Patient Question.
Disease: Perimenopausal ~ 48 years old Description: Hot flashes and sweating for more than 1 year, insomnia, urinary symptoms, palpitations, weakness for more than 1 month, memory loss is very obvious, and menopause for more than 4 months so far. No abnormalities in cardiac spot diagram, blood count, liver and kidney function in annual physical examination.
Previous treatment and results: Six months ago consulted a gynecologist, because there were too many patients too noisy and not very clear, the specialist recommended taking tibolone 2.5mg/day for a week and then see again, not implemented. Changed to self-psychological and behavioral regulation plus dietary therapy, symptoms improved, then related symptoms appeared intermittently for a short period of time, recently due to increased hot flashes and sweating with eye loss, had to use hormone replacement therapy. At this time, I have been taking Tiberone 1.25mg for 5 days, and I have a Kupperman score of 24 from your article.
Addendum: I have been taking tibolone 1.25mg/day for five days, and I feel that my sweating has decreased, and I wake up at night once every two to three hours instead of once every hour. Because I work very hard, the quality of sleep is okay. Thank you Dr. Meng! Help wanted: Please ask Dr. Meng: Is the dose I’m taking insufficient? Because I plan to take estrogen for the 10 years of my window period, I don’t want to use too big a dose to reduce side effects.
Meng Jun’s reply: This dose is OK. The effect is usually significant only after 2 or 3 weeks, so don’t be in a hurry. If you take it for a long time, the main thing is to prevent side effects and you need to choose a program that suits you. If you can pass me the medical examination information, I can help you analyze it. It is also necessary to read my related articles to exclude contraindications, etc.
Patient Question.
Dr. Meng: Thank you very much for your reply! I will continue to read your articles in order to properly understand the essence. I will upload the latest medical examination information to you after some time. Last night I started having nausea, like an early pregnancy reaction, I guess it’s a side effect of estrogen ~~ all the side effects labeled by the medication are manifested in me. I should be the lab technician’s favorite kind of mouse. Thank you Dr. Meng! Have a great weekend!
Meng Jun replies.
You can consider taking it before going to bed so that the nausea symptoms may be resolved. And it will get better after a while.
Patient Question.
Thank you! I am taking it regularly every night before going to bed, and I wake up with nausea in my dreams, but I hope it will get better after a while. I hope it will get better after a while. I also had nausea, dry heaving, salivation, and stomach pain before bedtime, and I couldn’t fall asleep because of taking erythromycin before bedtime. Dr. Meng, you have worked very hard too, so I won’t go into details.
Patient Question.
Dr. Meng, I woke up last night because of nausea and discomfort on the 6th day of taking Tibolone 1.25mg, which passed after a while. I was afraid to bother myself and my doctor and did not go to the emergency department, so I left a message for you while weeping. The pain was much lessened after four or five consecutive rounds…statistically speaking, I averaged more than one hot flash per hour during the day yesterday. I don’t expect to live long, but I want to live a quality life and work for another 12 years. Please ask Dr. Meng what should I do next? What other medications should I take orally ~ I don’t have any of the contraindications listed in your article. I would like to express my deepest gratitude to you for being the first person I thought of when I was in the most difficult and painful time, a good person I may never meet in this life!
Meng Jun replies.
Be sure to see your doctor today. Usually hormone replacement rarely causes severe abdominal pain, but more rarely there is a hematoporphyria to be aware of, the color of the urine will gradually become darker and very dark. Be sure to have a urine test. As for the next step of drug replacement and then adjust accordingly, there must be a program.
Patient Question.
Thank you, Dr. Meng! I read the instructions at least 10 times off and on before taking the medication. The first side effect was lower abdominal pain, except that my pain was in the epigastric base. I ruled out diet, but couldn’t rule out a drug cause, and I think the tibolone clinical trial results must have been flawed and deficient. The good thing is that I am now living a very healthy lifestyle and my menopausal symptoms are tolerable, but I am afraid that it will affect my work and quality of life in the future. I’ll send you the urine test results this afternoon, but you have to work today. Bye.
Meng Jun replied.
If you need emergency surgical treatment, please exclude this disease first.
Patient Question.
I think it is not necessary ~ pain has been relieved for 5 hours, the rest of the discomfort, the previous intravenous or oral gastrointestinal reactions to drugs have appeared nausea and stomach pain, infusion of metronidazole taste will change, there is chest tightness and nausea, because of forgetting the meal immediately after taking the drug, more than 2 hours oral erythromycin stomach pain, early in the morning to infuse pantoprazole, 10 minutes after the infusion of stomach pain disappeared. Therefore, I think it is not necessary.
Meng Jun replied.
As long as there is a clear cause and the abdomen does not dare to press and other signs, it is possible.
Patient Question.
Hello, Dr. Meng! The blood and urine routine has been sent. Today, because the stomach still has some discomfort, lying all day, a rough understanding of porphyria, the morning urine under the sun for 1 hour, urine color deepening is not obvious. I can tolerate the spicy food in Sichuan, but the ravages of drugs are always hit every time. Can I take oral painkillers when I have stomach pain?
Meng Jun replied.
I can’t confirm that it’s the tibolone problem, but the stomach discomfort should be related. If you take it again today, you should consider whether it is acceptable. If it hurts again, it is very likely to be related. If you have abdominal pain, there is nothing wrong with taking the right medicine to stop the pain. If tibolone is not suitable, you can switch to other options. Personally, I would recommend Sonchic skin patch plus drospirenone. The advantages of low hormone, the disadvantages of skin medication is not very convenient.
Meng Jun replies.
You are the main person to consider whether to take it today.
Patient Question.
Dr. Meng, I just checked the medication you recommended, the patch should be convenient, but I don’t know where to put it. Will I get my period? I can’t afford to have a period… 32 years, 420+ periods, I’ve really had enough! I’ll take my chances and try again. Forgive me for shivering, but it’s amazing to think that an expert with a lot of experience is using his wisdom and love to help an unknown patient because of the internet. Thank you, Dr. Meng! Thank you for this internet era!
Meng Jun replied.
You can take it again today, it is more convenient to take it orally. The skin patch does not affect the bath, stick to the skin below the waist, just change it once a week. Didrogestrel is to inhibit the growth of the endometrium. Transdermal medication is used because it is not inactivated by the liver, so the amount of medication entering the body is very low. Of course, there are other drugs that are taken orally. For example, Anjingyi. It’s not good to be absolute because you don’t have a full understanding of your situation. The skin patch is relatively safe, so it is recommended first.
Patient Question.
Dr. Meng, thank you for your advice! I will consider the use of drugs in conjunction with their own situation and the convenience of drug purchase or not, so you bothered, and will continue to consult you in the future, you take care of your health, good night!
Patient Question.
Hello Dr. Meng, I did not have any stomach pain last night ~ I suddenly remembered that I was taking medicine on an empty stomach before going to bed, so I swallowed Tiberone with food, so I wanted to let you know so that you would not miss it. I’ll continue my journey with Tebolone, and you can help me analyze and adjust my plan later when you have a full understanding of the situation, okay? There is very little sun in Rongcheng, and every time I think of your help and concern, I feel warm in my heart, thank you!
Meng Jun replied.
Tiberone has many advantages in the long run as long as you overcome the recent discomfort. Maybe another week will be a good gain. Bless you!
Meng Jun replied.
Thank you for your affirmation!
Patient Question.
Director Meng, I have browsed through your perimenopausal consultations throughout this year and have gained a lot of knowledge and witnessed your hard work! Because I want to become your long-term consultant, so that you can choose the right medication for my individual plan, according to your articles and past consultations I am doing examinations intermittently. Director Meng, I have consulted you many times, and I have made you take the trouble, but you have increased the number of consultations for me. I will pass on your love to those who need my help.
Patient Question.
At present, the vague discomfort in my stomach is an insurmountable obstacle, but because I think of your help and blessing, I still have hope for a better future.
Meng Jun replies.
Bone density is only one aspect and not the main one, so either one is not a big problem. Usually ultrasound is fine. Stomach discomfort for a long time is also not acceptable, then use a period of adaptation to see if you can overcome, should be able to. There are several options to choose from when your health is fully understood, and there should be something suitable.
Patient Question.
Director Meng: Hello! Here are the test results today. At present, the main symptoms are bouts of vertigo and hot flashes and sweating. I have taken glutamine orally for 4 days and woke up slightly better several times a night. I have been more afraid of cold since the previous winter, and when the cold wind comes, the lower half of my body seems to blow naked. I’ll review it again in February. The other thing is 1. there are not many hospitals with Levi’s love, I bought in the pharmacy is Beijing Zizhu Avi, although strongly support the national product, I do not know whether the efficacy is different? 2. A colleague took Levi’s 25 days off for 5 days and then took the next course of treatment, can I take it like this?
Patient Question.
Additional information: heart rate 58 beats/min, blood pressure 113/66mmhg.
Meng Jun replied.
The test is consistent with menopausal changes, and the issue of abnormal nail function requires an opinion from an endocrinologist. Symptoms can occur during menopause, and thyroid problems can have some effect. Uterus, liver and kidney, menstrual condition need to be checked. Levi’s imported tibolone will have fewer side effects. Generally do not need to stop the interval, young maybe, but young more than not use Levi’s love. Gap is easy to cause irregular bleeding, etc.
Meng Jun replied.
Liver and kidney function is best to see the labs, including lipid profile. Recent menstruation, and your attitude towards menstruation.
Patient Question.
Hello, Director Meng! The results of thyroid function have been consulted with the endocrinology department, the conclusion is not good to comment, to be checked again during the physical examination anti-thyroid peroxidase antibody and anti-thyroglobulin antibody, in order to confirm the diagnosis and identification. I have a good liver and kidney function, no bad habits, a healthy and simple diet, and rarely take medication, so I will use last year’s checklist for reference. Last night, after a full meal, the stomach discomfort disappeared, however, in the past two days, the left ankle joint has become painful again, but after a while, it will heal as if it never happened. The results of the bone density test have been released, so please take a look at them. The person who took Levi’s 2.5mg/day for 25 days was a 47 year old OB/GYN who had been menopausal for 2-3 years. Many of my friends of the same age (including medical and nursing) do not quite understand why I need estrogen. I have heard lectures from OB/GYN specialists and am willing to work hard to improve my quality of life, so I look forward to Mr. Meng’s guidance.
Meng Jun replied.
It is fine to choose Levi’s for 2 years of menopause. Even medical professionals have many problems in this area, both in terms of awareness and practical application. That’s what keeps me going! I’ll reread the whole conversation and give you advice. Please let me know the last menstrual period.
Patient Question.
A: Last menstrual period was mid-July 2014.
Meng Jun Replies.
Looking at your entire medical history, there is no special need for attention at this time except for thyroid. Therefore, no special protocol design is needed, just taking regular medications. It is good to have new physical examination information and contact promptly if you are not feeling well.
If you do not feel well on Levi’s, you may consider changing your medication. Levi’s is not an option often chosen for those who have just stopped menstruating, if they do not have a specific need. It is often considered if there are fibroids, breast problems, or significant depression.
Now, if you are considering a change of medication, as you have no specific contraindications to the medication, just the regular dosage form will be fine. If you want to keep your periods coming, you can consider Clomid; if it is optional, Fentanyl (1/10th dose) should be a good choice. After stabilization, you should re-evaluate at least once a year, and evaluate and adjust whenever there are physical changes.
Patient Question.
Director Meng, I feel so beautiful after receiving your reply, thank you! Don’t like menstruation, very much! The side effects of fentanyl are also daunting, so I am really worried about it. I’m actually getting used to Levi’s – although I’m still in the break-in period. 2. Do I have to wait for a year to be sure that I am menopausal before I supplement with Levi’s. I think I may be able to overcome menopausal symptoms through exercise and diet and my own willpower. 3. Do I need to take estrogen for life or just for the 10 years of the window period?
Meng Jun replies.
Levi’s is fine, as long as you can break it in. One year of menopause is not absolute, especially if there is no requirement for menstruation. One year of menopause is based on the fear that it may affect the remaining follicles, so it is acceptable for you to take it. This is the meaning of “individualization”. With a score of 25 it is not very desirable to just exercise, etc. The medication is necessary to help. As long as the benefits outweigh the drawbacks in the annual evaluation, you can continue to take it. Not only can it relieve symptoms, but it can also be beneficial for certain chronic diseases. Long-term monitoring is more important! Finally, I would also like to say that phenometholone is not that scary, and it is still safe to evaluate and monitor well.
Meng Jun replies.
That is, Levi’s is not something you have to wait until one year after menopause to use, despite what some instructions say. Each person is different and has different requirements. This is one of the implications of individualization. As long as it is tolerated, you can use it.
Patient Question.
Thank you, Director Meng, you have explained it very clearly! I have another question about oral tibolone for fear of affecting the follicles, but I’m afraid to work your eyes out, so I’ll stop and go study other doctors’ articles about it. It would be inhumane to make you suffer any more. Good night!
Meng Jun replies.
It is not a problem for you, there is no need to spend time to investigate deeply. Some professional doctors do not always notice.
Patient Question.
Thank you! A month later and then according to the fact that the new rating. Have a good weekend and good mood every day, for sure.