Women's Health Community

Dear An: The bleeding patterns do suggest that you still have enough estrogen (estradiol) to make a uterine lining that is available to be shed. The marked irregular pattern to the bleeding can suggest that you are no longer having regular ovulations. Both of these can be consistent with perimenopause--the 4-5 year transition into complete menopause.

That your FSH and LH levels are in the menopausal range can also be consistent with perimenopause. Our aging ovaries with their "old eggs" become less responsive to the normal hormonal cyclic patterns. An analogy would be the old maid popcorn kernels at the bottom of the pan. Most of the eggs in the ovaries have popped effectively. We begin to miss ovulations, or if they occur, less progesterone is produced. To compensate for this, the brain "turns up the controls on the stove" to try and get the last ovarian follicles to ovulate. Like our popcorn analogy, when the hormonal stimulation is turned way up by the hypothalamus, the last few of the ovarian follicles do ovulate---sometimes two or three at a time, because of the increased stimulation. (This is one factor in the increased number of twins born to older mothers). When more than one follicle is stimulated estrogen levels can actually spike up briefly.

The overall effect is that hormone levels are rapidly rising and then falling and then rising again. This produces the varying intensity of hot flashes, and other menopausal symptoms, that confounds both women and their GYNs during perimenopause. It also makes the use of hormonal blood tests problematic during this time.

One last thought, hyperthyroidism can also prompt missed periods (by different mechanism than low thyroid). Given your insomnia/flashes/hear palpitations I would suspect that your thyroid levels have been recently checked as well.

Ultimately, if perimenopause is the culprit, it will eventually declare itself as actual menopause. It sounds like your own GYN is taking your symptoms seriously as they are doing continued testing so as not to miss any of the uncommon explanations.

Yours,
Jane

Most recent blood work results are in.
TSH 0.27
T4 8.3
T4 free 1.5
Vit B12 294
Cortisol 3.9
DHEA sulfate 37
FSH 91.7
LH 47.2
Estradiol 25

My last FSH, LH and Estradiol was a year ago. I can't remember what the exact numbers were but I took a copy with me three months ago to my OB/GYN for my routine woman exam, she told me that the levels were showing menopause in the FSH and LH but Estradiol was at 200 and I was still having menstrual cycles so therefore I was not in menopause. The reason I took them with me is because I was having symptoms a year ago and now they are getting much, much worse. All these levels were tested at the PCP for my yearly exam due to symptoms and previous test just last week. She also did a testosterone but that one is pending still. I have a Oncology OB/GYN appointment next week. I am praying that something can be done soon. I feel so miserable and I didn't mention that I am only 40 years old. Thank you for all your input, it has been helpful.