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    Dr. Hohner, Does the pill mask menopause?
    sabine48 posted:
    Hi Dr. Hohner,

    I am female, 50, on BCP's for apprx. 34 yrs. My gen. prac. mentioned she can not know if I am in menopause unless I stop the pill for 1 mo. and they can test me. New to me was the fact that she said I would always have a 'period' while on the pill regardless. Does that mean even if I were in menopause (which I take to mean no more periods) what she is saying it to mean? Am I still bleeding because I am taking the pill?

    Perhaps at my age I should know these things but I do not. In the past couple of years I had very heavy bleeding problems. My BCP had to be adjusted to a higher dose which did help. I was also anemic and took iron pills at that time. I no longer take them but wonder if it would be harmful to continue an iron supplement, I feel very tired much of the time, I sleep perfectly fine but remain tired and even go so far as to nap most afternoons for up to a couple of hours going to bed around 12 a.m. and sleeping through the night. I am also overweight about 25 pounds and have terrible eating habits which because I don't like the result (weight gain) I am seriously considering making the necessary changes to my diet to lose. But in the meantime, about the iron, can you suggest a safe amount or do I need to ask my dr.?

    Sorry for all the questions but you've been such a great help in the past that I felt good about asking once again.

    Thank you!
    georgiagail responded:
    It's important to understand that while you are on "the pill", it controls when you bleed and not your own body. This is why going on the birth control pills (or increasing the strength of them) often helps with heavy or irregular bleeding. This medication contains hormones; the same reproductive ones that your ovaries would normally be producing.

    Thus, if your physician wishes to test if your own body is still producing these hormones naturally (or if you are starting to decrease these...or have stopped, indicating menopause) they need to take you off the pill for a while.

    Anon_1448 responded:
    Dear Sabine: Gail is correct (as usual!), but I would like to add some additional input.

    1. Some of the newer, lower dose birth control pills (BCPs), contain pills containing a very low dose of estrogen during the usual placebo pill week. Where there is recent exposure to estrogen it can artificially suppress the levels of FSH (common blood test for menopause).

    2. Other studies have shown that even being off BCPs for a full two weeks may still not yield an accurate FSH result. This is despite the fact that most clinicians will usually test for menopause at the end of the 7 day placebo/non-hormone containing pills.

    3. For women on BCPs, the FSH level may be suppressed by as much as 25%.

    4. In terms of symptoms (eg hot flashes), the amount of synthetic estrogen in a BCP is about 4 to 6 times more than what one would get in HT ("HRT"). This is why BCPs help control hot flashes very well.

    4. Surprisingly, use of synthetic progesterone methods of birth control (eg DepoProvera) may not provoke an artificially suppressed FSH level. Thus, the FSH test may be more accurate in determining menopause.

    5. During the transition into true menopause, FSH levels can vary wildly among women not using BCPs.

    Bottom line, your GP is correct that it may take being off the BCP for a month to get a more accurate blood test for menopause. You might notice hot flashes during that time as well.

    angel04 replied to Anon_1448's response:
    Dr. Hohner,
    I was put on the BCP in my early 40's for perimenopause. Actually it was called, lo/estrin. When i got closer to age 50, i did have night sweats. At age 50 and 2002, the year that made us all question any kind of HRT. I did stop completely. Never to see a period again. I might add that i did have less and less of one each month on the BCP. & sometimes not one at all. It was a great help! I felt wonderful on them. Full of energy. Infact, at my ideal weight because of this. Once i got OFF, i went right down hill. I was extremely fatigued. All my joints ached & quite stiff as well. I cried non stop & gained a lot of weight. I literaly could not get out of my own way. I wish i never got off. Would it be possible now @ 60 yrs. to go back on the lowest dose again of BCP to help with all this? I am so miserable. No energy, no libido, arthritis is aweful, and very moody. Cannot loose any weight at all. My thyroid has been checked repeatedly. I was told some women could be on low doses all their life if they desire and need it. Please help!
    Nevarda replied to angel04's response:

    Check Dr. Hyman's web site. great info. about hormones and thyroid (just in case). I hope this will help you!
    sunfan responded:
    It is not always easy to be sure of the menopause:
    1- Menopause is usually diagnosed with certainty in retrospect, i.e. if one full year have passed without any periods Or
    2- Check FSH on two occasions at least 1 to 2 months apart, If both FSH levels are >30 IU/l this is highly suggestive of ovarian failure and menopause.
    Fertility in this age group is unreliable and you should follow a family planning method until you are sure of the menopause. Your options are:
    a) 1- Stop hormonal contraception, use another non-hormonal method (barrier methods, local spermicides, emergency contraception or the intrauterine device) and check your FSH 6 weeks after you stop hormonal contraception as above
    b) 2- Or continue with your current hormonal contraceptive (if it is safe and you are happy with it) until you reach the age of 55 when the natural loss of fertility can be assumed for most women (96%)
    Hope above helps
    Dr Adel Elkady
    angel04 replied to Nevarda's response:
    Thanks for responding. I would love to check out that website, but i can't seem to find it. What website is Dr. Hyman's?

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