GERD).  Am I going into menopause or could something else be the cause of these symptoms.  I cannot tolerate birth control pills.

Answer:  There is no reason to consider perimenopause as a cause of your problems. You have to decide yourself to take birth control pills or not. But they are excellent for cycle regulation and for ovulatory problems. Periods of 12 days are not normal. Do you have consulted a gynecologist for that reason?

Please check-out the PCOS Pavilion for more information about your question. 

Question:  I'm 44 years old had my tubes tied 19 years ago. I've missed 3 months of periods is it possible that I'm pregnant or is it more likely to be menopause?

Answer:  The possibility of pregnancy still exists after tubal sterilization. The change becomes lower with age, but you have to check it.

Question:  I am 43 years old and had a partial hysterectomy at the age of 25 (the doctor left one ovary).  For the past year I have been having occasional night sweats. My sleep has really been disturbed by this.  I also get a little nauseated with this. Since I do not menstruate how would I know if these were perimenopausal symptoms?  I talked with my Gyn doc last year and asked him to do a hormone level but he said that it wouldn't indicate perimenopause.  Should I ask for hormone replacement?

Answer:  Perimenopause can be diagnosed by a FSH test. With one ovary it is not unlikely to experience menopause earlier than the mean. You have typical perimenopausal complaints and I suppose that your ovary is not working as good as in the past. With estrogen replacement your nightly flushes will disappear and sleep will be better again.

Question:  I am 50 years old and I am in excellent health and physical shape. I have  been on HRT for 6 years. I have a great deal of breakthrough  bleeding every day. Is there a better regime that I can try? My gyn history includes endometriosis and infertility (I took Danazol 20 years ago), left oophorectomy, resection of right ovary for endometrial tumors at age 30 and at age 32. At what point is hysterectomy recommended?

Answer:  I can never recommend on hysterectomy only with a history. There are a lot of other relevant considerations before such a decision. You are using a continuous combination of estrogens (premarin) and progesterone (prometrium) and with such combinations erratic bleeding is often seen. Alternatives are birth control pills, or sequential combined HRT such as Premphase.

Question:  I am 46 year old still getting my periods, but notice that I get migraine headaches with my period. What Should I do ? Do you have any natural treatments? Also what labs should I have to find out if I'm perimenopause and when should I have the labs drawn in my cycle?

Answer:  Menstrual migraine is a rather common problem. During that time estrogen levels are low. Sometimes the use of estrogens during that week will be helpful e.g. a one-week patch during the menstrual phase of your cycle. Perimenopause can be diagnosed by elevated FSH, but such a determination is not really useful. FSH can fluctuate enormously during perimenopause and it will tell you nothing about what to expect with the menstruations.

Question:  At what stage of menopause will I be unable to get pregnant?  

Answer:  You can never say never, but after 12 months of amenorrhea there is almost no chance to become pregnant again.

Question:  I am 36 years old and I am in good health. I have been spotting up to 2 weeks before my period starts and my periods are coming sooner. I also have been experiencing a lot of gas pain in the 2 weeks prior to my period. Approx. 1 week before my period, I also suffer from indigestion, which worsens 1 to 2 days before my period starts. Am I experiencing Perimenopause symptoms?

Answer:  It looks like Premenstrual Tension Syndrome.

Question:  I am 53, had a hysterectomy 5 years ago for heavy and extended periods. Right ovary removed also, hot flushes commenced and increased by stress, especially severe emotional stress, but also physical stress, like late night or illness, but can be absent for months on end.  Only other symptoms weight gain, especially on stomach, irritable bladder, and loss of libido. My skin is still oily, and I have very few lines. I am on thyroxin for longstanding Hashimoto's disease.  Am I perimenopausal as I think I must be, and without periods as indicators, how can I tell when the process is complete? Many thanks.

Answer:  Yes, you are perimenopausal. The process is complete when symptoms are over. There is no other way than waiting for that. No diagnostic test available.

Question:  I am a 51 year old woman that has been diagnosed as perimenopausal, but I was given no hormonal tests or any other exam.  I went to the doctor because I had two irregular periods,  and fibrocystic breast problems.  However, I have none of the typical perimenopausal problems.  I am thin and in good shape (due to regular exercise) and have no other health problems.  What I want to know is how can one be diagnosed as perimenopausal when one does not have the typical symptoms. Does age 51 always mean perimenopause?

Answer:  Perimenopause is defined as the period before menopause with irregular menstruations. No complaints are necessary. Sometimes women have no complaints at all during the total perimenopause. At the age of 51, irregular periods are nearly always a sign of perimenopause. No tests are necessary, no tests are conclusive.

Question:  I am 44 years old a mother of 4. Have had one ovary removed, one tied 11 years ago. And in the last month I have had 2 periods first one in the beginning of the month flow was heavy, the second one, the second week of the month flow was heavy 11 days later still light bleeding. My breasts were not tender with the first period but with this second one am in pain all the time especially if they are bumped & they hurt when I take off my bra. Is there a medical reason for this such as menopause? Or is there an under-lying problem?

Answer:  You have had now one strange bleeding period. Maybe this is the start of a period of irregular and heavy bleeding, that needs thorough investigation. Maybe it was just once an anovulatory bleeding: a breakthrough first and two weeks later the anovulatory menstruation. Wait and see what happens next time. And if it is again an abnormal bleeding, consult your physician.

Question:  I am a 43 yr old woman.  This month I had a positive home pregnancy test on day 20 of my cycle then negative the next day.  I was told that perimenopause could cause false positives.  What happens during perimenopause to cause this?

Answer:  High levels of LH (Luteinising Hormone) can cross-react with the pregnancy hormone hCG,  hCG is tested in pregnancy tests.

Doctor, am I experiencing Perimenopause?   

Question:  I am 49 years old...when are these hot flashes going to stop? I started having them at 46. I currently take a product called Hot Flash (soy) it certainly reduces the number of hot flashes. With HRT I was hot 24 hours a day. So...when?

Answer:  No one can tell you how long you have to go. Some women experience no hot flushes at all, and others have problems with it during more than 10 years. In about 25% it is at least 5 years.

Question:  I had my lh/fsh levels checked. My lsh was 3.5 and my lh level was 2. I am 53 years old and had a partial hysterectomy 12 years ago. Should I worry that my levels are so low? I exercise regularly and eat a lot of soy but  shouldn't my levels be near post menopause numbers?

Answer:  Those levels indicate that you still have working ovaries. Be happy with that. Certainly no reason to worry about.

Question:  When I am on regular doses 21-day pack of Orthocyclen, is it normal to have breakthrough bleeding that starts 5 days before I usually start that is very heavy and goes on for a week or so from missing only one pill?  Is it normal to have mood swings and depression that rival that of my pre - pill phase and breast tenderness and swelling so severe I can barely stand to wear a bra? Is it normal to have all these signs and symptoms occur even though I am on the pill?  My energy is so zapped all the time and I am tired of feeling like this to the point I am thinking about finding a Gyn that will give me a hysterectomy.

Answer:  Many women experience an increase in blood loss during the years before menopause. With birth control pills these bleedings are seldom as heavy as you describe. It is a reason for further investigation. Fibroids are often seen with problems like that, or endometrial polyps. With vaginal ultrasound these conditions can be diagnosed.. Furthermore problems in clotting should be checked, and thyroid disturbances. If those tests are all normal, treatment with endometrial destruction can diminish the amount of bleeding enormously. The other symptoms direct to the premenstrual syndrome. These symptoms can not be cured by hysterectomy!

Please check-out the article "Perimenopausal Bleeding - What's Normal?" by Paul D. Indman, MD

Question:  I am 46, and this last period took 46 days to come.  I have always been 28 day cycle.  It wouldn't stop, and I had a D&C and hystop. test, which came back normal.  It did show ovulation.  Now 11 days later , and after an internal which started the clotting, I have been bleeding extremely heavy with large blood clotting.  Dr. put me on low dose bath control pills also. What is going on and what should I do?

Answer:  Your doctor has done already the necessary investigations. Although ovulation is detected, probably it was not a proper one with an insufficient luteal phase. The story is that of perimenopausal dysovulatory bleedings. Low dose birth control pills are excellent to regulate that. 

Please check-out the article "Perimenopausal Bleeding - What's Normal?" by Paul D. Indman, MD

Question:  My period hasn't come yet and my periods only last for 24 hours or 48 hours not very much blood at all when I do get it so I was wondering if I could be having the change or not. My other symptoms are loss of sexual desire, mood swings, and semi- hot flashes?

Answer:  I do not think that it is menopause. Menopause is extremely unlikely at the age of 30. Probably other ovulatory disturbance is the cause. Maybe pregnancy? Maybe polycystic ovaries? Maybe high prolactin levels? When a normal cycle does not return soon, consult your doctor.

Please check-out the PCOS Pavilion for more information about this question.

Question:  I am a 43 yr. old female whose mother went through menopause at age 43, so naturally I'm worried that's what's happening to me.  For the past year now I've been awakened each night, several times, by night sweats. I also have severe insomnia, depression, mood swings and absolutely no interest in sex.  My vaginal lining is extremely dry so sex is very painful.  I'm having sever memory loss and hair loss.  For the past 2-3 years, I've started having problems with facial hair on my chin and on my upper lip and the hair even on my arms is turning black even though it was blond.  Now my periods are now getting closer together as in 20 or 21 days and only last maybe 3 days instead of 5.  I'm on Synthroid 88 mcg's for hypothyroidism since Oct. '96.  I'm also very fit. The worst is the horrible sweating, sometimes even during the day, and the constant insomnia. I'm so tired of being tired!  Do I need to have the blood levels drawn and see if I'm perimenopausal or does sound anything like it?

Answer:  Your history is a one of perimenopause. With birth control pills you can regulate your cycle and probably all other symptoms will disappear.

Please check-out the PCOS Pavilion for more information about this question.

Question:  I am 46 years of age.  I have been suffering for 9 months with terrible anxiety since my cycle has become irregular.  I have been on HRT which makes the anxiety worse.  I have terrible tenderness in my breast.  My medical doctor now has me on buspar 10mg, and atrivan 1 mg.  Is there something I can do about the hot flashes and night sweats and palpitations?

Answer:  Hot flashes and night sweats and palpitations can be part of anxiety problems. When HRT does not resolve the problems, you have to consult a psychiatrist for treatment of your anxiety attacks.

Question:  I just turned 40. At 37 my fsh levels were 42 , 32 and 42. Perimenopause was the diagnosis. I have been on lo/estrin for the last year but I still get periodic hot flashes. My question is... For the last 2 cycles I have not had a "flow" for a period just a spot or two and also mild hot flashes but frequently. Is this the  best treatment for me? Am I further into menopause than peri. I am also 50 pounds overweight but I don't smoke. My other question is prior to starting the BCP I was put on progesterone for a chemical d&c but it did not work -- no shedding at all. My last question is... Can I get an accurate fsh reading being on BCP?

Answer:  Spotting or no bleeding at all with birth control pills is no problem. It is only a sign that the endometrial lining is hardly stimulated by the combination of hormones in your pill. This has nothing to do with the "stage of menopause". No withdrawal on progesterone = no shedding: that is because a shortage of estrogens and that fits very well with your high FSH level. With birth control pills FSH is decreased very much and no accurate reading can be done. A measurement after one week without pills (just before the start of a new package can give some      information.

Question:  If you could help me figure this out, I'd appreciate it.  I am a 45 yr old woman, 2 children ages 10 &15.  For the past year or so, I have been having problems with my memory.  At first everyone thought it was funny, because it seemed like silly little things I'd forget.  However lately, last few months, I've been getting truly frightened, thinking it might be early Alzheimer's.  Could this be possible?  I've been forgetting events, forgetting things that were just told to me, and forgetting words really badly.  A friend thought it could be peri-menopause.  Is this possible? Is there any test for Alzheimer's or perimenopause?

Answer:  Loss of memory is not a perimenopausal symptom. Early Alzheimer is usually a genetic disorder: it runs in families. But you can consult a neurologist for further advice.

Question:  My lovely wife is 40 years old. She had four children. She is experiencing difficulty sleeping for longer than 2 to 3 hours at a time even when she is exhausted. She hasn't been on birth control. She has symptoms of depression, anxiety, anger and has fits of rage directed at me. One day she is her normal regular sweet self and out of nowhere she turns her anger on me as though I am the cause of her unhappiness. She says that her problems are related to stress caused by our jobs. Is this normal for a women in perimenopause?

Answer:  This is not perimenopause. Probably it has nothing to do with hormones. Symptoms of depression or stress are more likely. I think that you can better consult a psychologist with these problems than a gynecologist.

Question:  I am 32 years old and had a hysterectomy. I have polycystic ovaries I am taking progesterone 60mg and testosterone for my sex drive.  I am on Prozac 20mg. Should I still be taking the progesterone? My brother-in law is a Oncology Gyn. and said to stop taking it because of bone mass loss and when taking progesterone  your ovaries do not produce estrogen. Is this true and do you have any suggestions for me?

Answer:  There is no reason to take progesterone for polycystic ovaries after hysterectomy. It is true that progesterone can interfere with estrogen production in the ovary, but usually not in the dose mentioned here. Bone loss is documented in some depot progestagens used for contraception.

Question:  I am a 51 year old woman who has been on the patch, Climara 0.05mg/day and Provera 10mgs, the first ten days of the month.   I was put on these medications about three years ago, for perimenopause symptoms.  I still have regular periods every month. Recently, I had my 21 year old IUD surgically removed.  I would like to know if I can still get pregnant? Should I be practicing some type of Birth Control?

Answer:  No one can tell you with certainty if pregnancy is still possible. But after the age of 50 and three years after the start of perimenopausal symptoms this is very unlikely and extremely rare. If even a very small risk is not acceptable to you, then you have to use contraceptive measures.

Question:  Would you please give me a brief explanation of hyperplasia and some possible treatments for it?

Answer:  Endometrial hyperplasia is a condition of the endometrium after unopposed estrogen stimulation. The proliferation (growth) of the endometrium is normally interrupted by progesterone. Without progesterone growth goes further and further and sooner or later there is not enough estrogen to maintain this stage and breakthrough bleeding occurs. A treatment of the condition is a course of progesterone or progestagens. The proliferated endometrium goes in secretion and after stopping the progesterone shedding occurs and the endometrium will disappear with withdrawal bleeding. For prevention of recurrence two possibilities exist: the use of birth control pills or the regular use of a progestagen course every month day 15-26 of every cycle. Atypical hyperplasia is quit another condition and is regarded as a premalignant stage. The treatment is usually hysterectomy. This is totally different from normal benign hyperplasia.

Question:  My doctor has done two FSH tests this year.  The first one in January was a 12, the one last month was a 6.  I am 46 years old.  I feel premenstrual most of the time in the last two months.  My checkups with my gynecologist are fine, so there is nothing wrong female wise.  My family physician started me on anti-depressants and they are keeping me somewhat sane!  But not alleviating many of the symptoms.  Is the FSH test reliable or does it vary from day-to-day?

Answer:  The FSH test is reliable. It varies from day to day but within a certain range. With regular cycles and normal FSH you are still premenopausal. Your physician has taken the right decision in my view to start the antidepressant. But such a therapy takes time.

Question:  I am 43 years old.  I have never had children but 3 years ago I attempted extensive infertility treatments.  I had 3 IVF treatments where I became pregnant twice with miscarriages.  Lately I have been suffering severe PMS (very new to me), my periods are still regular but accompanied with severe bleeding and are shorter 3-5 days.  The skin on my face is becoming red and patchy.  I drink 8-10 glasses of water daily. I eat and exercise regularly.  I have put on weight that I can't seem to get off even with regular workouts.  My PMS includes breast pain and swelling. My memory is fading and my perfect eyesight is eroding daily. Also lately, I have been experiencing daily nausea and fatigue.  I am not taking any medication but do take several vitamins e (1000),msm, cq10 (50), grape seed extract(50), milk thistle w/ B multiple, selenium, ester c (3000), pine bark extract and substitute milk with soy beverage daily.  I have no vaginal dryness or pain and my libido is very active. Are these symptoms of perimenopause?  Is there some kind of natural supplement that I could take or should I start on hormonal treatments? Do the creams work?  The nausea bothers me the most? Is this a symptom?

Answer:  Shortening of the menstrual cycle is a normal manifestation of early perimenopause. And PMS is often exaggerated during that time. But PMS is not cured with hormonal therapy. The problem is mainly with serotonine levels and serotonine reuptake inhibitors are the only treatment proven for at least part of the symptoms. Breast pain and swelling is sometimes lessened with local application of a progesterone cream. A diabetes test is also prudent.

Doctor, What should I expect from HRT?   

Question:  I have been reading about perimenopause and different treatments. Several books, espousing the 'natural' method of symptom control, explain that the prescribed "progesterones" are all synthetic and are in actuality "progestins".  They further say that these progestins are not assimilated and thus not recognized by the body as progesterones.  Is this true?

Answer:  No it is not true. Most progestagens are synthetic indeed, except for Prometrium: This is really progesterone. Also the progesterone in Crinone cream is pure progesterone. All progestins are absorbed very well, bind to the progesterone receptor and the body recognizes them very well.

Question: I am 42 years old and have not had a period in 4 months. Went to the doctor, had hormone levels checked, and FSH was 60, estrogen levels below 20. My left ovary was removed due to an endometrioma two years ago, and my doctor and I believe that the remaining ovary has simply failed early. He wants to put me on low dose birth control pills instead of HRT. I can't get a good reason why from him and I don't think this sounds right. Any suggestions?

Answer:  Even with this high FSH and low estradiol, sometimes pregnancy occurs. To be certain on HRT you would need additional contraception. For hormonal levels alone, HRT is enough and contraceptive pills are not necessary.

Question: I have always been exactly 28 days apart with my cycle. In the last year I had heavy bleeding and never did before. They gave me provera but was told that is not good to give to people who have heart disease in the family. I always had very bad cramping and the things that go with that. They just gave me estrace and said to rub a small amount inside the thigh area daily. What do you think?

Answer: When there is a contraindication for provera because of familial heart disease, there is the possibility to use pure progesterone such as prometrium for regulation of the menstrual cycle. I do not know why an estrogen gel can be useful for heavy bleeding. Ask your doctor what the reason is for this Estrace topical. It certainly will not diminish the heavy bleeding.

Question:  How does heavy consumption of soy affect fibroids? I am 44 with one fibroid the size of an orange. I am slender, feel fine, exercise regularly and for the past three years had been consuming large amounts of soy (80+ milligrams per day)--soy milk, tofu, soybeans etc.--and also had an increase in my fibroid size. Are the soy consumption and growth possibly related? I thought the soy would counteract too much estrogen in my system. Is this the case? Is there a connection between the soy consumption and increased no. of cycles? If so, how would fibroids be affected?

Answer:  No data is available on fibroids and soy. Soy contains several phytoestrogens. Phytoestrogens bind to the estrogen receptors. There are two kinds of receptors with different actions. The idea is that phytoestrogens in a women with menstruations counteract the ovarian estrogens. There are studies that indicate that the menstrual cycle is somewhat prolonged with soy and not shortened. After menopause, with low endogenous estrogens, phytoestrogens will act as weak estrogens. On this base, we suppose that estrogens will not have influence on the growth of fibroids. But there is no proof of that.

Question:  I will be 39 years old in December and have been experiencing irregular periods since my miscarriage in Feb. 99.  I sometimes spot for 3-4 days, followed by 4-5 days of bleeding, and ending with 2 days of spotting. This has been going on for approx., a year and a half.  I use to run a 23 day cycle now its all over the place, 23days, 30days, 14 days etc.  The most disturbing matter is my last 3 periods I've been experiencing bad headaches, night sweats, nausea, numbness and burning in my neck and ears. My ears hurt.  I've been to UNC because my doctors thought it was migraines.  I truly believe these symptoms are associated to the on set of my period.  My OBGYN wants to put me on Nordette which will allow me to get my period 4 times out of the year.  I've never heard of this and I'm not sure of the treatment and reason for this.  Could you tell me if I am experiencing signs of perimenopause.  I had my period 2 weeks ago and I've begun to spot again.  This spotting appears different.  I have to wear a party-liner because of the spotting.  The 3rd day of spotting I feel like I'm going to get my period I'm blotting, cramping, weak, etc.  I feel lost and I'm not sure what I should be doing.  Could you please shed some light.  Thank you.

Answer:  As you can not understand the reason why your gynecologist prescribes Nordette, ask it directly to him or her. I suppose that the aim is to regulate your cycle and to prevent headaches during the week off. With this scheme you will only have 4 times a year a week without pills and the risk of menstrual migraine. There are several possibilities as cause of irregular cycles, perimenopause is one of them. Anyhow, birth control pills will cover most of the problems of irregular cycles.

Question:  I'm 37,and am experiencing extreme anxiety, depression and fatigue during my menstrual cycle and while I'm not on my cycle I feel fine and function normally.  I do exercise regularly and I do not feel stress from my job, family, and am financially stable.  When I visited my gynecologist she prescribed Zoloft, but I do not get depressed any other time except during my menstrual cycle.

Answer:  Zoloft is a serotonin-reuptake inhibitor. Prescribed as antidepressant, but also prescribed for menstrual cycle related problems like premenstrual syndrome. The symptoms of premenstrual and menstrual complaints are caused sometimes by high serotonine levels. And serotonine reuptake inhibitors can cure that kind of symptoms, while other antidepressants can not.

Question:  Will Evista increase my appetite?

Answer:  Increased appetite is not a recognized side-effect of Evista. 

Question:   I am looking into Estratab but haven't been able to find anything on it's effect on a woman's breasts, and if there is the increased risk of breast cancer as with animal estrogen.  Studies seem promising, but why no mention of breast cancer risk?

Answer:  The risk of breast cancer with Estratab is exactly the same as with other estrogens. Synthetic, animal or plant source does not matter. Only the duration of use counts.

Question:  For nearly 18 months I had heavy bleeding during my periods that always lasted for up to 14 days. Then I would begin my period again in 2 weeks. My Dr. determined that I was no longer producing estrogen and placed me on PremPhase which is estrogen and progesterone. I quit taking HRT because of the risk of cancer. Recently I read an article that uses plant based estrogen. I want to take this product because there are no sides but this product (Promensil) advertises the only ingredient is estrogen. Will I need to supplement with progesterone or do you think this can help the bleeding and still be effective.  Are you familiar with this product and do you have another opinion that will help me eliminate the problem naturally?

Answer:  Promensil is a fixed combination of phytoestrogens derived from red clover. Promensil is designed for combating hot flashes and some studies indicate that it is possible helpful in osteoporosis and in prevention of cardiovascular disease. But these claims are not substantiated. Only hot flushes will decrease in intensity but not as good as with estrogens, but better as with placebo. There is no need to take progestagens as far as we know on this moment, but the expertise is limited.

Question:  I am a 43 yr old woman, never had children.  I am presently taking Celexa and have been on medications for depression for the past 10 years.  I have been having hot flashes, confusion, sever breast pain, panic attacks, loss of memory, migraines.  I purchased several natural products such as Kava Don Quai, etc. My question is: is it safe for me to be taking natural products while I am on the Celexa and probably will be on some type of serotonin re-uptake medication the rest of my life?

Answer:  No one has studied the so called natural products in combination with antidepressants. Most products act (if they work at all) in one way or another by modifying the neurotransmitters: cerebral neuroactive compounds. One of them is serotonin. On a theoretical base there is no reason to suppose that the combination of serotonin re-uptake medication and the natural products can not be combined.

Question:   I am 38 and recently diagnosed as going through menopause, I am taking premphase, zoloft and halcion and in the past few days I have found massive bruising in the oddest places can any of these medicines attribute to this and or possibly the mix of these medicines.  I have never bruised like this before?

Answer:  These side-effects are unknown to me, please visit the Women's Health Forum for more information.

Question:   Does taking progesterone in synthetic form help relieve premenstrual depression? What are the latest treatments available?

Answer:  Progesterone, natural or synthetic, has never proved any benefit for premenstrual depression. The current idea is that premenstrual tension is cause by serotonin dysregulation. Serotonin re-uptake inhibitors are the only compounds with proven benefit on this kind of problems. Other antidepressants will have less effect.

Question:  At 42 I had a complete hysterectomy and removal of ovaries.  I'm 48 now.  The only HRT that worked for me and eradicated hot flashes was Premarin, 2.5 mg. daily. Although I am not at high risk for breast cancer (even though my maternal grandmother died of the disease), my doctor felt this dosage was dangerous and placed me on Evista a few months ago.  The hot flashes and night sweats continue and are extremely uncomfortable.  I have headaches either way I go, from the high dosage of Premarin or being without estrogen via Evista, for which I take medication.  With the Premarin, I had a better sense of well-being and sexual intercourse wasn't painful; with Evista, the opposite is true.  I see no signs of my hot flashes diminishing after all this time.  What can I do?

Answer:  Evista can cause hot flushes. And there is no proof that Evista have the same long term benefits as estrogens have. Evista is licensed for prevention of osteoporosis. With the hot flashes of this moment, start again with Premarin and continue that for a long time. As regards the dose: some women have a poor resorption of estrogens in the intestine and need a higher dose. To much estrogens can result in side-effect as breast tenderness. To less estrogens will result in flushes. Use Premarin 2,5 mg for a while and try sometimes (once a year?) if 1,25 is sufficient. As regard the risk of breast cancer: dose seems not important. It is the duration of exposure. And the duration of endogenous estrogens and exogenous estrogens together must be counted. In your case you have the same risk as women with normal functioning ovaries at the age of 48. The model that describes the additional risk with long-term estrogens starts at the age of 50, with 38 years of endogenous estrogens followed by 10-15 years of estrogens. Every year with a functioning ovary has the same meaning as a year without ovaries but with estrogen medication.

Question:  I've been on hormones for a year now.  I've been on prempro, premphase and now on cenestin.  Since I started on hormones my blood pressure has slowly been on the rise.  I've always had perfect blood pressure before starting on HRT.  My blood pressure is 170/100 which concerns me.  I was wondering what your thoughts are as far as going off the hormones for a month or so to see if my blood pressure will go down.  My doctor wants me to go on blood pressure pills but that would be my last resort.  She has also suggested trying Menest 0.3 mg. The last month or so I've had some stress.  Also my parents both have high blood pressure.  I'm 48 yrs old.  Any helpful suggestions would be appreciated. 

Answer: In most women estrogens will lower blood pressure somewhat. Rising blood pressure because of HRT is rare. But for a proof you can stop the medication for 3 months and restart it after that. With normalizing blood pressure without HRT and a rise after restarting you can conclude that you belong to that rare group. But bigger change is that your blood pressure has nothing to do with hormones. Hypertension is not a contraindication for HRT.

Question:   I am a 42 year old woman who has been taking Desogen 28 for approximately 3 years due to incredibly heavy menstrual periods.  My Dr. prescribed either a DNC or a low dose of Desogen.  I am now becoming concerned about the weight gain I have experienced, even with dieting and exercise.  Nothing seems to work as I slowly gain (about 10 lbs. total).  Should I go off the Desogen, and see how my periods are and then consider the DNC if needed, or can I stay on the Desogen and deal with the weight gain?  What is best for long term?

Answer:  An D&C is only a diagnostic procedure. Unless endometrial polyps are removed, a D&C will not decrease the amount of blood loss. When the actual treatment benefits you stay on it, you could stay on it for the next decade. Weight gain is a universal problem and only dieting and exercise will be helpful.

Question:   I have been taking estradiol daily and from the 7th of each month until the 16th I take a progesterone tab for the past two and one half years. What would be the affects of discontinuing either of them and just letting "nature" have a chance to take its course?  I still have my uterus.

Answer:  Unopposed estrogens (not taking progesterone) will cause erratic bleeding and a high risk of endometrial cancer. Not taking estrogens will place you again in your natural position. Maybe you will experience menopausal symptoms, maybe not. No one can predict that. You have to try it. Of course, it is important to know for what reason you started the hormone replacement 2 years ago.

Doctor, What should I expect from HRT?

Question:  I am 46 and began menopause symptoms about 2 !/2 years ago.  I totally stopped my menstrual cycle about 18 months ago.  Because of the menopause symptoms, my doctor put me first on Prempro, then changed me to FemHRT.  I enjoy the freedom from the monthly cycle and the hot flashes and anxiety, but know nothing about this drug.  I have researched on the internet but I cannot find any information.  I would like to know if I have gained 10 pounds because of the drug or my age.  I have changed nothing in my normal exercise or diet routine.  Also, is it menopause or the medication, or age that decreases the sex drive?  I once enjoyed a healthy "drive" but since this all started, it has diminished. 

AnswerFenHRT is a continuous combination of ethinylestradiol (a synthetic estrogen) and norethisterone (a progestagen) It is not causing weight gain. On this age the basal metabolism needs a little bit less calories for the same activity. With no change in exercise or diet, a daily small extra calories remain and will cause weight gain. It has nothing to do with the hormones but with aging. More exercise or less eating will restore the equilibrium. Sex drive has to do with androgens not with estrogens. But maybe the 10 pounds extra will cause emotional problems to you and indirectly libido problems? Sometimes a small dose of androgens is advised with serious libido problems.

Question:  After I turned 42, I was placed on Prometrium Caps (100 mg) and Estratab Tab (0.625 mg).  I noticed immediately that my hot flashes, night sweats, memory loss, and severe heart palpitations dissipated quickly.  At the beginning of this year I began having severe pain during my periods and discussed this with my doctor.  She switched my HRT therapy and I began taking Femhrt to stop my periods.  It is my understanding that Femhrt has both estrogen and progesterone  in it.  I don't understand how this differs from my previous medication and why it was necessary to stop my periods all together.  I am currently experiencing night sweats again with slight heart palpitations.  However, the most significant difference I am feeling is my inability to focus and use my memory. Can you help explain the differences between these two therapies? 

AnswerFemHRT and your former treatment are according to the same principals: continuous combination of estrogens and progestagens. Only the kind of estrogen and progestagen differs. When your wish is a regular monthly bleeding, sequential combined HRT will be better: continuous estrogens with the cyclic addition of a progestagen during 10-14 days every month. It is of course not possible to answer why your doctor switched. You have to ask this yourself. When you were happy with the first treatment and not with the current one, switch back again. There is nothing wrong with Estratab and prometrium.

Question:  I am 52 years old and have been on natural HRT that is mixed at an apothecary and was prescribed by my ob-gyn for the past 9 months. I have continued to have a period every two weeks and they have changed the estrogen dosage 3 times and it does not seem to make any difference. I have had a biopsy and an ultrasound and all looks normal. Should I just get off hormones altogether and start  over or what? I do not have any history of osteoporosis or heart problems and did not have hot flashes. My doctor prescribed HRT because of my blood test and hormones levels. I would prefer the most natural way to go about dealing with this as possible. Should I worry about the frequent bleeding since I have been tested?

Answer:  When the compounds of your treatment are not known, I can not guess if this has something to do with your bleeding problems. But why take any drugs when you have no complaints and not a high risk for osteoporosis or cardiovascular disease? Any drug treatment needs an indication.

Question:  My physician recommended flaxseed oil as a source of low level estrogen.  What dosages would be appropriate?

Answer:  I can not find any scientific evidence about this oil. I suppose that the manufacturer gives some advice on the box or on a leaflet. Or ask it the prescriber, your physician.

Question:  I have been on prometrium for two years to regulate periods.  During the  last two years I have had occasional blurred vision,  feeling of restlessness, extreme fatigue and times that I feel I am on speed the first two hours after taking prometrium.  Should I be concerned?

Answer:  This symptoms are not side-effects of prometrium, except perhaps fatigue. Prometrium can induce sleep. Therefore it is advised to take prometrium in the evening and not in the morning.

Question:  I am 48.  I have had a hysterectomy, but have my ovaries.  I have no signs or symptoms of menopause, but my doctor still wants me to start on Premarin.  When do you recommend starting HRT?

Answer:  I recommend estrogens to women with complaints, or to women without complaints but at high risk for osteoporosis or cardiovascular disease. This is only after making a risk profile. With no increased risk and no complaints, there is in my opinion no reason to recommend estrogens. But I am aware that some doctors believe that estrogens are good for all women. But there is a small risk for thrombosis, for gallbladder disease and for breast cancer. So, you have to have a good reason for a recommendation.

Question:  I am 55 yr. old, I am post menopause, and 2 yrs. ago the doctor had to remove the ovaries and the womb.  Now I am on the estradiol 0.1 mg patch. I  like this patch, they do help me. Sometime I feel better in my mood. Would dhea or pregnenolone cream's be okay to use?

Answer:  No, estrogens alone is sufficient for all your needs. Only when libido problems arise, sometimes a little bit of testosterone will be welcome.

Question:  I am 48 years old.  I was tested about 3 years and am starting perimenopause. I have the night sweats bad.  I tried all the hormone treatments.  Nothing worked.  My doctor tried birth control pills.  It did regulate my periods. But now I don't want to have a period.  On the other hand, I don't want to have surgery.  Can I take the birth control pill all the time, never stopping for that week?  Just continue taking the pill?  Will this be harmful?  I have read a little information on this?

Answer:  You can continue taking the pill. This is not harmful. But after a few months, some women will have breakthrough bleedings and others get a bloated feeling. In such a situation it is better to stop for a few days. But without bleeding or bed feelings, continue without problems.

Question:  Unopposed estrogen that also affects thyroid, as described by Dr. Lee, sounds like what I experience, but I can't find any discussion that's not by someone hawking progesterone cream. Is there evidence in the medical community that unopposed estrogen can inhibit thyroid function despite normal thyroid production? And evidence that applying a transdermal progesterone cream is effective in resolving symptoms such as weight gain, fatigue, menstrual problems, swelling, emotional instability?

Answer:  That theory is not scientific based. Thyroid levels are not influenced by menopause nor by estrogen therapy. And the effect of transdermal progesterone cream is not substantiated by research. Actually the progesterone level after application of the cream is very low and probably not active at all, certainly not active on the uterine lining and on bone.

Question:  I am 44 years old with a history of migraines for 7 years.  As time goes on, they have become worse.  The most severe are with my period, daily 5-7 days and mid-cycle 3-4 days, and 3-4 times per week during the rest of the month.  My periods have become more irregular in the last year. Mid cycle I have what appears to be bloody discharge for a couple of days also.   In addition, I have been experiencing mood swings.  This all feels like perimenopause to me.  I am a smoker.  My neurologist is running out of ideas, as we have tried about all of the traditional preventative meds, but are thinking about HRT once I have stopped smoking?

Answer:  There is no distinct relationship between migraine and hormone replacement therapy. Sometimes it will be better with hormones, but usually it makes no difference. Fluctuating estrogens are blamed sometimes for migraine. That is especially true with menstrual migraine. But your story is a different one.

Question:  I went to a new physician and talked to her about symptoms of perimenopause. My periods are every month, but irregular.  I also have some trouble sleeping and have a couple of days each month where I am over-emotional.  I had tried natural progesterone about 6 months ago (prescribed by my previous doctor).  It made me extremely sleepy during the day and I stopped taking it.  She gave me a prescription for Provera, has asked me to get a pelvic-vaginal ultrasound and blood work.  She told me during an exam that everything seemed normal and in place, but after asked me to have the ultrasound.  I am a bit uncomfortable with what she is telling me.  I have looked at the internet and found the side effects of Provera and the controversy about it. I don't know what to believe.  I think that a D&C seems a bit drastic.  I just really want to get rid of the feelings of being over-emotional and it would be nice to know when my cycle is each month. Is this something that is normally done? Should I go to a different doctor and get a second opinion? I don't want to do anything that is unnecessary.  She also talked about HRT as perhaps being needed sometime.  My mother had a very easy time with menopause and has never taken any hormones. Should I seek a second opinion or  not?

Answer: There are a lot of questions here. To much to answer all. I can only add some information. Natural progesterone can cause sleeping, so it is advised to take it in the evening. Birth control pills are excellent to regulate the cycle in perimenopause. But also courses of Provera in adequate dose taken days 15-16 will regulate the periods. A D&C is a diagnostic procedure, only needed when the cause of bleeding problems remains unknown and it has no place in cycle problems. Such is ultrasound. When provera or birth control pills have satisfactory results no further diagnosis is necessary.

Question:  I had been taking black cohash for peri-menopause symptoms with good results.  But they recommend only using for 6 months.  Can you explain why.  I felt better while using it, would a lower dose be better?

Answer:  No, I can not explain why. Maybe the manufacturer is afraid for claims for advising extended use without scientific data. There is hardly any serious research done on black cohosh and certainly not with long term use. But I see no objections for long term use on a theoretical base.

Question:  What is your opinion of using progesterone creams over the counter, without consulting a physician?  How much and how often would you use it?  Thank you.

Answer:  I do not advise it at all. There is no scientific proof for  effectiveness. It does not harm, so you can buy it over the counter, but the benefit of progesterone cream is very questionable. In Europe it is used only for local application on the breast in case of breast tenderness. Vaginal application of progesterone cream is different. Then it is used to administer progesterone for uterine lining protection in infertility clinics. That kind of cream is very potent and not available over the counter.

Question:  Within the last 3 years my wife has had a D&C, complete hysterectomy and a modified radical mastectomy of the right breast.  She had been taking estrogen for a couple of years until cancer had been detected.  She is 53 and is experiencing hot flashes frequently.  She knows that she mustn't take estrogen and that she will have to live with the hot flashes.  Her question is, how long will she have to put up with hot flashes?  What is normal or what can be expected?

Answer:  No one can tell that. Most women have the hot flush period during 1-2 years. But in 25% it will last more than 5 years. Hot flushes can be treated also with clonidine without interference with breast cancer. There is also anecdotal information on the beneficial effect of serotonin re-uptake inhibitors, like Prozac, for treatment of hot flushes.

Question:  I am 39, and for about the last year have suffered sleep disturbances, depression, worsening PMS, poor concentration, breast tenderness, and  headaches.  I do not have hot flashes or irregular periods.  While the majority of my symptoms have been irritating, the headaches are almost daily.  I suggested trying femhrt to my doctor, given the other symptoms.  I have the pills, but after reading the drug information insert I'm confused.  At a health symposium, the doctors said that the low dose tablet would help ease the symptoms I've described; however, the insert stated that these symptoms could be side effects to femhrt. Can you clear up the confusion?

Answer:  I have no reason to consider your symptoms as perimenopausal ones. So, you cannot expect help from HRT treatment. Ask your doctor to help you with the symptoms of depression and headache with appropriate treatment. The side-effects on the leaflet are quit another story. When you follow the advice on the inserts you can never take any medicine because there are usually more side effects registered than effects. But you have to realize that  you take the tablets  because of problems. You have to weight the benefits vs. the side effects and then make your choices. That is the daily practice of the art of medicine.

Doctor, What should I expect from HRT? 

Question:  I began menstruating when I was 8 1/2. I've had PMS & spasmodic dysmennorea my entire life, beginning w/ my first menses, consisting of severe cramping, nausea & depression. I have been taking oral birth control since the age of 17.  I am now 37 & although my cycle is regulated by the pill, I sense a change in my body. I've begun having headaches prior to my period & my cramping has increased. I experience extreme fatigue several days prior to my period. I have night sweats &  occasional hot flashes where my ears turn red. Am I experiencing perimenopause? If so, what does this mean?

Answer:  With the use of birth control pills there is no activity of the ovaries. The pill contains a lot of estrogens and inhibit FSH production. There is a steady state of pill use and no signs of perimenopause can occur with the use of the birth control pill.

Please check-out the PCOS Pavilion for more information about this question.

Question:  My doctor has prescribed Evista for me.  I am 50 years old.  Another Dr. told me he would not recommend Evista until I was 60.  Also I saw that it was subscribed for breast cancer patients.  Should I take it?

Answer:  Evista is advised for prevention and treatment of osteoporosis. During the studies for this approval, it came evident that during the course of Evista less women developed breast cancer than in controls. But this is not yet substantiated enough. Evista is nowadays not advised in breast cancer patients. It is never studied in that population. When you are at risk for osteoporosis, Evista is a good choice, after menopause. When still menstruating, it is not appropriate.

Question:  I am 55 years old, have three children, weigh 120 lbs, and am premenopausal.. I took birth control pills for many years, then was treated for breast cancer five years ago and took tamoxifen for five years.  I always experienced regular menstrual cycles and no breast pain but since stopping tamoxifen I have experienced menstrual cycles of 2 and a half to three weeks with very heavy bleeding for the first two days. During the weeks without bleeding I have extremely painful swollen breasts.  My estrogen levels were tested and were normal. My doctor checks my uterus lining frequently but has no suggestions.  This unpleasant cycle lasted seven months, stopped for three months but now has started again. Is this a hormonal imbalance?  Would progesterone cream help?  Would natural estrogens help? Is there anything you can suggest I can take to stop the short cycles and the swollen breasts?

Answer:  The most likely diagnosis is anovulatory bleeding. Progesterone cream will not be helpful fro this. Also natural estrogens can do nothing, because you have enough estrogens produced by your ovaries. I propose cyclic use of progestagens (Provera 10 mg or Prometrium 200 mg on days 15-26 of your cycle). That will make regular bleeding pattern and almost certainly give relief to your breast tenderness. As long as your ovaries produce estrogens, bleeding will occur after stopping the progestagen course. Without estrogen production no bleeding occurs anymore. Progesterone cream locally applied on your breast will reduce breast tenderness.

Please check-out this article "Tamoxifen" from

Question:  I am post menopausal and my basic complaints were with mild hot flashes, lack of mental acuity, and irritability.  But the great part was that I didn't have my periods. I am 51.  The doctor put me on 1 mg estradiol and 2.5 mg medroxyprogest tablets that I take every day and the symptoms disappeared but my periods came back.  I hate my periods. Is there anything that can be recommended that will get rid of both symptoms and periods?

Answer:  This problem is a common problem with HRT. I wonder if you can call this bleedings periods. When using a continuous combination of 1 mg estradiol and 2,5 mg medroxyprogesteron, the aim is to have no bleeding at all. But unfortunately about 30-40% of women using this kind of low dose continuous combined HRT experience breakthrough bleedings. But they are not regular. Usually it becomes lesser when continuing the medication. Periods are to be expected with a cyclic course of progestagen with continuous use of estrogen. With low dose (1 mg) withdrawals are seen in 80%. There is no way to guarantee to become bleeding free. But with low dose continuous combined HRT the chances are high. Bleeding is the payment for the benefits of estrogens.

Question:  Is there a suitable combination therapy available to women who have had a full hysterectomy?  I have no sex drive at all, and am interested in testosterone treatment.

Answer:  Estratest is a combination of estrogen and testosterone.

Question:  I can't find any information about HRT and paraplegia.  Is there any contraindication in offering HRT to a patient confined in wheelchair for MS? I am concerned about the possible increased risk in thromboembolism (immobility and HRT). I would like to know your opinion.

Answer:  Nothing is known about paraplegia and HRT. Your concerns of thrombosis are real. With HRT the risk doubles. But you have to consider the indication for HRT also. Regarding MS and hormones also hardly anything is known. I found one abstract.

From the Journal of the Royal Society of Medicine, 1992 Oct; 85(10): 612-3
Answer pilot study of the effect upon multiple sclerosis of the menopause, hormone replacement therapy and the menstrual cycle. By Smith R, Studd JW - Abstract
"A questionnaire enquiring about changes in severity of symptoms of multiple sclerosis with the menstrual cycle, menopause and use of hormone replacement therapy was answered retrospectively by 11 pre-menopausal and 19 postmenopausal women. Eighty-two per cent of menopausal women reported an increase in severity premenstrually. Of the postmenopausal women 54% reported a worsening of symptoms with the menopause, and 75% of those who had tried hormone replacement therapy reported an improvement. The results of this pilot study indicate the need for further research to clarify the effects of the menopause and hormone replacement therapy upon multiple sclerosis."

Question:  I'm 36 years old and have been suffering from mood swings, strong hot flashes, night sweats, palpitations (at times severe), irregular periods and panic attacks for 4 years. My doctor says my estriol (serum) is at 28 and that is too low and indicates perimenopause. I have these episodes of panic and palpitations and bloating right before or during my periods. When the period decides to show up. My question is this: I can't take BC pill due to a mild stroke while taking it and smoking 10 years ago. What are my options? I know progesterone crme has no proof of working-but since I've been on it(2 months) my cycles are a little easier to handle. What can I do to feel better? I exercise regularly and eat right. But the hot flashes and palpitations are debilitating! I have been to a cardiologist and several specialists. This is the only thing they can find - the low serum estriol.

Answer:  I think that the lab test was estradiol and not estriol. But the level of estradiol in women still menstruating is not of much value. The level has to be higher in other parts of the cycle. Otherwise you will have no bleeding. So they have found nothing until now. Your symptoms and especially the panic attacks can maybe be handled better by a psychiatrist. With panic attacks many of the perimenopausal symptoms are mimicked.

Question:  I am 38 years old. I went to my regular ob/gyn  I had been having emotional problems and decided to ask him about depression. I had been feeling like I was on an emotional rollercoaster as well as feeling tired. He said that I was perimenopausal and put me on the combipatch. I was on the patch for approximately 6 months. They always put sores on my stomach and so I requested something else. He now has me on Estratest. My husband is very worried about me being on either of these medicines. Should I get another opinion? 

AnswerYou have not mentioned the effect of the combipatch. Did it have any benefit to you, or did it give no cure at all. Stomach sores are not a well known complication of patches. Estratest will not be a good choice because it is a combination of estrogens with androgens and estratest contains no progestagen. It will likely cause bleeding problems. When decided for further hormone treatment (only when the patch cleared the symptoms) sequential combined hormone therapy will be better (like Premphase or other brands).

Question:  I had a hysterectomy 12 years ago and have been on Premarin till a couple weeks ago.  Doctor took me off Premarin due to my having frequent bouts of thrombosis in my legs.  He made no other suggestions and I feel I need to be on some type of hormonal therapy which is either herbs or something natural. I am in my 50's.

AnswerWhat are frequent bouts of thrombosis in your legs? What is the precise diagnosis? After thrombosis you have to be careful with hormone therapy. But frequent thrombosis is rare and you will need anticoagulant treatment. Have you?

Question:  I just recently reached menopause.  My doctor has put me on FEMhrt.  I have been taking it for approximately 1 month now.  I have a strong history of breast mother, her mother and my mother's sister. I know the pros and cons of taking HRT.  However, I am torn between taking it or not taking it due to the breast cancer issue.  I feel uncomfortable taking them when everyday I hear something on the news or in the papers that if you take estrogen and progesterone combined that you are more than doubling you risk of breast cancer.  I believe I would like to stop taking HRT. I am very uncomfortable taking it.  I really need another opinion.

AnswerThere has to be an indication for taking hormone therapy. Why did you start the treatment. Because of complaints? Because of high risk for osteoporosis (alendronate or raloxifene are alternatives)? Because of high risk of cardiovascular disease? For preventive indications there are several alternatives. With a high risk of breast cancer the only reason for estrogens can be heavy complaints. And then you have to weight the pros and cons. There are some studies that indicate that combined therapy have a higher risk than estrogens alone. However, the studies are of the observational type and give no proof, only a possibility.

Question:  I am 38 years old, and without question, am experiencing  symptoms of peri-menopause.  I have irregular bleeding, night sweats,  no interest in sex, and vaginal dryness.  Most are tolerable at present, except for the loss of sexual desire.  I had noticed a gradual decline over the past 6 months or so, but now  it has gotten to the point where it is totally non-existent.  This really bothers me more than anything.  Is there a treatment for this?  I am in excellent health.  I exercise every day and have no other health issues.

Answer:  When the loss of sexual desire becomes a problem, the reason has to be searched for.  Perimenopause is no reason for this kind of sexual problem. Maybe a sexuologist can give you good advice.

Question:  I was recently switched from zovia bcp to demulen due to the fact that my pms was beginning to get worse again (it had gotten better for a few months on the zovia initially) I am noticing a few things that I am wondering if they are related to the pills or perimenopause: big increase in appetite, feel numbness in legs (if crossed) and fingers, extreme afternoon fatigue (even after 7 or 8 hours sleep), itchy scalp, face (not the kind that feel like ants), increase in vaginal discharge with strong odor. Is there a major difference in these two kinds of pills? I am a 38 year old healthy mother of two.  Work full time and do not smoke or drink alcohol.

Answer:  There is no difference at all between the two kinds of pills. Demulen and Zovia contain 1 mg of ethynodiol diacetate and 35 mcg of ethinyl estradiol. So it is not clear why you get the advice to switch. And your symptoms are certainly not caused by the switch.


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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