Lesand

[Out of answers]

I had my gallbladder out January 17th of this year because I had pain in my right side and tenderness and numbness under my breastbone since December.  I came down with this pain after a bout with Bronchiditis, which I coughed continiously for a month.  Doctor took ultrasound and found sludge in gallbladder so decided pain was from that, but here it is March 20th and I still have pain.  I have taken all the tests under the sun and they can't seem to figure out what the problem is.  My question is not about my pain, but my menstrual cycle.  My last day on my cycle was day of surgery (1-17-03)and I have not had one since.  My doctor has put me on in the past two rounds of antibotic (antibiotic), pain pills, and a round of antibotic (antibiotic) thinking I had a kidney infection.  Needless to say, none of the medications that I was on helped with the pain in my side and currently I have not been on any drugs other than Motrin that I take when pain gets bad  for one month.  I am 41 years old.  I know I am not pregnant because my husband had surgery 13 years ago for that reason.  In fact, to make sure I took a pregnancy test today and it showed up negative.  I was wondering maybe if my pain is coming from maybe a whole different problem, which is why I haven't had a menstrual cycle or the prescription drugs I was on is the reason I have not had a period.  I know I should go to my OBGYN and have them answer my questions, but after everything I have been through since December the thought of seeing another doctor scares me. Do you think I need to see if they can get it regulated again or do you think I should wait because it might start up again on it's own?  Thank you!

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

There are many causes that your mentrual cycle has stopped.  Pregnancy has already been ruled out.

Peri-menopause may be a consideration.  A clinical diagnosis of menopause is made by the presence of amenorrhea for six to twelve months, together with the occurrence of symptoms of menopause such as hot flashes.  

Perimenopause is defined as the two to eight years preceding menopause and the one year after the last menstrual period. It is characterized by a normal ovulatory cycle interspersed with anovulatory cycles of varying length. As a result, menses become irregular, and heavy breakthrough bleeding, termed dysfunctional uterine bleeding, can occur during longer periods of anovulation. Thus, vaginal bleeding becomes unpredictable in both timing and amount. In addition, some women complain of hot flashes and vaginal dryness more typical of the postmenopausal period.

After excluding pregnancy, the most common causes of secondary amenorrhea are:

Ovarian disease — 40 percent
Hypothalamic dysfunction — 35 percent
Pituitary disease — 19 percent
Uterine disease — 5 percent
Other — 1 percent

In addition to measurement of serum hCG to rule out pregnancy, minimal laboratory testing should include measurements of serum prolactin, thyrotropin, and FSH to rule out hyperprolactinemia, thyroid disease, and ovarian failure (high serum FSH in primary ovarian disease).

An elevated FSH would also be suggestive of menopause, although in early menopause it may not always be elevated.

I would suggest the basic laboratory testing as described above.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[kevinmd]

Hello,
I answered this question in the Gastroenterology Forum.  Was there anything specifically different you were wondering about?  I would be happy to research any question you may have.

Thanks,
Kevin, M.D.

[kevinmd]

Hello again,
My mistake - I read your case again and realized you were asking a different question.  I'll answer your question as soon as I can.  

Thanks,
Kevin, M.D.

[Out of answers]

I was wondering if you thought an irregular mentrual cycle is due to the prescription drugs I was on in the last month?  How long should I go before I talk to doctor about late period or could pain in my side be due also to late menstrual cycle?