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[deansgirl]

I know all the symptoms regarding perimenopause but yet to find anything on this one. I started skipping the odd period at 37 but now I'm almost 49, I skip quite a few. My question is, I've now skipped 5 months but continue to ovulate once a month and have CONSTANT painful breasts, just like I normally get a month before my period. Is this normal? Why ovulate but no periods???

[bombsh3ll]

Missed periods are typically associated with anovulatory cycles, however all manner of hormonal crazy can take place during untreated perimenopause.

Breast tenderness often results from high estradiol levels, which can be another feature of perimenopause as multiple follicles can begin to develop and there's also what's known as LOOP (luteal out of phase) cycles. It is also possible to ovulate twice per cycle (hence fraternal twins being commoner in older mothers) and if you aren't producing enough progesterone, this can also result in absent periods.

There are multiple things that can be done about this - if you want it treated.

One would be to try some cyclical progesterone or progestin to induce a bleed. This can help protect against endometrial hyperplasia. It wouldn't treat the sore breasts.

Two would be to use a low dose combined oral contraceptive pill to shut down your own cycle and add back a consistent low dose of estrogen and progestin.

This may well help the breast pain if it is due to excessive endogenous estrogen peaks as it gets rid of these. It is also very protective against endometrial hyperplasia, and you can choose to either take it continuously and not bleed at all (like me) or have the regular withdrawal bleeds if you prefer.

[Hurdity]

I know all the symptoms regarding perimenopause but yet to find anything on this one. I started skipping the odd period at 37 but now I'm almost 49, I skip quite a few. My question is, I've now skipped 5 months but continue to ovulate once a month and have CONSTANT painful breasts, just like I normally get a month before my period. Is this normal? Why ovulate but no periods???

Hi deansgirl

Apparently it is possible but very uncommon to ovulate without having a period so it is unlikely that you are still ovulating each month, unless eg you've had a D and C or procedure on your womb lining?

For an informative article about what happens to your hormones during peri-menopause then have a look at this back magazine article:
https://www.menopausematters.co.uk/article-perils-of-the-perimenopause.php

Incidentally if you've skipped that many periods and also skipped quite a few for the past 10 years then maybe think about extra oestrogen in the form of HRT or as bombsh3ll suggests a combined contraceptive pill but you shouldn't need to add extra oestrogen.

There are two that are designed for women in your positions, that contain estradiol - bio-identcial with our own estrogen, or near enough (estradiol valerate which is changed to estradiol in the body). QLAIRA has different doses of oestrogen throughout the month to mimic the cycle to some extent - ranging from 1-3 mg and only 2 oestrogen free days. ZOELY is low to medium dose with 1.5 mg estradiol and the same dose for 24 days with 4 placebo days.

QLAIRA in particular should give you enough oestrogen as well as alleviating your symptoms because it suppresses the cycle.

Hope this helps  and 

Hurdity x

[joziel]

How do you know you are ovulating? The only way to really know is to pee on very reliable urine ovulation test strips which test not just rising estrogen but the LH surge as well.