WOMENS-HEALTH Messages for August, 1998: Re: perimenopause and provera

Re: perimenopause and provera

From: William D. McIntosh, MD (anonymous@obgyn.net)
Sun, 30 Aug 1998 14:47:03 -0500 (CDT)

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In reply to: janice: "perimenopause and provera"

At Sat, 29 Aug 1998, janice wrote: >
>I am hesitant to repeatedly take provera to induce periods. I am 47 and
>am experiencing perimenopausal symptoms including increasing episodes of
>amenorrhea. Have had a number of sonograms and a sonohysterogram,
>revealing some endometrial thickening; treatment with provera for a
>couple of months resulted in normal test results. Have never taken
>birth control pills, no history of medical conditions, and would rather
>avoid taking any hormones if at all possible. Currently, no period for
>3+ months. Doctor has prescribed 10 mg provera every other month, and
>I'm reluctant. Isn't amenorrhea 'normal' during this time? If provera
>must be taken, what would be the minimum dosage/schedule I could try?
>Would cutting the 10mg tablet in half for 10 days be sufficient to try
>and induce a period? Would very much appreciate your comments.
>
>--
>janice martin
>

The perimenopause is a very difficult time in any woman's life, and your concerns are not unique. The problem is that you do not cycle regularly, but you still have sufficient estrogen to cause proliferation, or thickening, of the endometrial lining. Since ovulation is infrequent, or absent in you these days, the progesterone that you would normally produce after ovulation is not produced, so the endometrial lining is not shed appropriately. Over time, this situation could lead to an overgrowth of the endometrium known as hyperplasia, then hyperplasia with atypia, followed by endometrial cancer. The Provera that your physician is giving you is a way of preventing this probem. You're right, amenorrhea is on its way, but judging from your endometrial lining, you're not there quite yet. There are multiple dosages for Provera, so talk with your doctor. As far as hormones are concerned, please remember that your body is a veritable soup of hormones, and has been your entire life. There is not a cell in your body that does not have some use for estrogen, many of them critically important. For those who argue that hormone replacement is not natural, I would reply that the unnatural part is living long enough to reach menopause. That has been true for significant numbers of women for only 100 years or so, and even then, only in certain parts of the world. To paraphrase an old line from the battle of the sexes, if men went through menopause like women do, hormone replacement would be a sacrament.

-- William D. McIntosh, MD Clarksville, TN

This is for educational purposes only. It is not intended to replace consultation and examination by your physician or other health care provider.

Next message: Patti Tessler, FNP: "Re: 2nd post on nabothian noduals"
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In reply to: janice: "perimenopause and provera"

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