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Dr. Andrew Rynne

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Can I take medicine in perimenopause with high estrogen level?

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Dr. Timothy Raichle

OBGYN

Practicing since :1999

Answered : 1681 Questions

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Posted on Mon, 31 Dec 2012 in Menstruation and Miscarriage
Question: Hi, I am in perimenopause and live in Argentina. I would like to know if it is normal in the states to prescribe this for someone having high estrogen/severe perimenopause issues.
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Answered by Dr. Timothy Raichle 1 hour later
Hello, I would be happy to help you with your question.

Given your family history, it is likely that you too will go through menopause at an earlier age. As you likely know, menopause is defined as no period for 12 months. In terms of the workup of a 40 year old with abnormal bleeding, estrogen levels are relatively useless in terms of figuring out a cause. Here is what should have been done (perhaps it was - let me know)

1. You need an exam and an ultrasound of the uterus
2. You need labs that would include tests of thyroid function and an FSH (a better indicator of early menopause)
3. You need a biopsy of the lining of the uters - to evaluate for pre-cancerous changes (this is indicated in any woman at 40 or older with abnormal bleeding)

Estrogen levels vary dramatically during your cycle. The levels might seem "high" during the early part of your cycle. And given your abnormal bleeding, I find that this number really does not tell you much.

In terms of treatment of irregular bleeding:
1. You can do nothing if the above workup is normal
2. You can consider hormonal therapy to regulate your cycle
3. If indicated, you can consider surgery to stop the bleeding.

I hope this helps. Let me know if you have followup questions. You did not mention what exactly it is they wanted to "prescribe".
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Timothy Raichle 40 minutes later
Hi,

Sorry, I wrote too quickly. The doctor prescribed Qlaira. I had a very bad reaction to XXXXXXX a few months ago and I was worried that adding estrogen might be bad if I already have very high estrogen levels. XXXXXXX gave me a severe headache/nausea/felt like I was having a panic attack feeling. Once I stopped the medicine this went away so I feel a bit nervous now to start another one. My FHS levels are normal but I have had many symptoms of perimenopause for about a year now. (Hot flashes, mood swings, breast tenderness/erratic changes in size, fatigue,others). The thing I am most worried about is the depression/mood swings. I am someone who is very sensitive to hormones (have always had bad PMS, rough emotional time post-pregnancies). So I was wondering what is the normal course of treatment for someone like me? The reason I have felt frustrated here in Argentina is that they can't seem to believe I am in perimenopause bc I am too young (I am 40) but I told them my family history. So I am worried that my doctor here isn't following the correct course of treatment. It is reassuring that she ordered all the correct tests. My ultrasound came out normal and there is no signs of cancer or other abnormalities. I am otherwise very healthy and have a healthy lifestyle (exercise/healthy eating/etc.)
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Answered by Dr. Timothy Raichle 1 hour later
Thank you for the followup clarification.

First of all, don't get fixated on the "high estrogen level" issue. This is simply a reflection of cycles where you do not ovulate. This occurs more often as you transition to menopause. The lack of ovulation leads to a buildup of the lining that then sheds in an unpredictable manner. This is exactly what you are experiencing, and it can possibly go on for years or months. The lining NEEDS to be cycled in some regular fashion, or you are going to be driven crazy by the unpredictability of your bleeding!

Qlaira is simply another form of birth control that claims to be more "natural". It too contains estrogen and progesterone. It is worth a try in terms of regulation of your cycles. Here are some other options to discuss with your doctor regarding abnormal bleeding and mood related problems:

1. Consider a progesterone only form of cycle regulation (depo-provera injection every 12 weeks OR Provera taken two weeks out of every month)
2. Nuvaring - a low dose form of birth control inserted vaginally (for 3 weeks, then one week off for a cycle)
3. A Mirena IUD - your cycles will lighten up and go away (this is a popular option with minimal to no hormonal side effects)
4. A low dose of antidepressant such as Lexapro 10 mg per day

I hope these options help. Good luck!! Discuss this with your doctor and be patient!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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