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Menopause & Perimenopause Ask The Expert March, 2000

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

[Dr. Barentsen]

Are these symptoms of Menopause?
Are these symptoms of Menopause? page 2
What about life after "the change?
Doctor, What about life after "the change?"  

Q: Post Menopausal Bleeding
My sister is 55, and has been through menopause for about 3 years, now she is starting to spot, is this a normal sign? Or is this something we should be worried about.

A: This is postmenopausal bleeding and there is a need for further investigation. There are several columns on OBGYN.net covering postmenopausal blood loss. Have a look at this article Menopause FAQ - Menopause, Perimenopause & Postmenopause: Definitions, Terms & Concepts by Peter Kenemans, MD, PhD

Q: Does Menopause cause digestive problems?
Can menopause create or be responsible for digestive problems, i.e. stomach cramps, diarrhea etc?

A: No.

Q: Could my itching be caused by menopause?
I have recently heard in a health report that itchy skin may be a system to perimenopause. I have been suffering from extreme itchy skin for the last 4-5 month and can't seem to figure out why. No rashes, no dry skin, just itching. What can be done about this?

A: This question cannot be answered at a distance. Diabetes can cause itching too as well as other systemic diseases, consult your doctor.
Q: If you don't use it, do you lose it?
Doctors, I think that I have this perimenopausal thing pretty much under control. I was having horrific hot flashes that would drench my clothes, and frightening mood swings, sleepless nights, memory lapses, etc. My GYN put me on Levlite and it finally kicked in after a few months. My question is sexual in nature. I have not been in a relationship for over four years, I am 47, and I am afraid of the vaginal dryness. All that I read is to continue having intercourse and it will help to keep you lubricated and your muscles toned. I am concerned about the future, if and when I have a relationship again. Anything that I can do? Or do I just sit around and shrivel up?

A: It is useless to be afraid for problems that will never come. First of all problems with intercourse occur only by 20% of postmenopausal women. So you have 80% change of no problems at all. And when problems arise, there is an easy cure.
Doctor, What should I expect from HRT?
Q: Frequent periods while on Prempro, is this "normal"?
I began taking Prempro in July of 1999. As of this writing, I am currently experiencing a period every one to two weeks. The Prempro has eliminated the heart palpitations, hot flashes, and irregular sleep patterns that I had been experiencing. I had an endometrial biopsy done in April of 1999 and was found to be fine (this was done because I had experienced some heavy bleeding for one month, 3/99). After the biopsy I did not have a period until two weeks after I began the Prempro (July 1999). My doctor had a blood test done to determine the FSH level and found it to be extremely high and thus recommended that I start on the Prempro. I have read and understand that the HRT can cause irregular bleeding for the first several months as the body adjusts. I would like to know if after 7 months of continuous therapy that the periods every one to two weeks is considered "normal". I have taken the Prempro at the same time every day and have never missed. I understand that you can't give specific info but I would appreciate your guidance.

A: I think, The problem is that you have still some ovarian activity. And then bleeding comes more often with Prempro. When you are not postmenopausal, Premphase with every month a withdrawal bleed is much better. Continuous combined therapies are not so good in perimenopause. Sequential combined therapies are preferred.

Q: Is there a link between estrogen and insomnia?
I recently had my estrogen increased to treat severe night sweats. I am 44 years old. I feel much better but I immediately noticed an increase in vaginal secretions to the point of having to use tissue. I have started taking the estrogen at night. Is there any link between estrogen and insomnia?

A: An increase in oestrogens can be accompanied with heavier transudation. It has nothing to do with infectious discharge. There is certainly a link between oestrogens and sleep behaviour.

Q: Antithrombin III Deficiency/Ovary removal?
I am 38 yr. female, uterus removed already, looking at possible ovary removal. Have AT-III deficiency Family history of CAD mother deceased age 50. No clinical Thrombosis evident x38 yrs. Hematology conferred no HRT'S for me. Pain unbearable in Abdomen. Lupron Depot used 3 mo. pain relieved. But controversy involving Lupron. A decision needs to be made, Progestrin mentioned, searched HERS Study, also Homosiestine Abnormality and adhesions. If no HRT than what is % risk for Cardiovascular disease, etc. vs. pain management if any other than Lupron Depot . Any research available to help with Education to make best decision? Where to go? Choice's all seem to be high risk.

A: I cannot give medical advice for such a personal history. In complicated decisions like this, you have to discuss all relevant data and to set them in proper perspective.

Q: A question regarding side effects of Estroven
I took Healthy Woman soy for a period and I took Estroven for a few days. They say there are no side effects, but I have trouble sleeping when I take them. It seems like I am running all night and my legs ache. Is there a study about this? I also took Prempro for awhile and it made me sick to my stomach and very gassy. It seems that I must go through this menopause thing without help. One doctor prescribed birth control pills, but I couldn't even take them when I was younger. I will be 50 in October. Do you have any advice?

A: I have no further advice. Estroven is unknown to me. And Healthy Women Soy has not studied. No one can give any advice on plant estrogens for climacteric complaints, because there are no placebo controlled studies

Q: Plant derived estrogen?
My doctor recently prescribed Prempro for me but I asked her to give me something that was not derived from horses and she is going to prescribe estrase and progesterone for me next month. Is estrase plant-based?

A: The source of estrogens is usually on the leaflet in the package. And there is no difference at all between estrogens from plant sources or the same estrogens from industrial plants. The structure of the compound is the only important point, regardless the source.

Q: Will natural estrogen control bleeding without side effects?
I am 46 years old and have been dealing with perimenopause for about 2 1/2 years. Heavy bleeding for long periods and placed on the bcp - Lo-Estrin. I don't like taking the bcp for obvious concerns . My question is will a "natural" estrogen supplement, i.e., Estroven control bleeding and regulate a cycle as effectively as the bcp, without side effects? Thank you for any information or direction that you may provide in advance.

A: I do not know what Estroven is. What kind of estrogen? All estrogens can have side effects. I am not aware of any medicament natural or not without any side effect.

Q: Is breast calcification common?
I was diagnosed with breast calcification that is probably benign. There is no need for further testing now, but I need to return for another mammogram is 6 months. I am 48 yrs old, no history of breast cancer myself or in family. My gyn says this is very common. What do you think?

A: Only microcalcifications are a sign of early breast cancer. Other calcifications have no meaning and I cannot guess what reason exists for another mammogram in 6 months.

Q: HRT Medicine causing dark patches?
I have been taking Premarin 0.625 Day 1-25 then I add Provera 5 Mg. from day 14 to 25. I have been doing this for 21 months now. My question is that I am experiencing darkening on my face that seems to be getting worse. Is this due to the hormones and if I stop using them will it go away?

A: I know this problem with oral contraceptives and in pregnancy. It is called chloasma. And although I am not aware of chloasma with HRT, I think that here is also a kind of chloasma. If this is true, it will disappear slowly over several months after stopping HRT. By the way, chloasma worsens with sunlight. When you avoid the sunshine, no problem exists. Also sun blocking creams are helpful.

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Note: Opinions expressed here are for educational purposes only and, as such, do not constitute and should not be interpreted as initiation of a physician-patient relationship. This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.