Menopause Symptoms: Irregular Periods and Ovarian Cysts

Menopausal discharge

Since I turned 40, my menstrual flow has gradually decreased.
Now, at nearly 43, on the heaviest days, I only use about 1 to 1.5 sanitary pads.
I experience dysmenorrhea on the first and second days, and on the other days, the menstrual blood is very light, not even half a pad.
In recent months, the last few days of my period have included dark discharge that lingers until about the 12th to 13th day, around the time of ovulation, before it completely clears up.
I'm wondering if the reduced menstrual flow and light spotting are signs of approaching menopause.
I also experience vaginal dryness, which makes me prone to inflammation and increased discharge.
However, my cycle remains relatively normal at 28 days.
I consulted a doctor who mentioned that at my age, I should not be nearing menopause, but I am concerned about the possibility of cervical or other pathologies.
Additionally, an ultrasound revealed a 3.4 cm ovarian cyst and a 2 cm fibroid.
Is it safe to supplement with DHEA? The ovarian cyst has been monitored for nearly 10 years without resolution.
The doctor mentioned that if the cyst has not resolved, it could be due to adhesions.
Are these adhesions possibly affecting the intestines? If there are intestinal issues, such as increased intra-abdominal pressure, inflammation, or constipation, could these be contributing to the persistent ovarian cyst? If adhesions are present, would surgical removal be necessary? If surgery is not performed, is there a risk of malignancy?

Lo, 40~49 year old female. Ask Date: 2023/12/13

Dr. Chen Zhiyu reply Obstetrics and Gynecology

It is recommended that you visit the obstetrics and gynecology outpatient clinic for evaluation and consultation.
If you have any concerns, please consult the physician in person.
Thank you.

Reply Date: 2023/12/13

More Info

Understanding the symptoms of menopause, particularly in the context of irregular periods and ovarian cysts, can be quite complex, especially for women in their early forties. As you approach this transitional phase, it's common to experience changes in your menstrual cycle, including lighter periods, increased pain, and variations in the duration and flow of menstruation.
From your description, it seems that you are experiencing a significant reduction in menstrual flow, with only 1 to 1.5 pads used on heavier days, and spotting that extends beyond the typical duration of a period. This could indeed be indicative of perimenopause, the transitional phase leading up to menopause, which can begin several years before the last menstrual period. During this time, hormonal fluctuations can lead to irregularities in your cycle, including lighter periods and changes in menstrual flow.

The presence of a 3.4 cm ovarian cyst and a 2 cm fibroid, as noted in your ultrasound, adds another layer of complexity. Ovarian cysts are fluid-filled sacs that can develop on the ovaries and are often benign. However, persistent cysts should be monitored, especially if they have not changed in size over a long period. Your doctor’s recommendation to continue monitoring these cysts is prudent, as they can sometimes lead to complications if they grow larger or if there are concerns about their nature.

Regarding your concerns about DHEA (dehydroepiandrosterone) supplementation, it's essential to consult with your healthcare provider before starting any new supplements, especially considering your existing conditions. DHEA is a hormone that can influence estrogen and testosterone levels, and its effects can vary widely among individuals. While some women may find it beneficial for symptoms related to menopause, others may not experience significant improvements, and there can be side effects.

Your mention of vaginal dryness and increased discharge is also common during perimenopause due to declining estrogen levels. This can lead to vaginal atrophy, which may increase the risk of infections and discomfort. Over-the-counter lubricants and moisturizers can help alleviate dryness, and discussing these symptoms with your healthcare provider can lead to effective treatment options.

As for the potential for adhesions (or "adhesive disease"), these can occur after surgeries or infections and may affect the ovaries and surrounding organs, including the intestines. If adhesions are suspected, they can sometimes lead to complications such as pain or bowel obstruction. However, not all adhesions require surgical intervention unless they are causing significant symptoms or complications.

In terms of your concerns about malignancy, it is crucial to maintain regular follow-ups with your healthcare provider. Most ovarian cysts are benign, but any changes in symptoms or new concerns should be evaluated promptly. Regular pelvic exams and imaging studies can help ensure that any potential issues are identified early.

In summary, while your symptoms may suggest that you are approaching menopause, it is essential to continue working closely with your healthcare provider to monitor your menstrual cycle, ovarian cysts, and any other symptoms you may experience. They can provide personalized advice and treatment options based on your specific health needs and concerns. Regular check-ups and open communication with your doctor are key to managing your health during this transitional phase.

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