Hormone levels - Menstrual cycle disorders - Perimenopause
April 16, 2010 | 50,00 EUR | answered by Dr. med. Susanne Plotz
Hello,
I have just turned 45 years old. First menstruation at 10.5 years old.
My mother had her last menstruation at 48.5 years old.
Since my 33rd year (since my first thrombosis - congenital blood clotting disorder), contraception has been done using the symptothermal method in combination with Persona (previously using the pill). My cycle has always been like clockwork, always 27 days, always with a temperature increase, etc.
Since age 35, I have experienced mild hot flashes during the day.
Since age 38, I have had uterine fibroids, with sometimes very painful and heavy periods. Often unable to work for several days. A hysterectomy has been considered multiple times, but I have always avoided it.
At age 40, I had a severe thyroid overactivity (Graves' disease) and underwent thyreostatic therapy for over 1.5 years - no relapse since.
Since age 40, I have also experienced very strong hot flashes at night, waking up drenched, and long-lasting hot flashes during the day.
Also since age 40, I have experienced mid-cycle bleeding and pain around ovulation (no more stretchy mucus), spotting and mild incontinence a few days before menstruation, water retention, breast pain in the second half of the cycle, and almost always a migraine attack 1-3 days before menstruation.
Laboratory values from August 2006:
Follicle-stimulating hormone = 7.1 mIU/ml
Luteinizing hormone = 2.7 mIU/ml
Prolactin = 9.9 ng/ml
Estradiol = 113 pg/ml
Thyrotropin = 1.6 uE/ml
Evaluation: Normal hormone levels corresponding to the first half of the cycle.
No indication of premature menopause.
For 1.5 years, the length of my cycle has varied between 21 and 35 days, with short cycles always without a temperature increase and the extended cycles with a temperature rise from day 18.
The last 7 cycles were without any temperature increase. The last 4 cycles were 21-23 days long with daily lighter or heavier breakthrough bleeding. The actual menstruation is longer and heavier (up to 7 days), no more PMS symptoms. My hemoglobin levels are back to normal, and I regularly take ferrosanol duodenal after a severe iron deficiency anemia.
Last examination by my gynecologist on the 17th day of the cycle: no ovarian cysts, no excessive buildup of the uterine lining, myomas not growing (both about 5 cm). Synthetic progestins are not allowed, I should now take monk's pepper continuously, and it is not advisable to have a dilation and curettage (risk of thrombosis and whether it would be effective
Dear inquirer,
I can understand your concern well. Let's start with the elevated estradiol value: this is not uncommon at all. Hormone levels often fluctuate with the onset of menopause and cycles are no longer as regular. It is also common for ovulation to no longer occur, but hormones continue to be produced. During this transitional stage, hormone levels can fluctuate greatly and estradiol can indeed be elevated as part of this adjustment. As the process continues, hormone production gradually stops and bleeding decreases. However, it is difficult to predict how long this will last for you. There is a wide range and since each person is unique, it is unfortunately not possible to determine this in advance. In your case, it does seem that you have already entered perimenopause.
The other question pertains to fibroids and the curettage. Due to your history of coagulation disorders, I would also advise caution and lean towards advising against it. In some cases, fibroids change with the onset of menopause. Since no hormones (in this case: no estrogen) are being produced anymore, fibroids may shrink or even disappear (as they occur exclusively due to hormones - children and women beyond menopause do not get fibroids). If you do not want to wait for menopause to occur and for the fibroids to hopefully decrease (or disappear), then separate removal of the fibroids (without removing the uterus) - known as myomectomy - could be an alternative. However, the success of this technique also depends on where the fibroids are located (this technique is suitable for fibroids located on the surface, directly under the mucous membrane). The individual fibroids are essentially removed from the uterus. Another option would be to coagulate the blood vessels that supply the fibroids with blood. But again, given your coagulation disorder, this is a rather risky endeavor. If you are not suffering too much from fibroid symptoms, taking a wait-and-see approach would be advisable (waiting for menopause and the likelihood of fibroids shrinking).
A visit to an endocrinologist regarding thyroid levels is definitely advisable.
Regarding symptoms of early menopause: since you are not allowed to take hormones, you can try herbal remedies. It must be noted that there are no major randomized studies confirming the effectiveness of these herbal remedies, but if you tolerate them well, it is definitely worth a try. Known herbal remedies in this area include: black cohosh, St. John's wort, dong quai, wild yam, evening primrose oil, ginseng, kava, ginkgo, licorice, valerian, hops, and vitamin E. However, I am not specifically informed about the interactions these plants may have with the coagulation system. You would need to discuss this with your treating physician. If you are experiencing severe mood swings or depressive moods, a mild antidepressant may also provide relief in this case.
I hope I could help you and wish you all the best, warm regards, Susanne Plotz
