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Delayed menopause/prolonged climactericFrom: Rafael Haciski (haciski@earthlink.net)Fri Mar 17 10:00:56 2006
I am reaching out to the collective brain trust ----> I have a pt who is pushing 56 years of age, who is having irregular periods (heavy bleeding 2-3 times per year over last year) since I stopped her OCP. When I saw her for the first time last year at age 54, she was still on Yasmin (OCP) and happy. Wanting to know if she was menopausal, I checked her serum FSH 4 days after stopping OCP (between her OCP packs), her serum FSH was <1 Repeat bloods 2 months later (in June 05) after being off OCP for 3 weeks showed: ... estradiol 45, FSH 11 ==> neither in menopausal range She stayed off OCP with no bleeding until Dec. when major bleeding occurred. Repeat bloods in early Feb show E20 and FSH1 (could have been midcycle surge) with menses late February. Repeat bloods again in early Mar E2a FSH Menses in mid march. Sono was negative except for few small fibroids, thin (5 mm) endometrium, normal ovaries. My take on this is that she is in climacteric, albeit delayed and prolonged, but how to manage her irregular bleeding. ... Ignore it? how often to recheck menopausal status? (at which point does it become PMB?) ... OCP? increased risk of VTE in someone this age (although nonsmoker) In reality, if the VTE risk is from estrogen, her estrogen levels are higher now and therefore she would be at higher risk for VTE without OCP, but....? She does have small fibroids so I could always do Laparoscopic hyst and BSO (with pathology supporting surgery) but that is a bit drastic.
-- Rafael Haciski MD FACOG Palmetto, FL
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