Test results are indicating not menopausal but no periods

I am 45 (almost 46). Have always had irregular periods (in the 40 day range) but last summer began having periods every 2 and a half weeks.  After third period in six weeks went to my gyn to see if she could figure out what was going on.  She tested hormone levels and put me on Provera to regulate cycle again.  I was previously diagnosed with PCOS so she chose provera over bcp.  After second month or so I stopped taking the provera (I can't recall exactly why) but periods continued as they had before (40 days) for a few months.  During the last year periods ceased.  Has been at least six months.  I also have thyroid issues so endocrynologist tested hormone levels and also said I was not menopausal and needed to check in with my gyn.  Went there for the yearly check (but had to see her PA) and the PA told her what was going on.  She wants me to go back on provera.  I am perfectly happy not having periods.  I have very minor spotting once every 4-6 weeks.  I am on synthroid, spironolactone (I believe for the regulation of DHEAS which has been high in the past), nadolol (for heart valve issue) and aspirin. I really hate the thought of going back on provera due to the meds I already have to take and I don't seem to be having any symptoms except the lack of a period and I don't see anything bad about that! What types of things can cause cessation of period besides menopause and are any serious enough to take a medication to induce periods?  Thank you very much for your time-bzmed

[Machelle Seibel, MD]

Without any hormone levels, I really can't say what is causing your periods to change in frequency. The Provera is given to cause you to shed the lining of your uterus. If your are not ovulating, which is usually the situation in cases similar to yours; you are making estrogen but not progesterone. If the estrogen continues to make the uterine lining build up, it can over a period of years turn into precancerous and eventually cancerous changes.

In most situations such as yours, if the lining is building up due to estrogen production, it isn't necessary to take Provera more often than every 3 months. Alternatively, you can have an ultrasound done of the uterine lining. If it is building up to 4 mm thickness or more, most doctors recommend the Provera at least every 3 months. If it's <4 mm, you don't need the Provera. In that case the change could be due to perimenopause.

You can also talk with your doctor about your thyroid medication. As your estrogen level goes down, your thyroid medication needs will likely change and you might need less thyroid medication.  Also, if you are on Spironolactone for long periods of time, it is a good idea to check your potassium level as Spironolactone can lower blood levels of potassium.
Machelle Seibel, MD