Periods after premature ovarian failure/estrogen therapy?

I was diagnosed with premature ovarian failure in 2011 after not having had a menstrual cycle for three years. In June, my doctor put me on a twice-weekly dose of Premarin cream to treat vaginal dryness and atrophy. In August, I had premenstrual symptoms, followed by a surprise bright red period that lasted 4 days. I called my doctor in a panic, went in for an appointment, but was reassured that this can be normal with estrogen therapy (the doctor didn't even feel a need to examine me - I had just had my annual exam and Pap smear in June). I had also noticed some diminishment of symptoms such as hot flashes in the 2 or 3 months prior.

The doc did put me on a 10-day course of Provera to balance the estrogen. About 16 days after I stopped it, and 1 month after I had that initial "rogue" period, I had another 5-day period (September). And a month later (October), I had a third one, also 5 days. In both cases, the blood alternated between darker red and bright red before tapering off.

In November I had a recurrence of the hot flashes and other menopausal symptoms, which also corresponded with a period of heavy stress and anxiety. Those lessened gradually. I had vague premenstrual symptoms at the end of December, and today, I woke up to mild cramps and - you guessed it - another bright red period. It's also worth noting that I have missed my Premarin doses for the past 2 weeks.

Does this sound normal, as my doctor seemed to think, or should I seek a second opinion?

[Sanjivani Wanjari, MD]

Hi,
Cyclic estrogen and progesterone therapy will usually lead to cyclic bleeding upon withdrawal of the hormones. But it is difficult to comment without other details. Hence you may seek a second opinion. An ultrasound scan may be done to see the endometrial thickness and the condition of the ovaries.

Hope this helps.