Will I ever go into menopause?

[heart2heart]

Currently I am 55 yo, my recent FSH is only 13 and estrodial is 69. This is reading as normal. I have been having abnormal bleeding for the past 12 years and had several D&C's, ultrasounds, endometriel biopsies, and an MRI. I get functional cysts that are painful and recurrent. There are a couple of fibroids but they are only marble sized. My gyne has tried Provera, Aygestin and Prometrium and a combo of Prometrium and estrodial with limited success. Any additional estrogen made me bleed heavy. The progestins had little success, on Prometrium I either spotted or had the period 3 weeks after stopping the capsule. Weird, huh? Also, sometimes I ovulated right after finishing the Prometrium. The other progestins gave me severe cramps and bloating. Several months ago I stopped therapy to see what is going on. I did not have a period for 2 months but now its come back with a vengence, 8 days and picking up speed. Is there anything that can be done to make this menopause transition smoother for me?  I have a history of complicated migraines and afraid to go on the pill for fear of blood clots.

[Machelle Seibel, MD]

The range for going into menopause in the United States is 45 to 55 so you are at the extreme end of that age span. Hopefully, menopause will come before too long. In the meantime, since you are being followed carefully, it seems there is nothing bad going on and this is just a challenging transition.

There are some things to discuss with your doctor for this type of bleeding. There are progesterone containing IUDs that are often helpful for this problem. One is called Mirena and it is often effective. There is also medication such as Lupron which turns off periods and should stop the bleeding. There is also endometrial ablation which involves using an instrument placed into the uterus that 'burns' the lining so it cannot bleed. It is done in the OR with general anesthesia. This would be a last choice if the others fail.

Finally, if all else fails and the problem continues, you can discuss the decision to do a hysterectomy and remove the uterus and possibly the ovaries. That is a big decision and should only be done if you are comfortable with the idea and nothing else works.  One final thought, have your doctor check to see if you are anemic or if your iron levels are low. Those problems can sometimes lead to vaginal bleeding and can be cured by taking iron tablets and multivitamins.
Machelle Seibel, MD