Menopause Symptoms: Do Hormone Levels Always Drop?

Menopausal disorder inquiries?

On March 25, 2020, after work, I felt unwell with symptoms of palpitations, arrhythmia, weakness, and loss of appetite.
That night, I went to the emergency room where an electrocardiogram and blood tests were conducted, all of which returned normal results.
I was prescribed Anpan, and after taking it, I was able to sleep and felt normal the next day.
Later, I had a follow-up appointment in the cardiology clinic where I underwent a cardiac ultrasound and additional blood tests, including thyroid function tests, all of which were normal.
In April, I experienced two menstrual periods, from April 9 to April 16 and from April 27 to May 6.
My usual menstrual cycle lasts about 4-5 days, but these two periods lasted 7-8 days each, with significantly reduced menstrual flow.
Since I am already 51 years old, and during this time I experienced irregular menstruation, intermittent palpitations, anxiety, abnormal twitching of the left eyelid, and difficulty sleeping at night, I suspected that I might be experiencing menopausal syndrome.
Therefore, I sought treatment from a traditional Chinese medicine practitioner to help regulate my body.
During the month of treatment, my condition improved; my palpitations and anxiety lessened, and I was able to sleep more soundly at night.
However, on May 11, I suddenly experienced a rapid heartbeat, increased anxiety, and panic, along with occasional tinnitus and mild dizziness.
Consequently, on May 14, my gynecologist ordered blood tests to check hormone levels.
The results showed that my hormone levels and follicle-stimulating hormone (FSH) levels were normal and not low, so the doctor did not prescribe any supplemental medication.
After this series of examinations and my physical and emotional responses, I would like to understand if the onset of menopausal symptoms necessarily indicates a deficiency in hormones.
Given that my blood test results show normal hormone levels and FSH levels, does this mean I do not have menopausal syndrome? What direction should I take to identify the underlying cause of my symptoms? Thank you.

Ms. Wu, 50~59 year old female. Ask Date: 2020/05/22

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if you are experiencing symptoms of menopause and are feeling uncomfortable, it is recommended to consider hormone therapy to see if it improves your condition.
Wishing you good health.

Reply Date: 2020/05/22

More Info

Menopause is a significant transition in a woman's life, typically occurring between the ages of 45 and 55, marked by the cessation of menstruation and a decline in hormone levels, particularly estrogen and progesterone. However, the experience of menopause can vary widely among individuals, and not all women will experience a drop in hormone levels that leads to noticeable symptoms.

In your case, it appears that you have been experiencing a range of symptoms, including palpitations, irregular menstruation, anxiety, and sleep disturbances, which can indeed be associated with menopause. However, the fact that your hormone levels and follicle-stimulating hormone (FSH) levels were reported as normal suggests that you may not be in the typical menopausal state, where hormone levels are expected to decline significantly.

It's important to understand that the transition to menopause, often referred to as perimenopause, can be characterized by fluctuating hormone levels rather than a straightforward decline. During this time, estrogen levels can vary widely, leading to symptoms such as irregular periods, hot flashes, mood swings, and anxiety. Some women may experience symptoms even when their hormone levels are within the normal range, as individual sensitivity to hormonal changes can differ.

Your symptoms of heart palpitations and anxiety could also be attributed to other factors, such as stress, lifestyle changes, or even underlying health conditions that may not be directly related to menopause. For instance, anxiety and panic attacks can occur independently of hormonal changes and may require different management strategies. Additionally, the presence of symptoms like ear ringing (tinnitus) and dizziness could indicate other medical issues that should be explored further.

Given that your hormone levels are normal, it may be beneficial to consider other potential causes for your symptoms. These could include:
1. Psychological Factors: Anxiety and stress can manifest physically, leading to symptoms such as palpitations and sleep disturbances. Cognitive-behavioral therapy (CBT) or other forms of counseling may help address these issues.

2. Lifestyle Factors: Diet, exercise, and sleep hygiene play a crucial role in overall health. Regular physical activity, a balanced diet, and good sleep practices can help alleviate many symptoms associated with menopause and anxiety.

3. Thyroid Function: Since you mentioned having thyroid tests, it's essential to ensure that your thyroid function is optimal, as thyroid disorders can mimic or exacerbate menopausal symptoms.

4. Cardiovascular Health: Given your history of palpitations, it may be worth discussing with your healthcare provider whether further cardiovascular evaluation is necessary, especially if symptoms persist.

5. Alternative Therapies: Since you have tried traditional Chinese medicine with some success, you might consider exploring other complementary therapies, such as acupuncture or herbal supplements, which some women find beneficial during menopause.

In conclusion, while menopause is often associated with a decline in hormone levels, not all women will experience this drop, and symptoms can arise from various factors. It is crucial to work closely with your healthcare provider to explore all potential causes of your symptoms and develop a comprehensive management plan tailored to your needs. Regular follow-ups and open communication about your symptoms will help ensure that you receive the best possible care during this transitional phase of life.

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