Re: Delayed menopause/prolonged climacteric
From: Charlie Chambers (ricechaz@gorge.net)
Fri Mar 17 12:04:45 2006
Just continue her OC's.
On Mar 17, 2006, at 9:02 AM, Rafael Haciski 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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Charlie Chambers
--
Hood River, OR
cchamber@alumni.rice.edu
"Almost anything you do will seem insignificant but it is very important
that you do it....You must be the change you wish to see in the world"
-- Mahatma Ghandi.
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