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I have not had periods for five months inspite of having couple of cysts on ovaries?

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I am in desperate need of help. I am 44 years old and I have not had a period since September 2013. My gynecologist wants me to take progestin to see if my periods will come back or if I am indeed in menopause. My bio-identical doctor has me on paraben free progesterone cream. My hormonal test shows I am post-menopausal. I am using it 25 days out of the month. I advised my gynocologist about the cream and he laughed and said the cream is not strong enough and not FDA approved and that I needed to take Provera just to see if I was indeed in menopause or not. I have read the reviews online from other patients and the news in frightening. My Gynocologist stated if I do not do this to rule out if in fact I am in menopause I could be setting myself up to potential have adverse health issues in the future possibly uterine or ovarian cancer. I am terrified. I was having hot flashes and insomnia and the progesterone cream and the DHEA and sleep aide that my bio-identical doctor gave me is working. My gyno states I can at least try it once. I am scared and lost. I thought about trying to get a prescription for Progesterone 400mg oral from my other doctor. Will that work the same as progestin? Or if I take the progestin just once and not take it again will that have any adverse effects. My bio-identical doctor stated that the progesterone cream keeps the lining thin. I had a trans-vaginal ultra sound and my uterine lining is thin. I just had 2 small cysts on ovaries. Finally is the ORAL progesterone 400mg stronger than the cream? Any help or advice would be greatly appreciated. I have not had a period since 9/2013. I received my lab test back and I am figuring I may be post-menopausal. My results are as follows (55.8) range is 7.7-58.5 FSH (95.2) range is 25.8-134.8 and TSH (1.910) range is 0.450-4.50. I forgot to add my bio-identical doctor stated that the use of progesterone cream helps keep the uterine lining thin and healthy is this true?
Posted Sat, 15 Mar 2014 in Women's Health
Answered by Dr. Cori Baill 1 hour later
Brief Answer: Not a big fan of bio identical doctors. Detailed Answer: You have not had a menses for approximately five months and are over age 40. There is no way to know if you've had your final menstrual period or not. The brain is working hard to try to stimulate your ovaries which is why you have a couple of small cysts and your FSH measurement is elevated. Most women require some form of estrogen to relieve their menopausal symptoms and there is no reason that they cannot begin HRT prior to the final menstrual period. You do not have to wait to begin treatment. Progesterone by itself is not usually sufficient to relieve symptoms unless you're using huge amounts of it. Your GYN is correct that progesterone cream it's not FDA approved and has not been adequate to counteract estrogen stimulation effect of the lining of the wound. If you have a reassuring ultrasound showing an endometrial thickness of less than half a centimeter and have not had any bleeding then there's no reason that you should need a progesterone challenge with either Provera or progesterone cream. In addition there is a third option which is a micronized natural progesterone in an oral form taken at bedtime which will help to make you sleepy is FDA approved is available as a generic and could be prescribed as an alternative to Provera. Approximately 15% of women do not tolerate Provera well and it makes them feel anxious. Finally the risks of hormone replacement therapy,HRT, have been vastly overstated in the media. There is little downside to 5 to 10 years of therapy. If you have a uterus you do need some form of progesterone but natural progesterone is available in the prescription. The term bio identical is a marketing term not the medical term made popular by a Hollywood star who wrote a book about menopause and staying young. I do not buy into it. I think it is a way of making money primarily. Estradiol the same Hormone that your ovaries made in the reproductive years and is available for four dollars a month at your local Walmart. oral FDA approved progesterone also identical to what your ovaries made in the reproductive years is a little more expensive but still available as a generic. And by the way you do not state that you've been asked to do saliva tests but they are complete waste of time and money except for the person who orders the test.
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Follow-up: I have not had periods for five months inspite of having couple of cysts on ovaries? 1 hour later
Here are the ultrasound findings: Uterus measures 6 x 4 x 4 CM. The endometrial stripe is 2mm. There are no significant uterine fibroids. Left & right ovary measures 2.4 cm length. Small cycts are on both ovaries. A small amount of free fluid is seen in the pelvis most consistent with recently ruptured ovarian cycts. They concluded: Essentially normal pelvic ultrasound for age. I have a prescription to pick up some natural form of Oral compounded progesterone today 200mg I forgot I had. So if I take it for 10 days and still no period then I would get my answer I guess if I bleed or not correct? So Progestin is synthetic and Progesterone is natural occurring in body and one is not stronger than the other just different processing correct? Thanks for your help btw I really appreciate it! BTW-I did saliva test paid $275.00 as well as blood work. This is the first time my blood work came back as elevated : Finally if I took the provera 10 days and then the following month change to the microinized progesterone capsules can I do that?
Answered by Dr. Cori Baill 43 minutes later
Brief Answer: Oral progesterone works better than cream Detailed Answer: I am still unclear why anyone wants to give you a progesterone challenge test. It will not tell you whether or not you have had your final menstrual period. And with a 2 mm endometrium on US there is virtually no chance that you're going to have anything other than the lightest of withdrawal bleeds if that. You can talk it over with your gynecologist. Perhaps he is just trying to reassure you if you're anxious. You are absolutely correct Provera is a synthetic progestin which 85% of women tolerate well. Progesterone can be compounded or is available commercially at 100 and 200 mg strengths. It is mildly sedating and should be taken only at bedtime. Either Provera or progesterone will counteract estrogen stimulating effect on the endometrial lining. Estrogen causes the lining to thickening grow whereas progesterone causes it to mature and shed. With a 2 mm endometrium there's nothing to shed. You can see my previous answer regarding what I think a bio identical treatment. Not much. Progesterone cream and saliva testing are both expensive and unreliable.
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