Re: Delayed menopause/prolonged climacteric

From: Karen Lee (karen@karenlee.org)
Fri Mar 17 11:20:40 2006

1. Endometrial ablation, preceded by EMB, if the fibroids are not encroaching on the endometrium 2. Mirena

--- Rafael Haciski <haciski@earthlink.net> wrote:

> 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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