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Dr. Andrew Rynne

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Have irregular periods and dry vagina. Family history of early menopause. Hormone test done. Worrisome

Answered by
Dr. Mahesh Koregol

Infertility Specialist

Practicing since :2000

Answered : 3768 Questions

Posted on Wed, 19 Dec 2012 in Infertility Problem
Question: I'm a little embarrassed about this but perhaps someone can give me a clue as to what is going on with my body.

I have a fertility/sexuality question that is somewhat embarrassing. I'm 33 years old, and have always had fairly regular periods (generally 28-31 days, occasional outliers at around 35 days). They remain regular but I'm dealing with a number of changes.

Until the past year, the pattern of my periods had been as follows: 1) I would have fairly severe cyclic mastalgia leading up to my period: this was so noticeable and so regular that I barely had to keep track of my period as breast pain was an indicator that it would be coming; 2) my periods were "dry", the blood was brownish black, and the length of the bleed very short; 3) I had a healthy sex drive; 4) I lubricated very adequately. I also had very severe acne on my backside - had it from puberty onward, and was going to start begging for Accutane if it didn't clear. I should mention that during this phase - what I considered normal - I once had a transvaginal ultrasound and the doctor remarked upon the great number of ovarian follicles I had.

Over the past year, the acne first got worse, then cleared up by about 90% (I could almost say it's "gone" in comparison to the way it used to be). The cyclic mastalgia was temporarily insufferable for a number of cycles, and I had emotional PMS symptoms in a way I had never had previously (felt "crazy") but now I don't have cyclic mastalgia at all. My period became heavier and is much more red from the dark brown it used to be. My libido has disappeared completely (and practically overnight) along with any lubrication I had. My energy levels temporarily suffered quite a bit.

I've had a few hormonal tests performed and the ones done have come up normal. I've had certain day 3 hormone tests done on day 6 of my cycle (which my docs didn't make too much of a fuss about as it seems close enough to day 3). One time this was done, I had an FSH of 4.2 and an LH which the doctor called "normal" (don't know the actual result). A few months later, I was retested and I had an FSH of 5.1, LH of 6.3, estradiol of 44 (presumably this was pg/mL), and normal DHEA (288.2 ug/dL out of a normal range specified to be 98.8 to 340). Blood glucose was within the normal range as was everything else except Vitamin D3 (the deficiency not being a new thing). Thyroid tests came back normal; I am not obese or underweight. I've used ovulation prediction kits and the kits detect an LH surge (or two!) when I test my cycle.

I have not been tested for progesterone, free testosterone, or had any AMH testing done.

I am not, nor have I ever been on any form of birth control, nor have I ever been pregnant.

My life is stressful, but it has been stressful for a very long time and this never affected me previously. There are also too many bodily changes for my libido change to be purely psychological, in my opinion.

As if the complete disappearance of my sex drive and lubrication isn't worrysome enough, I have a family history of early menopause or POF (mother: age 42; aunt: age 38; grandmother: age 36).

All that to say this: from what I've read, I'm not understanding much of what's going on. I theorized that my testosterone might be low, based on my low libido and the disappearance of my acne, but I don't know why that would be the case when my DHEA is on the healthy side of normal. I also realize that vaginal dryness is an issue in the approach to menopause but again, my numbers are normal and not indicative of a problem (at least the one time it was tested). Also, I've heard that in perimenopause, estrogen is relatively high at first - again, I can't figure out why, if I were only in permenopause, and given my other stats, I would be dry to the point of discomfort.

I thought that perhaps I previously had undiagnosed PCOS (the acne, XXXXXXX voice, gaining weight around the middle, doctor remarking on a large number of follicles) but even if I did and it suddenly went away, the new "norm" for me does not seem "normal".

Can you help me identify any sort of problem/disease state that would account for all of the changes I've seen?
Answered by Dr. Mahesh Koregol 51 minutes later

Thanks for the query. I read your concerns and following is my reply:

1) First of all I would like to reassure you that what you are experiencing is normal phenomenon which many women experience all over the world.

2) You are absolutely in fine health. Your hormones reports are fine and you dont need other tests like AMH, Progesterone or free teststerone.

3) The only major factor I see here is stress. You variation in menstrual cycle flow, colour and vaginal dryness are attributable to your stress levels ( even libido decrease).

4) PCOS is not a disease oer se as many women have it and you can conceive even if you are PCOS. Hence remove that from your mind.

5) With FSH around 4 to 5, I would advice you to stop worrying unnecessarily about POF or early menopause / perimenopause. It is not happening to you right now or It wont happen to you sooner at all.

6) I dont know what stress you are going through. Please XXXXXXX a counselor to reduce your stress and try to be relaxed by removing stressful reason from your life. You are better person to decide how to tackle this stress.

7) I would like reassure you again that you are more healthy than 70 % of women in your age group. All problems are related to stress.

I hope I answered your query. Please let me know if you have any follow up queries.

Dr.Mahesh koregol
IVF & Infertility Specialist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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Test Name : Serum Testosterone Result : 411.7

MALES (YEAR) Unit ng / dl

0 - 4 10 - 160
4 - 12 10 - 290
12 - 16 10 - 560
16 - 20 260 - 730
20 - 49 270 - 1734
> 50 212 - 755
FEMALE (YEAR) Unit ng / dl

12 years upto 20
Ovulating 63 120
Postmenopausal 49 113


Tests Normal Value Result

FSH UNIT:mlU/ml 46.72
Mid-cycle: 6.6-29.0
LH UNIT:mlU/ml 46.72
Mid-cycle: 9.4-27.9

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