A menses after menopause -- can pregnancy occur?
This happens fairly frequently which is why the definition of
post menopause is one year without any menstruation. I couldn't
find exact numbers on how frequently it occurs but have included
some abstracts below that show it is well known to happen. My
subjective impression is that ovulation can still take place
sporadically for up to a year after menopausal FSH levels in
about 20-30% of women. There are many other factors negatively affecting
fertility at that age that we don't usually put women on
contraception during that time but it is remotely possible to get
pregnant.
Commonly now, during the perimenopause/?menopause period we
will have women use very low dose contraceptives (1/20 level) as
estrogen replacement if they are non smokers. This obviously has
dual benefits although before we started doing this it was still
quite rare (but not impossible) to have a late age pregnancy at
47.
Eur J Endocrinol 1994 Jan;130(1):38-42
Diagnostic role of follicle-stimulating hormone (FSH)
measurements during the menopausal transition--an analysis of
FSH, oestradiol and inhibin.
Burger HG
Prince Henry's Institute of Medical Research, Clayton, Victoria, Australia.
This review examines the role of follicle-stimulating hormone
(FSH) measurement in assessing the significance of symptoms and
possible continuing fertility during the menopausal transition.
Follicle-stimulating hormone measurement is advocated frequently
as a useful diagnostic tool in perimenopausal patients. Several
investigators have shown that the serum FSH level increases in
the early--mid-follicular and early postovulatory phases in women
over the age of 40 years who continue to experience regular
menstrual cycles. The serum oestradiol level may fall (although
this is controversial) and the immunoreactive inhibin level
falls, being inversely correlated with the rising FSH level. When
alterations in menstrual cyclicity or flow commence, signalling
the onset of the menopausal transition, FSH levels may change
abruptly, rising into the normal postmenopausal range and falling
again into the range normally seen in young fertile women.
Oestradiol and inhibin generally fluctuate in parallel with each
other but inversely to FSH, although at times oestradiol in
particular may be increased markedly. Postmenopausal FSH levels
may be followed by endocrine evidence compatible with normal
ovulation. After the menopause, FSH levels rise 10-15-fold, with
low oestradiol and undetectable inhibin levels. It is concluded
that FSH measurement is of little value, if any in the assessment
of women during the menopausal transition because it cannot be
interpreted reliably and because, apparently, ovulatory (and,
presumably, potentially fertile) cycles may occur subsequent to
the observation of postmenopausal FSH levels. Both oestradiol and
inhibin are important negative feedback regulators of circulating
FSH.
*****
N Z Med J 1988 Mar 9;101(841):103-106
The approach of menopause: a New Zealand study.
Metcalf MG
Department of Endocrinology, Princess Margaret Hospital, Christchurch.
Once weekly observations of the excretion of FSH, LH, oestrogens
and pregnanediol have been used to monitor the changes which
occur as New Zealand women approach and pass through the
menopause. There were 3 patterns of hormone excretion. (1)
Premenopausal women (aged 40-51 yr) had regular menstrual
cyclicity with hormone patterns similar to those seen in the
ovulatory cycles of fertile young women. (2) Women in the
menopausal transition (40-55 yr) had irregular menstrual
cyclicity with erratic hormone fluctuations. There were ovulatory
cycles, postmenopausal episodes in which amenorrhoea was
associated with high gonadotrophin levels and low urinary
oestrogens, and times when the excretion of both gonadotrophins
and oestrogens soared. Ovarian activity did not cease at the
menopause, and postmenopausal women in the 6 months following
final menstruation (44-55 yr) had hormone patterns which were
indistinguishable from those observed in the long anovulatory
cycles of the menopausal transition. (3) Older women (57-67 yr)
had senescent ovaries with the unvarying high gonadotrophin and
low oestrogen levels which are a consequence of ovarian failure.
   
How long does menopause last?
Symptoms (without hormone replacement) can last 1-25 years.
Most women though, don't have symptoms that last much past about 10
years.
Does extreme fatigue mean low estrogen levels?
By pre-menopause I assume you mean premature menopause, i.e., you are menopausal rather than perimenopausal. The doses you are
on are at the level of menopausal replacement. Sometimes the estrogen levels need to be checked (estradiol) to see if you are on a correct level of replacement. To answer your question, yes, fatigue can be a result of too low estrogen levels but usually if that is true, you are also having sleep disturbances and hot flashes at the same time.
Most common causes of fatigue, assuming thyroid and estrogen levels are ok, is:
- stress
- sleep-deprivation
- sometimes allergy flares and certainly antihistamine therapy
- depression
- medications affecting mood
- other medical conditions
To see if hormonal levels or replacement therapy is it cause, ask yourself the following questions. Does the fatigue vary with the estrogen, Provera® therapy? Does it get better, worse, on weekends (if you have any)? If is doesn't vary with the hormonal therapy and it gets better on weekends, then look to causes other than hormones.
Terrible hot flashes after stopping HRT
You need estrogen replacement that is more consistent than with herbal preparations alone.
It is very common to take estrogens, come off them and have hot flashes that are much worse worse than when you first started. Somehow the estrogen therapy sensitizes the receptors and when it is withdrawn, your "addiction" shows. That will get better over time. The main challenge now is to find hormonal therapy that will be absorbed by your body and cease of decrease you symptoms.
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