Menopause, what to do when you have multiple symptoms and no answers?
The Dodge
Here is a recent question, which is worth considering as it’s not uncommon for people to have multiple symptoms and to feel totally overwhelmed and adrift.
“This is all so confusing. Could you explain what to do when you are 52, still having periods, no hot flashes, constant bleeding. Heart palpitations daily for the last year, weight loss not weight gain, sleep problems, anxiety, fibroids, ovarian cysts…But doctors say your hormones are fine!! Should I be on estrogen or progesterone…should I not? What to do here? Nobody knows. I’ve literally been tested for everything and I swear it’s peri menopausal symptoms but no one agrees.”
There are several things to consider right off the bat…
Reproductive hormone levels, meaning estrogen, progesterone, and testosterone, are not helpful in sorting out symptoms over the age of 45. Meaning no one should be attributing symptoms to menopause or saying they aren’t menopause-related based on reproductive hormone levels. If the “hormones are fine” here means other hormones, then that is a different situation, which we’ll address below.
If someone is 52 and still having periods they are in the menopause transition. It would be very rare to not have a final menstrual period by 55, and given the menopause transition starts several years before by age 52 most people are in the transition. Whether it’s causing all of the symptoms is another matter.
When there are lots of symptoms and concerns the temptation is to look for a unifying diagnosis, but there may be several conditions, and so each symptom or problem should be addressed individually, although bleeding issues are usually grouped together.
When there is a lot going on often we have to start with the most medically concerning issues and then work down the list from there. It doesn’t mean all the issues aren’t important, but some may need to be considered first.
And keep in mind this is general information based on the symptoms reported above and not direct medical advice. Basically, these are some ideas on how to get started.
Heart palpitations
Heart palpitations are an abnormal sensation of being aware of one’s own heart beating. While palpitations are definitely symptoms reported in the menopause transition, they can be caused by many conditions. The urgency of organizing testing depends on whether the palpitations are associated with fainting or passing out, other medical conditions, and what is found when someone is evaluated by their provider.
An internist or family doctor generally does the initial workup for palpitations, but underlying medical conditions and what is found on exam or testing may require a cardiologist. Testing will depend on other symptoms, risk factors for heart disease, and what is found on a physical exam. For example, given a report of weight loss and a history of heavy bleeding it’s especially important to check a TSH (thyroid stimulating hormone, to test thyroid health) and a CBC (complete blood count) and a ferritin (iron level) to rule out anemia. Other blood work may also be needed and an EKG and a Holter monitor (wearing a heart monitor for 24 hours or long) are typically performed. There is more information on palpitations here and here. If all the testing is normal, it’s possible the palpitations could be due to the menopause transition, but in this case they aren’t treated with hormones.
For example, when I was 48-years-old I developed palpitations, it felt like my heart was rolling over in my chest. When I was evaluated, my heart rate was 32 beats per