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Menopause & Perimenopause Ask The Expert

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? Page 1
Am I experiencing Menopause? Page 2
What should I expect from HRT? Page 3
Doctor, am I experiencing Perimenopause?
 
Question:  I am 42 years old...recently my heart feels like it's beating irregularly...I can feel it beating. A physician told me it was premature ventricular contractions and normal. I have also been anemic my entire life with no typical signs of anemia, such as fatigue, paleness. I exercise quite a bit but sometimes don't follow a well balanced diet. Could this irregular beating be caused by perimenopausal symptoms or anemia?


Answer:  Premature ventricular contractions have no relation with ovarian function or perimenopause.

Question:  I am 43. No period for 8 months, Dr. put me on prem-pro 2.5.  I bled, spotty for 3 months, then bleed for 3 more.  I stopped counting the days.  New Doctor puts me on the 5mg.  No bleeding till stop taking the pills for a few days, then BOOM -- Big bleeding, lumps and clumps. As well as the sweats.  I'm specifically wondering if the 5.mg is too strong?

Answer:  Breakthrough bleeding is very frequent with continuous combined HRT like Prempro. This is the same with 2.5 and with 5. All regimens of continuous combined HRT have the same problem, especially in women with some residual ovarian activity. The advice for starting this kind of HRT is: only after at least one year of no bleeding or after about 6 months of sequential combined HRT with excellent cycle control. The best regimen of HRT for bleeding control is sequential combined HRT such as PremPhase or one of the many other brands available.
Question:  I am a 44 year old woman who was diagnosed with cervical dysphasia 1 year ago.  I had the LEEP procedure at that time.  I've had a pap smear every 3 months since this procedure and they have all been normal.  I've always experienced heavy menstrual flow; however in the past year they have been unbearable.  I use a combination of tampon and extra absorbent pad and for about 2 days of menses I have to change them every 15 minutes.  I also experience a great deal of clotting.  This leaves me extremely tired and sick.  I'm missing work and am very frustrated.  My doctor tells me that I may be pre-menopausal.  My iron level is normal and I am a vegetarian.  Thank you for any information you can give me.


Answer:  Increased menstrual blood loss has nothing to do with cervical dysplasia. This is not a perimenopausal symptom. Sometimes with perimenopausal menstrual irregularity, the amount of blood loss increases. But with a regular cycle other causes have to be looked for. With cycle irregularity, you can try first to regulate the cycle either with birth control pills or with a course of progestagens. When the menorraghia persists with regular menstrual cycle, further investigations are necessary.

Please check-out this article related to your question, "Diagnosis of abnormal uterine bleeding, fibroids, and adenomyosis" by Paul D. Indman, MD, USA
Question:  Blood testing has disclosed that I am perimenopausal.   Recently I was diagnosed with Erythema Nodosum.  Can this be hormone related?


Answer:  Erythema nodosum is an allergic reaction to some of the toxic products produced by streptococci. Streptococci are everywhere not just in the throat. In fact some streptococci are normal inhabitants of the vagina. To my knowledge, there is no relation with perimenopause.

The National Institutes of Health has an information page about Erythema Nodosom which lists oral contraceptives as a possible cause.

Question:   I am a 43.  I have not been able to have a period for approx. five months.  I have seen my Doctor about this problem and each time I have seen him I have been put on a progesterone for seven days, after which I do get a period.  However, if I don't take it, I will not have a period.  I had an internal sonogram and a VERY small ovarian cyst was found on the left side.  I am very over weight. However I have sustained this weight for many years and have always had a normal cycle.  The Doctor still thinks I'm not having a period because of my weight. Is it possible after having a normal healthy cycle all the years my weight would effect it?

Answer:   Menstrual bleeding occurs because of a period of stimulation of the endometrial lining by estrogens followed by a period of progesterone after ovulation. With the decline of progesterone endometrial shedding starts: the menstruation.

Your experience is a problem of ovulatory failure. The cause of this failure is not clear (because of lack of data) but being heavily overweight can certainly be the cause. Nevertheless, there is still a production of estrogens either by the ovaries or by the adipose tissue. Regardless the source, the estrogens will stimulate the endometrial lining to grow. Sooner or later this will result in a breakthrough bleeding and can increase the risk of endometrial cancer with estrogen-only stimulation.

The course of progesterone (or a progestagen) is intended to stop the endometrial growth. The usual length of the course is 10-14 days. After stopping a withdrawal bleeding will start as long as endometrial stimulation by estrogens continues. When estrogens are not produced anymore, no withdrawal will occur after the progestagen course.

Please check-out this article related to your question, "Obesity and Reproductive Disorders" from  The Female Patient.

Question:  I am 45 years old and have had several symptoms of perimenopause recently.  I have night sweats, irregular menstrual periods,  headaches, urinary incontinence, amongst other things.  One thing that I have heard from a few people, but not many is that people pass out while going through this period of time?  Have you heard of people passing out while going through perimenopause?  If so, is this atypical and what would cause this?  I have recently had a full medical evaluation, cardiac and neurological and all tests were negative.

Answer:  Passing out is not a manifestation of (peri)menopause. Please continue to discuss this condition with your physician.

Question:  I am a 35 year old female in good health.  In January 2001, I started experiencing hot flashes, night sweats, restless nights and in March 2001 a missed period.  I had hit an all time high weight of 172 ( I am 5'2" tall)  Initially the doctor said this was probably all stress related.  It made sense.  May 2001 through July 2001, I started experiencing severe migraine like headaches at the onset of my period and  just a general sense of confusion.   It seemed as though I had lost all control, even simple work tasks became a chore.  My doctor did several blood test, and discovered my estrogen levels on the second day of my period were "less than 32" and 180-200 was "normal"  He started me on Demulin 35-28 and Vivelle Dots .50 three days prior to my period, and the first day of.  I did well with this treatment, October to January 2002.  Now I have experienced "Break through bleeding"?  My questions are: 1). Does this indicate premature menopause 2.) Is this the proper course of action to take? and 3.)What is this break through bleeding, and should it be a concern? Any help, suggestions, etc., would be greatly appreciated.  Also, since April of 2001 I have joined a gym , hired a personal trainer, and have lost 23 pounds.  I feel better than ever.


Answer:  Low estradiol levels on the second of menstrual bleeding is quit normal and has nothing to do with early menopause. Especially not when the periods are regular. Menstrual migraine can occur because of the sudden decrease of estradiol just before your period starts. Some extra estrogens in that period will cure the problem. The choice of your doctor is also a possibility. Breakthrough bleeding is seen in 20% of starters with oral contraceptive pills and in 5% with continued use. No worry at all. It is quit normal.
Question:  I am looking for information on panic attacks associated with hysterectomy performed on the age group of early thirties.  Replacement hormones not introduced for seven years after surgery.  Menopause symptoms starting at 42
years of age. This is for my own education.  I am under a doctors care.  Thank you for your time and cooperation.


Answer:  Panic attacks are not associated with hysterectomy, and hysterectomy is not associated with panic attacks.
Question:   I had a regular period starting December 3 of this year. After 5 days it stopped and spotting began two days later, since that time I have had bleeding on and off in the form of spotting , scant flow to heavy, it is now Jan 26.  The heavier bleeding seems to occur first thing in the morning and I have refrained from coitus because I am never sure if I am bleeding. (I wear protection at all times. ) I  had a D&C two years ago for spotting and a six week space between one period.  I am 46 years of age in excellent health but I have had an extremely stressful year.  To complicate matters our family has a history of blood clotting disorder ( my daughter has had DVT and pulmonary embolism at 14) After screening our family it was discovered that I also have the same problem and hormone therapy seems to put me at risk for clotting. My question is two fold.

Can this be cancer even if my testing  has always been negative?  If hormone therapy is a choice, I understand that I would take some form of blood thinner so, would a hysterectomy be a wiser choice although I am not really wanting to have surgery? Thank you for your answer.


Answer:  This bleeding pattern is seen with polyps or fibroids in the uterine cavity, 
or by hormonal causes (so called dysfunctional bleeding). Necessary diagnostic measures are: transvaginal sonography for visualization of the endometrial lining (sometimes it is better to do so with installation of some fluid into the uterine cavity) and a cervical smear. With normal results a hormonal; cause is suspected and treatment can be started with a progestagen. Clotting problems do not interfere with progestagens for regulation of bleeding problems. A course of 10 days of Provera (10-20 mg) will usually stop the bleeding. thereafter a withdrawal bleed occurs. It is advisable to repeat the progestagen for 2-3 months during days 15-24 of the cycle (the start of the period is day 1).

Please check-out this article related to your question, "Diagnosis of abnormal uterine bleeding, fibroids, and adenomyosis" by Paul D. Indman, MD

Question:  I am 45 years old. My periods have always been 26-28 days apart with a small amount of staining just  prior to my period starting. Over the last year I've noticed that my periods are either particularly light or heavy. This last period was 15 days late and heavy with more severe symptoms  (cramps in lower back and legs). I also have been experiencing over the last month very intense and vivid dreams! I never thought of this as related to perimenopause but a friend of mine said she had heard of this -can you tell me your opinion.


Answer:   A change in periods (longer, shorter, heavier or lighter) is normal in early perimenopause. With a prolonged interval more severe menstrual symptoms can be explained by hormonal and endometrial changes, but changed dreaming experiences are not a well known phenomenon of changing periods.
Question:  I am a 36 yr old woman, who has not had a period for 6 months. I had a tubal ligation after my second child 6 yrs ago. I have had my hormones checked and naturally they turned out normal and I've had and ultrasound which came back normal also. I am experiencing mood swings, night sweats on a nightly basis with pajama changes sometimes 3 times a night, heart palpations, lower back pain and leg aches. I've been prescribed several hormones to get my period started with no results. I am having a uterine biopsy in two weeks. what advice can you give me as I am at my wits end.


Answer:  With normal hormones, this is not menopause. When FSH is normal, I advise a consultation with a gynecologic endocrinologist.
Question:  My sister is having irregular heart  palpitations. She has been to a couple of doctors and they say her heart is healthy. She heard that perimenopause could be a factor what information do you have?

Answer:  No, it is not. Only in conjunction with hot flashes. Usually the cause is too much workload. Take a holiday, or otherwise some more rest.

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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.