"I am 60 years old and I had
my last period in 1987. Since then my (PMS), or whatever
it is, is so bad it takes at least a week out of my
month! I have a woman obgyn because I thought she
would understand my problem. She doesn't. I have talked
to some other women about it and they have never heard
of having such a bad time after no periods. I have
headaches, backaches, cramps, bad-bad depression,
and even nightmares. Can you help? I'm on hormones,
Wellbutrin(R) and aspirin plus a high blood pressure
med."
The "whatever it is" is the key to this
problem. Premenstrual Syndrome (PMS) only occurs with
ovulation from the ovary and since you are postmenopausal,
your ovaries are no longer producing eggs and hormones
each cycle. Therefore we have to look for other hormone
sources that are mimicking PMS symptoms or perhaps
look for other conditions entirely.
You mention that you are taking hormones and I assume
those are estrogen and progestin replacement. If you
are taking the estrogen daily and the progestin for
two weeks or less, i.e., cyclically, that would be
the easiest explanation for your cyclical symptoms.
In PMS, investigators attribute the physical and
mood symptoms to either progesterone or an excess
of progesterone over estrogen. With postmenopausal
hormone replacement (HRT), many women have mood and
physical symptoms from the specific progestin that
is used. Provera(R) (medroxyprogesterone acetate used
in PremPro(R) or PremPhase(R)) tends to produce more
physical symptoms such as low back pain, bloating,
and cramps. Another progestin used in HRT is norethindrone
acetate found in Aygestin(R), Activella(R), and FemHRT(R).
It has been shown to produce more mood symptoms. Women
who had PMS before menopause tend to react more to
these progestins after menopause (1).
If you are taking your HRT with cyclical progestins
(5-14 days a month), then changing to a continuous
regimen will avoid the cyclical nature of your symptoms.
Unfortunately, it may also produce some of your symptoms,
albeit less severe, all of the time. In that case
you will need to ask your doctor to switch your HRT
to one with a different progestin such as norgestimate
in Ortho- Prefest(R) or natural micronized progesterone
such as in Prometrium(R).
If you are currently taking your HRT continuously
such that the progestin is taken every day, then switching
progestins may be helpful although it does not explain
why you get your symptoms for only one week out of
a month. You may need to keep a symptom calendar to
make sure when you get symptoms in relationship to
your medications and activities. That may shed more
light on the cause.
Other non hormonal medications can also play a role.
You may be having some side effects from your medications
that just for some reason seem to occur cyclically
rather than constantly. This can sometimes be due
to interactions between Wellbutrin (bupropion) and
beta blockers used for hypertension. Also, Wellbutrin
can cause headaches and muscle pains on its own.
Finally, the fact that you mention more nightmares
makes me suspect you are having low blood sugar problems.
Progestins can cause that and so can the Wellbutrin
and anti-hypertensives if taken at night. High insulin
and low blood sugar often produces nightmares. You
may want to have your doctor check you out for diabetes
or hypoglycemia. The nightmares can be lessened with
a protein/fat snack before bed such as a small cup
of yogurt or a piece of cheese. If you are taking
any of your medicines at night (except the aspirin
should not make a difference) then switch them to
the morning or take earlier in the evening.
If you do find the medications are causing the problems,
you may have to be switched to different medications
or even evaluate if the benefit of the medications
outweighs the side effects you may be having.
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