Early Menopause and Hormone Therapy: Key Concerns and Questions

Premature menopause and hormone therapy issues?

I am 43 years old and have irregular menstruation, so I had a blood test.
The doctor said my follicle-stimulating hormone (FSH) level is as high as 72.9, indicating that I have entered menopause.
However, since my age is considered early menopause, the doctor suggested hormone therapy with progesterone.
After stopping the medication for the first month, my period came right away, but after stopping the medication for the second month, I have not had my period for 9 days.

1.
Will hormone therapy with progesterone (the small white pill is said to be natural) increase the risk of breast cancer?
2.
The doctor advised me to continue the medication until I am 45, as that is the typical age for menopause.
However, since my period is not returning while on medication, is this irreversible?
3.
About a year ago, when I was around 40, I experienced anxiety, palpitations before sleep, difficulty breathing, and depression with loss of appetite.
I managed to cope through exercise and positive thinking for about a year.
Could those have been symptoms of perimenopause?
4.
If I stop the medication and officially enter menopause, will the symptoms I experienced at 40 return?
5.
While undergoing hormone therapy, can I have another blood test to check my menopause index? Will it be accurate?
Thank you, doctor.

Kelly, 40~49 year old female. Ask Date: 2023/11/25

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, you have some symptoms of menopause.
Please take medication as directed by your physician, and perform self-breast examinations.
Wishing you good health.

Reply Date: 2023/11/25

More Info

Navigating early menopause and hormone therapy can be quite challenging, especially at the age of 43, as you are experiencing. It’s important to address your concerns with a comprehensive understanding of hormone therapy, its implications, and potential alternatives.

1. Hormone Therapy and Breast Cancer Risk: Hormone replacement therapy (HRT), which includes estrogen and progesterone (or progestin), has been associated with an increased risk of breast cancer, particularly with long-term use. The risk varies based on individual factors such as family history, personal health history, and the type of hormones used. While some studies suggest that using estrogen alone may not significantly increase breast cancer risk, combining it with progestin can elevate the risk, especially after several years of use. It’s crucial to discuss your personal risk factors with your healthcare provider to make an informed decision.

2. Menstrual Irregularities and Irreversibility: The fact that your menstrual cycle has become irregular or ceased while on hormone therapy can be concerning. While hormone therapy is intended to alleviate menopausal symptoms and regulate cycles, it does not guarantee that your menstrual cycle will return to normal after stopping treatment. If you are experiencing prolonged amenorrhea (absence of menstruation), it may indicate that your body is transitioning into menopause, which can be irreversible. However, some women do experience a return of their cycles after stopping HRT, but this varies widely.

3. Previous Symptoms and Early Menopause: The symptoms you experienced around the age of 40, such as anxiety, palpitations, and depression, could indeed be indicative of perimenopause, the transitional phase leading up to menopause. Hormonal fluctuations during this time can lead to mood swings, anxiety, and other psychological symptoms. It’s not uncommon for women to experience these symptoms years before their periods stop completely.

4. Recurrence of Symptoms Post-Therapy: If you stop hormone therapy and officially enter menopause, there is a possibility that the symptoms you experienced previously could return. Each woman's experience with menopause is unique, and symptoms can vary in intensity and duration. Some women find that their symptoms improve after the initial transition, while others may continue to experience significant discomfort.

5. Testing Hormone Levels During Therapy: It is possible to check hormone levels while on hormone therapy, but the results may not reflect your natural hormone levels accurately due to the influence of the therapy itself. If you are considering testing, it’s best to discuss this with your healthcare provider to determine the most appropriate timing and type of tests to get meaningful results.

In summary, early menopause and hormone therapy present unique challenges that require careful management and monitoring. It’s essential to maintain open communication with your healthcare provider about your symptoms, treatment efficacy, and any concerns regarding risks associated with hormone therapy. Additionally, exploring alternative therapies, lifestyle changes, and support systems can also be beneficial in managing symptoms and improving your quality of life during this transition.

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