Post-menopausal occurrence needs investigation

Q: I have been in full menopause for three full years. I will be 45 in February. Yesterday I awoke with what appeared to be a light period. What could be going on? I have had all the same symptoms as usual, hot flashes, and night sweats. Nothing has changed in my diet and there have been no medication changes. Everything is exactly the same. Today it seems I have progressed as a typical cycle would. I do not know if this requires a call to the GYN or if it just one of those fluky things.

I have three kids, 22, 19 and 13 if that has any bearing on the situation. My two aunts both went through menopause in their late 30s. My mom was 55 and her mom 50.

A: The interior portion of the uterus has two layers known as the endometrium and the myometrium. Prior to menopause and in women who menstruate, the endometrium thickens monthly in preparation for pregnancy. If she doesn’t become pregnant, the thickened lining is shed during a normal cycle. Once a women completes menopause, this pattern stops, so uterine bleeding three years post menopause is abnormal. During the transition to menopause, estrogen secretions within the body continue, while progesterone secretions decline. These hormonal changes can cause the endometrium to produce excess amounts of tissue, increasing the possibility that polyps or thickening of the lining of the uterus can develop, causing an abnormal bleed.

Menopausal women who take hormone replacement therapy (HRT) may experience the symptoms you describe. You do not indicate if you are on HRT, so I cannot venture a guess as to whether this is your answer; however, you should make an appointment with your gynecologist because after three years, abnormal uterine bleeding should be investigated. You could have developed a polyp, fibroid, uterine infection, endometrial hyperplasia or another condition. If you are on an anti-coagulant or have had radiation therapy, this could also be a possible cause.

Your physician will likely perform a pelvic examination; he or she may take a Pap smear, order lab work, and may even schedule you for an endometrial biopsy, transvaginal ultrasound, or other testing . The biopsy will rule out endometrial cancer, while the ultrasound can provide a clear view of the uterus.This testing is not to imply there is anything wrong but your gynecologist will likely begin simply once you provide a history of what is going on with your body and will progress with more sophisticated testing until an answer is found.

Menopause is a natural biological process. While it can begin during a woman’s 40s and 50s, the average age in this country is 51, so you began the process earlier than most. Visit your specialist and get to the bottom of the issue so you can get on with what must be a busy life with three children. Good luck.

Other readers who would like related information can order Dr. Gott’s Health report “Menopause” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

Is HRT appropriate for 65 year-old?

Q: When I was 51 I had a complete hysterectomy. Since then I have taken premarin daily for over 10 years now, as I am 65. My new doctor has requested that I stop taking it. She explained I am well past menopause and no longer need it. She plans to slowly over the next two years keep giving me lower dosages with the outcome of being completely off the medication. What are your thoughts on this? I am so mixed up and it’s hard to find a website that explains my exact predicament – being 65, no uterus, ovaries or fallopian tubes. Thank you for your time.

A: Premarin is a female hormone prescribed to help reduce symptoms of menopause. As a woman advances through this life phase, the body produces less estrogen, which may result in unwanted side effects. Premarin contains conjugated estrogens obtained from natural sources (the urine of pregnant mares). It is available in both tablet and cream form and is prescribed to treat hot flashes, vaginal dryness, breast cancer that has spread to other parts of the body, prostate cancer in men, and as an osteoporosis preventive. The cream form is prescribed when vaginal symptoms only area are present.

Premarin therapy is recommended for symptoms of menopause, vaginal atrophy, primary ovarian failure, in the palliative treatment of breast cancer in selected men and women with metastatic disease, advanced androgen-dependent carcinoma of the prostate, hypogonadism from hypoestrogenism, prevention of osteoporosis that occurs in the post-menopausal phase of life, and other medical disorders as determined by a health care professional.

Oral premarin can cause stomach upset, headache, variations in weight, nausea, vomiting, breast tenderness and bloating. More serious effects can include depression, memory loss, vaginal bleeding, edema of the extremities, and more. While rare, the medication has the potential to cause blood clots and an increased risk of uterine cancer.

Estrogen is a hormone essential to the menstrual cycle and the reproductive process. Estrogen therapy alone can increase a woman’s risk of endometrial cancer in women with a uterus who use unopposed estrogens; by adding a progestin, there is a reduction in the risk of endometrial hyperplasia. When estrogen therapy is prescribed to a postmenopausal woman with a uterus, it should be coupled with progestin to reduce the risk of endometrial cancer. A woman without a uterus does not need progestin. Estrogen alone, or when coupled with a progestin, should be prescribed in the lowest effective dose for the shortest possible time span, taking into consideration the risks to the woman and treatment goals. Dosing should be reassessed periodically by the prescribing physician.

I am not a gynecologist but feel your new physician is on the right track. I don’t have any documentation to substantiate the two-year weaning period but it may be appropriate. Perhaps by accomplishing this over the extended time he or she endorses, your body will more easily adjust until you are off the premarin completely. If you still have questions about the approach, I recommend you make an appointment for a second opinion.

Readers who would like related information can order Dr. Gott’s Health Report “Menopause” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Gott’s Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AswkDrGottMD.com.

Post-menopausal spotting may be normal

DEAR DR. GOTT: I am 51 years old and stopped getting my period 21 months ago. All of a sudden this last month I had excruciating lower back pain and then started bleeding lightly. My gynecologist said it was probably just because I was a little heavy but did extensive testing only to find nothing abnormal.

In your opinion is being a little heavy cause for me to get my period after 21 months? I have never heard of anyone going through this before.

DEAR READER: You have gone through menopause, the end of menstruation and fertility that occurs to every woman, generally between the ages of 45 and 55. During the stages of menopause a woman produces less estrogen and progesterone. [Read more...]

Menstruation following menopause

DEAR DR. GOTT: I am 51 years old and stopped getting my period 21 months ago. All of a sudden this last month I had excruciating lower back pain and then started bleeding lightly. My GYN said it was probably just because I was a little heavy but he did extensive testing only to find nothing abnormal. In your opinion, is being a little heavy cause for me to get my period after 21 months? I have never heard of anyone going through this before.

DEAR READER: Irregular menstrual cycles can occur for a number of reasons, to include the use of specific medications, stress, lifestyle changes, vigorous exercise, eating disorders, weight loss or gain, current medical conditions, thinning of the tissues lining the uterus, and overall health. A cycle can vary from woman to woman when it comes to regularity or irregularity, [Read more...]

Weight gain may be due to menopause

DEAR DR. GOTT: I am a 57-year-old post-menopausal woman. I have been gaining weight despite the fact that my diet includes plenty of fruits and vegetables, eating meat as a condiment rather than the main event, drinking lots of water and getting regular exercise. Several times a week I bicycle 12 miles, walk three miles a day and use the stairs to my 4th floor office. Despite all this, I continue to gain weight. Is there a supplement I should consider taking or something else I should be doing? Until my mid-40s, I was slim and fit.

DEAR READER: My first thought for your weight gain was menopause. In the peri-menopause phase leading up to menopause, symptoms can include vaginal dryness, decreased fertility, irregular periods, mood swings, thinning hair, loss of breast fullness, hot flashes, sleep disturbances, [Read more...]

Are symptoms due to perimenopause or thyroid?

DEAR DR. GOTT: I am a 45-year-old female. I have two children, ages 10 and 7, and I’m in good physical condition. I exercise regularly, eat well, take a multivitamin and calcium supplement, and never miss my annual OB/gyn checkup and mammogram.

My problem is my hair has been thinning for about two years, and I don’t know how to stop or reverse it. My dermatologist dismissed it (took a blood test but never examined my scalp) as female pattern baldness, although no other females in my family seem to suffer from it (the men do, however). All my blood tests came back normal.
[Read more...]

Irregular menses a cause for concern

DEAR DR. GOTT: I just had my menstrual cycle on my birthday last month and now have it again. Can you please explain to me what’s wrong?

DEAR READER: I will attempt to respond to your question in a general manner because you do not provide enough information in your letter.

A menstrual cycle is not the same for every woman. Generally speaking, it occurs every 28 days and lasts between four to seven days. Variation in flow, regularity and more are extremely common in young women just starting their cycles, as well as in women approaching menopause. [Read more...]

On entering perimenopause

DEAR DR. GOTT: I’m 48 years old and just had what appeared to be a hot flash. Does this mean I’m going through menopause? My menstrual cycle has been sort of regular, but I’m not sure that I’m ready for this next phase in my life.

DEAR READER: Menopause occurs only after a woman stops menstruating completely for 12 months. My guess is you have perimenopause, a stage that precedes menopause. This occurs because your body is not producing hormones as it did before. It generally consists of irregular cycles. They may be more frequent, shorter in length, lighter, or you may skip a month or two only to return to a normal monthly pattern. You may experience hot flashes, night sweats, mood changes or periods of poor concentration. [Read more...]

Bee pollen helps reader with night sweats

DEAR DR. GOTT: I wanted to let you know how much I appreciate your column. Two years ago, I had been suffering from night sweats owing to perimenopause, and your column advised taking bee pollen. I tried it, and within just a few days, my night sweats all but disappeared. I kept taking the bee pollen (1,000 milligrams daily) for a few months and then stopped, thinking I didn’t need it anymore. Several months passed with no sweats, but recently they began again, as well as periodic daytime hot flashes. I went back on the bee pollen and, again, after just a few days, I don’t have any more sweating, day or night! I just wanted to pass this on to you and your readers, and to thank you, again, for your wonderful advice.

DEAR READER: Thank you for your kind comments. I am happy to have helped.
[Read more...]

Menopausal woman can’t sleep

DEAR DR. GOTT: I have been going through menopause for the past seven years and have made it through the difficult phase. However, I have a problem staying asleep. I fall asleep most of the time with no problem but will stay asleep for about two hours. Then I can’t fall asleep again. Do you have a solution to this problem other than using estrogen?

DEAR READER: As you are aware, hormonal changes occur during menopause. Those changes can produce symptoms of insomnia that can range from transient and temporary to chronic and annoying. A woman actually goes through three phases: perimenopause, menopause and postmenopause. During the first stage, estrogen levels can decline, resulting in abnormal cycles, hot flashes and temporary insomnia. Menopause occurs when a woman has remained free of a cycle for 12 months. [Read more...]