menopause & perimenopause, women's health, obstetrics, gynecology, infertility, pregnancy, hysterectomy, fibroids, and more

 

Print this page
OBGYN.net Advertisement
Menopause & Perimenopause Ask The Expert January, 2001

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?
Am I experiencing Perimenopause?		 Am I experiencing Perimenopause?
What should I expect from HRT?
Doctor, Are these symptoms of Menopause?
 
Q:  I am 42 years old and had a total hysterectomy in July of this year.  I have not had any complications from the surgery.  I have noticed since my surgery that I am always fatigued.  No matter how much sleep I get I am always tired.  Another thing I have noticed is vaginal dryness.  I am on Premarin 125 mg. daily.  I had a blood work profile done with CBC, Thyroid, and everything came back normal.  Do I need to consult my doctor to change my hormone therapy or do you have any suggestions.  This is really bothering me and it is affecting my sex life with my husband.


A: Sleep problems and tiredness are not influenced by your Premarin intake until now. So, you cannot expect that hormones are involved with that problem. Recovery from major surgery can last longer than expected. Vaginal dryness can be cured by lubricants. Replens is a very good product for this complaint.  
Q:  My mother is a 61 year old woman who has not menstruated in over 10 years. Over the past 2 years, she has experienced some light vaginal bleeding.  This has occurred very infrequently, a total of 3 times within the 2 year period.  She is not taking any medication (i.e., HRT therapy) and has not ever during either menopause or post-menopause. Is this something to be concerned about.


A: This  is postmenopausal bleeding and needs further investigation. 80% of the causes has to do with benign atrophic lesions, but there is a 20% change of (pre)malignancy.
Q:  I have some spotting that appears to be blood recently.  I have, no pain but I am urinating more frequently.  I am 59 and menstruation ended when I was about 45, without any negative effects. I have normal to low blood pressure, I am not diabetic or asthmatic.  I am fairly active and I maintain what would be considered good to excellent dietary habits.  I do not take any medication and I have regular annual checkups. I am beginning the following home therapy today: one quart or more of cranberry juice, 1500 mg of vitamin c, no dairy products, 100 mg of iron. Please advise.


A: This is postmenopausal bleeding and has to be investigated. About 15% will be caused by (pre)malignant lesions. Most times a polyp or atrophy is to be blamed.
Q:  I'm 52 and had my last "spotting" in November.  I'm taking 10mg. Lipitor for high cholesterol. The latest lipid profile I received 15 was Chol:  185, Trig:  225; HDL 38; LDL 107; Ratio 4.87.  I've been taking Co-Q-10 (250mg.) Gugulipid (1600mg) and Pantothenic Acid (500mg) since March 2000 and I believe these are what brought my counts into a better perspective (have been on Lipitor since March 1999).  I asked my cardiologist today if I can ever get off Lipitor and he said probably not because since I'm going through the "change" my LDL will probably rise and HDL will probably fall.  I have never heard/read of this.  Is that true?  Going on HRT is not an option for me since I had a transphenoidal removal of a pituitary adenoma.


A: With menopause there is a continuous rise of LDL-cholesterol. HDL will stay on the same level or decrease slightly. With HRT mainly LDL decreases and with many regimens, but not with all,  HDL will increase. The beneficial effect of HRT on cardiovascular disease is explained for 20-25% by this lipid changes, but for 75% by other mechanisms like direct vascular effects and anti LDL-oxidation.
Q:  Do fibroids reappear after menopause?  I was told that once my period stopped, they would go away.  If they do return, what are my options?


A: The return of fibroids after menopause is very rare. if it occurs one has to be certain that it is not the malignant version of a fibroid: a sarcoma. Growing fibroids after menopause are usually removed by hysterectomy.
Q:  I have been in menopause for 4 years.  For the first time since then I got my period.  It's a normal, strong period - not spotting.  Should I discontinue the estrogen/progestin compound I have been using for the past 3 years?  Is this normal?  Can you give me some information please?


A: I conclude from these scarce data that you are using a continuous combined HRT regimen. Usually this regimen is amenorrhoeic. And any bleeding occurring  after more than a year needs investigation. Endometrial cancer is very rare with continuous combined HRT, but has to be ruled out.
Q:  Will menopause make me gain lot of weight?


A: Menopause itself will not cause weight gain. With menopause the basal metabolism needs less energy than before. Weight gain is also during (peri)menopause a matter of equilibrium between intake of energy and expenditure.

Read Past Ask The Expert Topics


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