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    Periomenopausal symptoms?
    An_250831 posted:
    Hello, I will be 45 next month but for the last two months my periods have been four day cycles. And that is tops. I am used to having cycles that are between 6-6.5 days long. My periods usually start out light with two heavy days following then tapering off. Heavy enough to soak my tampons and wear liners but then it gradually starts to go away and by the fourth day it is finished up. I am nervous regarding this new change. My cycles are 25 days apart. My partner and I use condoms. Is this normal??
    Mary Jane Minkin, MD responded:
    Dear An_250831,
    These changes certainly could be related to early perimenopausal hormonal changes. It's very unlikely that these would be related to a pregnancy; if you want to do a home pregnancy test for reassurance, that's certainly fine-but these would be unlikely to be associated with a pregnancy. You do bring up a good point; you definitely want to continue to use contraception until you go a full year without a period. But as far as worrying: unless there is some unusual bleeding between periods-shortened days of flow with a period is fine. So do not worry. Always reasonable to consult with your health care provider for reassurance; but the type of change you are noting is not a worrisome one.
    Good luck
    Mary Jane
    An_250831 replied to Mary Jane Minkin, MD's response:
    Thank you so much for the reassurance. I am scheduled for a well woman exam on April 5th. Would it be helpful to ask her to check my hormones? I am anxious to see whether or not the next period I have will be the same way. I forgot to mention that I do indeed have menstrual cramping and the over all blah feeling that usually accompanies my period so that is still the same.

    Thank you....
    shila46 replied to Mary Jane Minkin, MD's response:

    I need an expert's opinion about my issue. I am 46 yrs.old and in a perfect health. 2 years ago after going under abdominoplasty and liposuction I got blood clot in my leg and I had to quit my birth control pills after over 10 years. Ultrasound showed no sign of remaining clot in my leg after 8 months. An experienced cardiovascular doctor did not believe that taking hormones would cause recurring blood clot or stroke regard to my health and family history. I went though other surgery and more liposuction later on and I recovered nicely. At present I feel I am suffering from the low level of estrogen( irregular periods, no periods for a month or two sometimes, vaginal dryness,low libido). My Gyn hesitates to prescribe any type of estrogen for me. My FSH level was 15 last year but my symptoms were not this bad . Is there any other option for me such as using an estrogen patch instead of pills, and taking aspirin on a regular basis to prevent any possible issue. If not, how these symptoms will be manageable now and later in my life. My other concern is osteoporosis due to the lack of estrogen in the future. There is history of this problem in my family. Thanks in advance.
    Mary Jane Minkin, MD replied to An_250831's response:
    Dear An_250831,
    Good question. Hormone levels alas aren't tremendously helpful at this point. If one is still having periods, they don't tell you a lot. One option is do an FSH test on the 3rd day of your period. If it is low, it will tell you that you are probably still far from the last menstrual period; if it is high, it will tell you you are approaching it-but neither result will really give you an exact time frame-sorry there isn't much that blood tests will do. Now occasionally thyroid dysfunction can give some similar symptoms; and in diagnosing thyroid disorders, blood tests are much more helpful. But estrogen levels aren't terribly reliable.
    Good luck,
    Mary Jane
    Mary Jane Minkin, MD replied to shila46's response:
    Dear shila46,
    Good questions. Did you by any chance have a blood workup to check on certain tendencies in a person to experience blood clots? These tests are referred to as a thrombophilia work up, and include blood tests for things like Protein C and S, and Leiden factor V. If any of these tests were positive, most docs wouldn't recommend any estrogen therapy. Even if they were negative, no one would recommend oral estrogen therapy for you. If the thrombophilia work up were negative, there are some gynecologists who might consider a low dose of a transdermal estrogen, although they are still officially not recommended in a woman with a history of blood clots. Most gynecologists would be comfortable prescribing vaginal estrogens for vaginal dryness, as the absorption into the blood stream is so minimal.
    For prevention of osteoporosis, try to achieve 1200 mg of calcium intake in your diet daily if possible (remember that 1 dairy helping -say an 8 ounce glass of milk or cup of yogurt) contains about 300 mg of calcium; you also want to get in 1000 units of vitamin D a day. And you want to do weight bearing exercise daily if you can. An excellent guide on bone strengthening is by Miriam Nelson, and is called "strong women, Strong Bones"
    Good luck,
    Mary Jane
    shila46 replied to Mary Jane Minkin, MD's response:
    Dear Dr. Minkin, Thank you so much for the response. I am scheduled for a check up in May, I will request for a thrombophilia test. I might need further advice from you. Regards.

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