Q: I am a 44 year old woman. I have a 20 day menstrual cycle since the last few months. I have also been suffering from palpitations, breathlessness (severe at times, asthma tests negative), tightness in the chest, nausea, joint pains, severe headaches before or during periods. Since last month I have been advised to take primasa and b-long for a week before my periods. Can I continue taking these medicines if they ease the symptoms, if so for how long? I have ovarian cysts in both ovaries and small fibroids in the uterus. I also suffer from lower abdominal and back pain. I want to avoid hysterectomy because I know a woman who suffers from loss of bladder and bowel control after hysterectomy. Please help.

A:From what you have written it seems that you are getting menopausal symptoms. Even though 44 is a bit young for menopause, the Ovarian function begins to drop anytime after 37 years and such symptoms can occur. While some of your symptoms may be menopausal and may improve with HRT (hormone replacement therapy) the headaches, the knee pain the back ache and abdominal pain is not and will not be relieved by HRT. All these symptoms need individual evaluation and appropriate tests and treatments depending upon the conditions diagnosed. The current opinion is that if the symptoms are severe then minimal possible dose of HRT for shortest possible duration can and should be given provided you understand all complications and implications. You have not mentioned if the symptoms are only premenstrually only, in which case it is probably a premenstrual tension something we talk a lot about but understand little. You said you have a 20 day cycle. Please see a gynaecologist about this as it is short. You have short cycles or is it that you have 20 dry days between two periods and the cycle is more than 21 days (the length of the cycle is determined by the number of days between the first day of one period to the first day of the next period and not the last day of one period to the first day of next in which case 20 dry days in between is a normal period). The menstrual cycle abnormality also needs to be evaluated by a specialist. I am not sure what you mean by cysts in both ovaries? If the cysts are large (larger than 7 cm) they need to be diagnosed and if diseased treated accordingly. On the other hand, if you mean multiple small cysts (smaller than one cm in each) in the ovaries they are quite ok after 40, since they are the growing eggs which did not mature and appear as multicystic ovary. The small fibroids are generally of no consequence and generally just shrink after menopause. None of the symptoms you have explained are such that you need a hysterectomy. At this point unless new pathology is discovered there is no need for a hysterectomy of any other surgery and I agree with you that hysterectomy may cause more problems than it will solve. So to sum it up, palpitations, breathlessness, tightness in the chest, nausea, etc may be relieved by HRT which you should take under supervision of a specialist and in a low does for a short duration. Headaches need to be diagnosed and treated accordingly. For joint pains and backache you need to see an orthopaedic surgeon. And the ovarian cysts need to be evaluated. For menstrual irregularity and for lower abdominal pain, please get an expert opinion as you may be having a pelvic infection as it is known to cause these symptoms at this age and appropriate antibiotics may be required.