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On low dose of estrogen and progesterone therapy. Started periods after 2 years and rapid heartbeat. Concerned

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Practicing since : 1999
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I am a healthy 43 old woman who has been undergoing a low dose of estrogen and progesterone therapy for approximately 4 months. I had my first period in two years today, and this evening I developed sudden chills, rapid heatbeat and a fever after feeling fine all day. Could there be a connection and could this be a symptom of any potentially XXXXXXX side effect?
Posted Mon, 20 Aug 2012 in Menstruation and Miscarriage
Answered by Dr. Timothy Raichle 1 hour later
Hello, I would be happy to help you today with your questions.

So from what you are saying, you went through premature menopause (defined as no period for 12 months). In ANY woman with bleeding in the "postmenopausal" period, an evaluation should be undertaken. This should include:

1. An exam
2. An ultrasound
3. An endometrial biopsy

This recommendation is regardless of the status of HRT.

With regard to the symptoms of chills, fever, rapid heart beat this sounds like signs of an infection. Given the correlation of these symptoms with the onset of vaginal bleeding, one would have to consider the uterus a source of infection in this case. If this were the case with involvement of the uterus, it is sometimes called "pelvic inflammatory disease" or PID. If you currently have these symptoms and the bleeding is continuing, then you need to be evaluated as soon as possible.

I hope this answers your question. If you have more questions, please ask. If you are satisfied, please take a moment to leave feedback! Good luck!
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Follow-up: On low dose of estrogen and progesterone therapy. Started periods after 2 years and rapid heartbeat. Concerned 8 hours later
Thank you for your helpful response. I have an appointment early next week to check everything. Oddly, the fever disappeared approximately 2 hours after it appeared, without any medication. (I did wake today with blocked sinuses, so perhaps that is also related).

I did want to ask one followup question. My understanding is that progesterone is given to help the body shed the endometrial lining and thus decrease the chances of endometrial cancer. I had assumed that the shedding would look like a period and was not particularly concerned about the light bleeding and tissue flow. From your answer, I gather that this is not the norm? What should the shedding normally look like?

Thank you.
Answered by Dr. Timothy Raichle 13 hours later
Thank you for the followup, and sorry about the delay getting back to you!

You are correct, we sometimes given progesterone to "protect" against endometrial cancer and also to induce a period. Usually the shedding looks like a period, but if the blood / lining has been present for a significant period of time, I can imagine that it might almost appear as though you are passing tissue in this setting.

I am glad you are otherwise feeling better - let me know if you have more questions.
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