Perimenopause Can Be a Confusing Time - Even for Doctors - How I Had Unnecessary Tests and Worry - It Wasn't Menopause
In December 2009, I began to have vaginal pain with intercourse. I wasn't surprised, as I'm of a certain age and my periods had been irregular for a while. In fact, the only vaginal bleeding since a "normal" period in June was one recent day of spotting. I had started using a lubricant a few months before. I decided to go to the doctor for a prescription for vaginal estrogen to repair my atrophic (thinned, sensitive) vaginal tissue. Having practiced medicine in the late 80's and early 90's, I thought I had a good handle on what was going on.
My doctor performed a PAP smear and an internal exam. She announced that my uterus was enlarged and told me to get a pelvic ultrasound and an FSH blood test. I told her I didn't want another uterine biopsy. I had one a few years ago for uterine cells on PAP in a woman over 40. The biopsy turned out to be normal and had been moderately painful. She gave me a prescription for Estring, a vaginal estrogen ring.
I had the ultrasound and the blood work. According to my doctor, the FSH showed I was in menopause. The ultrasound showed a uterus at the upper limit of normal size and a mass (something that shouldn't be there) beside the vagina. Now I began to think cancer and apologized to my husband of months for the possibility of leaving him so soon. He cried. Then I cried. I filled the prescription for Estring, but the package insert said not to take it if there was a chance of uterine cancer. The Estring sat on the table.
My doctor sent me a prescription for an MRI. On the prescription, one of the problems listed was post-menopausal vaginal bleeding. I knew this was not my problem, as a woman may have normal bleeding any time in the year after her last bleeding. In fact, perimenopause becomes menopause when a full year has passed with out bleeding. I am still in perimenopause and will be at least until March 2012. I, like my doctor, thought, though, that I was in menopause because of the FSH.
I wrote the MRI radiologists a note, saying that I thought the mass was endometriosis, something benign I'd had before. Turned out I was right. I had toyed with skipping the MRI that was necessitated by the unnecessary ultrasound, but was a little too scared.
When I finally saw the Ob-Gyn (my doc and I were internists), she said that FSH goes up and down during perimenopause and doesn't mean much. She also said my uterus was an okay size for perimenopause and was only too large if I were already in menopause. She told me that I didn't need a uterine biopsy, and even if I did, she could do a D and C instead. I would be anesthetized for a D and C. She reassured me that I had been extremely reasonable to go through all the tests and to balk at the biopsy.
I wrote a letter to my internist thanking her for her compassion and thoroughness. I explained what I now knew about perimenopause and my dismay at the unnecessary testing and worry. Maybe someone else won't have to go through what I had to. This includes you. Please ask questions in the comment section.