Question: After I had my PAP my next 2 periods became very scant and light brown in color, and since I have my period now, it is also the same way as the last two. I notice that my left side aches from time to time but have not thought too much about it until now. My PAP came back normal. Could I be starting my change of life? What could be going on? My Mother's period stopped at age 46 completely, and my sister's stopped at age 48. Am I next?
Answer: This has nothing to do with change of life. Scanty periods are sometimes seen with all birth control pills on all ages. Sometimes there is no bleeding at all. It happens. And there is nothing to worry about. As long as you use these pills, there will be no manifestations of perimenopause.
Question: Doctor, I am a 45 year old woman with a long history of menstrual problems. In December of 1998 I underwent an oblation using a thermal technique. February of this year I had a cycle of 31 days and I bled for 2 days with severe cramping. Since that time I have not had another period. I assumed that the cessation of periods was due to the oblation. My gynecologist was concerned that I had not had a period for more than 2 months. She put me on Provera for 5 days, stating that she did not think that I was in perimenopause (as I have not had any hot flashes) and that this would stimulate my period within two weeks of finishing the medication. I took the medication as prescribed and did experience PMS symptoms, including extreme tenderness, however, those symptoms have subsided and I still have not gotten my period. Is it possible for bleeding to cease as a result of an ablation more than a year after the procedure? If not, do my symptoms indicate that I have entered menopause?
Answer: It is not likely that an endometrial ablation will result in amenorrhea more than a year after the procedure. Sometimes amenorrhea occurs but directly after. The procedure resulted in less bleeding. Probably, there are some isles of endometrium left. And that isles will be stimulated by estrogens(Drug information on estrogens). It is not unlikely that at the age of 45 menopause will arrive. The FSH is necessary to diagnose that. Also a high FSH will not tell as that no bleeding will occur anymore. And menopause (the last menstrual bleeding) is only defined after a year of no bleeding.
Question: I am a normally healthy 38 year old woman. I have had a hysterectomy 3 years ago but I still have my ovaries. I have been experiencing sporadic vaginal bleeding for about 6 weeks. The bleeding is just some spotting 1x or 2x per week. We have ruled out any bacterial infections, done a urine test, (clear) and a rectal smear, (clear). What could this be caused from? I feel good otherwise except that lately, I have had little energy?
Answer: There are not enough data for proper answering. Important is the reason for hysterectomy (premalignant lesion, endometriosis?) and also the perfomed technique: total or supracervical, permanent or resolvable stitches? After 3 years scar tissue (granuloma) is very unlikely; so is tubal prolapse. But vaginal endometriosis is possible. With supracervical removal some endometrial tissue can be retained and intracervical lesions are possible. Is there any sign of fistula? With this symptom a thorough investigation by a gynecologist is necessary.
Question: I am 49 years old and have always had a fairly regular menstrual cycle. Three weeks ago, I had my period, however, a few days after it ended, I saw some light spotting and have continued off and on to have very light (pink) spotting. Could this be a perimenopausal symptom, or could this be a symptom of something else?
Answer: Intermenstrual spotting/bleeding needs to be investigated. Only after a gynecologic investigation a diagnosis can be made. With an appointment within two months there is no reason for immediate action. It is important that you can tell your gynecologist what happened and how it was during these two months from day to day.
Question: I have recently turned 40 years old. In the last year I have experienced very heavy periods at least one day in every cycle to the point where I soak through after 5 - 10 minutes. This lasts between 4 to 6 hours. I also sometimes experience spotting 5 - 7 days before my period. My last gynecological visit was normal. I am anemic and do take a low dose of synthroid due to Hashimoto's thyroiditis. (I am not hypothyroid). What should I do?
Answer: Go to see your gynecologist again. She/he has to search for all possibilities for menorraghia. Sometimes nothing is found. Sometimes intrauterine problems (myoma, polyps), sometimes systemic problems (hypothyroid, thrombocytopenia, coagulation disorders). There are several treatments for menorraghia.
Please be sure to check out OBGYN.net's articles on abnormal uterine bleeding: Diagnosing Bleeding by Paul D. Indman, Diagnosis of abnormal uterine bleeding, fibroids, and adenomyosis by Paul D. Indman; Perimenopausal Bleeding -What's normal? by Paul D. IndmanMD
Question: I have been having Hot flashes, and irregular menstrual periods for about a year now. I went to my OB/GYN, he drew my blood said I was going through perimenopause. What exactly is that? I am barely 30, and am planning on having another baby. What are my chances of having another baby? Would hormone replacement help at all?
Answer: Irregular periods and the wish to become pregnant is a reason for analysis by a gynecologic endocrinologist. There is a need to analyse what really is going on. Premature ovarian failure can happen on every age and it is important to make a diagnosis, because the chance to get another baby decreases fast in premature ovarian failure. But maybe another diagnosis can be made. An endocrinologist can tell you what are the changes. Hormone replacement therapy will certainly NOT improve the fertility prognosis.
Question: I am 46 years old. I Had a tubal ligation 10 years ago. Recently I had an endometrial biopsy for spotting after intercourse. This depicted a "disordered endometrium". Subsequently, I had a D&C with thermal ablation as well as cauterization of the cervix for friability. (pap has been normal, but D&C returned polyp remnants and focal crowding). Currently, periods are still crampy and pretty heavy. I have no symptoms of perimenopause, except for headaches post period. My question: Will the polyps return, and if so, what are the chances that they might become malignant? Do polyps shrink like fibroids after menopause? Should I return to my Gynecologist since the ablation does not seem to have worked?
Answer: Polyps are very seldom malignant. They can return and cause bleeding. But symptoms are very often there without any problem. Answer disordered endometrium reflect an imbalance between oestrogens and progesterone(Drug information on progesterone). And that is very common during perimenopause. The most effective therapy is a regular course of progestagens (day 15-24 or 26 of every cycle), because a lack of progesterone is the main reason for the imbalance. Thermal ablation is a treatment for menorraghia, for heavy menstrual bleeding and not for perimenoapusal bleeding disorders. But endometrial ablation is not always effective. Try birth control pills. They will regulate your cycle with half the amount of bleeding.
Question: I am 40 years old. Up until 6 months ago my periods came regularly every 28 days. Now they are coming every 23-26 days. Does this mean that I am perimenopausal?
Answer: Maybe yes. It is normal that menstrual cycle irregularity starts with a shortening of the cycle. In the second phase of perimenopause cycle length becomes longer. The mean time between first irregularity and end of periods (menopause) is 4 years, but it can vary from 0 to 8-10 years. So shortening of the cycle at your age is quit a physiological event.
Question: I just had a work related medical exam, and the Dr. said I could be in perimenopause. I am only 35yrs old and have not missed ANY periods. She based this on the fact that I have hot flashes at night and red hands. Could this be true?
Answer: It is a matter of definition. But in my belief, hot flashes without any menstrual irregularity can not be classified as perimenopausal.
Please check-out Menopause, Perimenopause & Postmenopause: Definitions, Terms & Concepts by Peter Kenemans, MD, PhD
Question: I am 42 and I am the mother of a 3 and a half year old daughter. I would like to have more children but for the past 2 months my FSH levels have been high. Last month's were at 33.4. My periods that were always regular are very irregular and short the last 3 months and I have begun to experience some hot flashes. I have been under unusual stress lately, work related as well as personal and I have had little sleep. Now the situation is back to normal. With good nutrition and added vitamin B could I bring my FSH levels down?
Answer: The chance to become pregnant with these data is very low. But sometimes it occurs. The problem is in the ovaries and nutrition and vitamins will not be helpful to restore the pool of follicles (eggs) in the ovaries.
Question: I am 50 and have been in perimenopause for almost 10 years. I have been experiencing a period lasting for about 30 days, from regular to light flow to spotting, to heavy flow with passing of clots. I am not on HRT, but was on a progesterone about 18 months ago. My doctor took me off of it when I had acute pancreatitis and became diabetic. I prefer to use a holistic approach to dealing with the side effects of perimeno, so I look for natural methods, like soy. I think my mother had heavy periods, but she passed away so I can't ask about her history. Are my heavy, constant periods normal for what some women experience in perimenopause? How long can I expect this phase to last?
Answer: A bleeding pattern like this is not unusual during perimenopause. It is the problem of a lack of progesterone with continuous production of estrogens. And the estrogens stimulate the endometrium. You can have breakthrough bleedings from a proliferative endometrium or from an already hyperplastic endometrium. And sometimes this bleeding will stay for a long time. A reasonable approach is the use of a progestagen, but with the pancreatitis there are reasons not to do that. But the natural progesterone (Prometrium) will not give problems and daily 200 mg during the 15th to 26th day of the cycle will regulate your periods. As long as the ovaries produce estrogens, such a course of progesterone will induce a bleeding. Soy and so on will not be helpful for bleeding problems; it is not the estrogen part (as in soy) but the progesterone part. Nobody knows when this phase will end. You have to wait for it patiently.
Question: I am 42 and have mood swings and some mild anxiety. Hot flashes, indigestion and bloating. My periods appear to be with in 29-32 days apart. I had my tubes tide 14 years ago. Tests for menopause come back negative. I have only had one test. Pap smears are done regularly and come back negative. All other blood test negative too?
Answer: A depression or anxiety disorder can mimic all signs of perimenopause and with regular periods and normal FSH it is prudent to contact a psychologist rather than a gynecologist.
Question: I am 35 years old and am having hot flushes daily, I don't seem to break out into a sweat then followed by the chills, along with a crawling feeling in my left leg and when I put pressure on it , it feels like a burn, my periods have become closer together in the cycle and much shorter, I have also had burning mouth and tongue for the last six months on and off, and terrible up's and down's in my mood, along with breast pain. I had my kids at a very young age 18 and 20 years of age not knowing if this has anything to do with it?
Answer: I cannot make any diagnosis of this mixture of complaints. My advice is to go to your physician and talk about your problems.
Question: What kind of treatments are there for a congested ovarian vein? I had a laparoscopy done and the doc found one of the veins enlarged. It will continue to cause problems with pelvic floor dysfunction till taken care of. Have heard of embolisation, but want to know if there are any other alternatives. Also why this vein can get congested? Doc said I have adenomyosis. Are there any other options beside uterus removal or hormonal? I would be open to some kind of surgery if it didn't involve removing the uterus. I am trying some immunotherapy and cod liver oil, full of vitamin A. This adenomyosis is very painful sometimes! Does it normally make the uterus enlarged?
Answer: It is very questionable if congested ovarian veins will cause any trouble. We see it often in women without any complaint. Embolisation or removal are the only therapies. Congested veins are seen sometimes together with adenomyosis or congestion of a retroflected uterus (not a retroflected uterus without congestion). Ademomyosis can be treated with intrauterine progestagens. In Europe we have the Levonorgestrel IUD Mirena and that is excellent for this diagnosis. The progesterone IUD Progestasert is not as good. Otherwise hysterectomy is the only cure.
Question: I am 44 years old and beginning to see changes in my periods. They were normally 28 days in cycle, but now I'm all over the place. 35 days in January, 26 in Feb, 29 in March, 31 in April, and now it's day 38 and still nothing. Does this sound about right?
Answer: This is a quit normal change in your periods. An irregularity of 4-6 weeks and occasionally 8 weeks has no meaning. If it disturbs you, you can ask your doctor to regulate your cycle with birth control pills. But there is nothing to worry about.
Question: Is there any link between someone having focal seizures and menopause? My friend is 49 years old, has all the "symptoms" of menopause and has developed seizures. The neurologist ahs no idea why she has had seizures and has prescribed anti seizure drugs. She is taking NO estrogen or any thing for her menopausal symptoms?
Answer: Estrogens lower the threshold for seizures. Thus with estrogens you can expect seizures with less focal disturbance, so earlier. Progesterone will increase the threshold and will cause less seizures (if the hormones are involved). So there is no reason to give estrogens in this case. Sometimes in perimenopause very high levels of estrogens are seen (with a persistent follicle). Maybe this happens with your friend. Usually the menstrual cycle is irregular and prolonged with a persistent follicle. She can try in consultation with her neurologist a regular course of progesterone in the second half of her cycle. Prometrium 200 or 300 mg from day 15 to day 26 of the cycle (the first day of the menstruation is day 1). This will regulate the cycle and a decrease of the seizures is possible.
Question: I am 46 years old and recently experienced heavy bleeding with some blood clots. I soaked two tampons in about an hour and passed a few clots that amounted to about the size of a chicken liver (and that's what it resembled). It was the third day of up until then a normal period. Then after this hour or so of heavy bleeding, it stopped! I skipped my last period - or rather it seemed to start up and then change its mind after one day. Anyway, I have never seen a blood cloth in my menstrual flow before, and am wondering if this is a cause for concern? I felt fine throughout this episode, although distressed to see what seemed like a lot of blood?
Answer: Blood clots are often seen with heavy bleeding. There is no reason to fear clots more then heavy bleeding per se. It is not dangerous, it is just disturbing you. When it happens more often, you have to consult your doctor. This is called menorraghia and should be diagnosed and treated appropriate.
Please be sure to check-out the OBGYN.net article, What causes abnormal uterine bleeding? by Paul D. Indman
Question: I started to menstruate very heavily this past year on & off. I have not stopped bleeding now for 45 days, very heavy at times and spotting at other times. My doctor took some blood test and said I am perimenopausal. My question, is this normal to bleed for 45 days straight?
Answer: No, it is not normal. Probably it is an anovulatory bleeding and sometimes these bleedings will stay for a long time. When no abnormality is found (transvaginal sonography, endometrial biopsy), you can call it dysfunctional bleeding. This can be treated with appropriate hormonal therapy.
Question: I recently had a pap smear, blood test and pelvic exam - all of which were normal and okay. The reason I went was for the last 2 and 1/2 months, I have been spotting everyday. It was mostly just annoying and without pain but then 2 weeks or so ago, I began having cramping along with the spotting.
Answer: Spotting is not a normal manifestation of (peri)menopause and has to be diagnosed.
Question: I am 51 yrs. old. I was having all the classic symptoms of menopause. The hot flashes were unbearable. My gyn put me on PremPro, which has been an absolute lifesaver. My question is this: If I take PremPro for the next 10 years, until age 61 and then quit taking it, will the symptoms of menopause reappear? Am I just delaying menopause with the PremPro, only to have to face it again somewhere down the road?
Answer: This is a very important question. Some women will have no climacteric symptoms at all, others will have them for more than 10-15 years. There is no way to find out how long this period will last with you. With estrogens, as in Prempro, complaints will disappear. After a few years (maybe 2?) you can find out if they are still there by stopping the treatment. Maybe it will be over, maybe not. When complaints are still there go for a further treatment for about 2 years and try again. There is no reason to think that estrogen treatment will delay menopause. Earlier or later you will observe that problems are over.
Question: I'm 43 years old. Last year I was diagnosed with a brain aneurysm behind my left eye. I had surgery and have recovered completely and had normal periods throughout the one year recovery period. I have been diagnosed with a Post Surgical Seizure Focus in the left side of my brain and have been on dilantin since surgery. I'm not pregnant, my hormone levels are normal and my dilantin levels are within the normal range. I have had no hot flashes, etc. I was told at OB/GYN "you're at that age when your periods can start to come and go". I asked them at the time if it could be my dilantin - they said no. I called my neurosurgeon and she said no. I have found some articles about seizures and menstrual cycles and that your menstrual cycles can become abnormal. My question, have you heard of this? If this is a possibility should I pursue this with neuro or is this just a fact of life as time marches on?
Answer: I agree with your gynecologist and with your neurosurgeon that there is no reason to blame Dilantin. You used it during one year without disturbance of your periods. There is no reason to think that during the second year Dilantin will act different.
Question: I am a 53 years old and have been on the HRT treadmill for about 2 years. I am now at the point where I am ready to throw them away and just live with menopause. Every hormone combination I take has the same side effects. Mostly breakthrough bleeding that continues for weeks at a time. I was recently on orthofest and that did not work. I just started on femhrt 2 weeks ago. For the past 5 days I have had heavy spotting and night sweats that keep me awake. According to the info on this product it is for people that have trouble with other therapies. Are there some people that cannot tolerate HRT at all? I am at my wits end any advice would be greatly appreciated?
Answer: There are two types of HRT. Sequentially combined (continuous use of estrogens with 10-14 days every month a progestogen added to it) and continuous combined (daily an oestrogen and a progestogen). The continuous combined HRT is very popular nowadays, but more than half the women have breakthrough bleedings, and that kind of bleeding is always unexpected. Sometimes women are so lucky that they are not bleeding at all with this combination. But when breakthrough bleeding is a problem, stop this combination and go to sequentially combined HRT. This will cause in 80-90% of the women regular monthly withdrawal bleedings. And these bleeding episodes come expected every month on the same moment. Especially in women recently postmenopausal continuous combined HRT will cause breakthrough bleeding very often.
Question: I have been diagnosed with adenomyosis. Birth control pills are out for me (I smoke), Depo (oral or injection) sounds questionable at this time (the weight gain & decreased libido), GnRh doesn't seem to be a positive choice for me (I fight depression), and a Hysterectomy will be the last choice I make - when needed. My doctor mentioned one alternative that I have been unable to find much info on: progesterone cream - or, in the herbal world progest cream - & haven't found much to read. Can you help me?
Answer: There is no reason to think that progesterone cream will be helpful in bleeding problems. Especially not with adenomyosis. Hysterectomy is the preferred treatment. There is a lot of talk about progesterone cream as a treatment for all female problems. But there is no evidence at all that progesterone cream will do anything that cannot be done by Prometrium capsules. And I do not expect cure with prometrium in your situation, but you can try it during 2 cycles (day 15-24 or 26 of the cycle, 200 mg/day) and see what happens.
Question: I am 42 years old and experiencing perimenopausal symptoms, I went on the pill last year because of irregular periods and hot flashes, once in awhile I still experience hot flashes, a couple of days before my period my nerves get bad, I get anxiety attacks sometimes bad enough to go to the hospital, sometimes I get muscle weakness where I can't even function and that brings on anxiety. I also get mood changes, crying and angry. My GYN told me to take Premarin. The symptoms seem to get better when I first starting taking the pill, but now they are back again. My question is would taking an estrogen relieve these symptoms? especially the anxiety?
Answer: Maybe it is premenstrual tension syndrome. And there is a belief that PMS has something to do with hormonal imbalance. In some women hormonal intervention will help. But it is not proven, so not evidence based. PMS is seen rather frequently above 40 years. Prozac is the only medical cure that is proven for PMS against placebo.
Question: Do all women need HRT? It is my experience that some women do well without it.
Answer: Certainly not all women need HRT. HRT will be helpful for women with heavy perimenopausal complaints as hot flashes and others. HRT can be helpful in prevention of osteoporosis and cardiovascular disease, but only in women at risk for those diseases. Women without complaints and without high risk for osteoporosis and cardiovascular disease will not need any HRT. And be aware that HRT has also complications, like thrombosis, gallbladder disease and breast cancer. Those risks are low and not important with clear indications for HRT. But they are certainly important in the use of HRT without clear indications.
Question: Are there any studies that can demonstrate the connection, if any, between birth control pills and uterine fibroid growth? Are uterine fibroids likely to increase with the use of oral contraceptives?
Answer: There are no studies that demonstrate any connection between oral contraceptives and fibroid growth. There are some case histories both on growth with OAC and on decrease with withdrawal of the pills. Usually there is no problem at all. And influence on fibroids by birth control pills is extremely rare.
Question: I started having symptoms of menopause and have abnormal spotting and discharge. I do not have any signs of when this will start. I may wake up to bleeding in the middle of the night and thinking I might be starting my period I use a pad and I will do nothing further. I see a OB-GYN on a regular basis. I have had several procedures in the past such as Cyro procedure and then a year later the Leep procedure due to abnormal pap tests. In the last 2 yrs. my pap smears have been normal. I have talked with my OB-GYN about HRT, but have not made any decisions as yet. I am 44 years of age. Is this something I should let my doctor be made aware of and should I consider taking HRT? Do you think that the abnormal bleeding is peri menopause or could it be something else? What type of HRT do you recommend?
Answer: First of all: abnormal bleeding needs a diagnosis. With dysfunctional perimenopausal bleeding as diagnosis (and not bleeding because of polyps or submucous fibroids) hormonal therapy to regulate the menstrual cycle is an option. This can be done with regular courses of progestogens during the second half of your cycle, with birth control pills or with HRT. The best type of HRT in women still menstruating is sequential combined HRT: continuous estrogens, combined with progestogens in the second half of the cycle (Premphase or other brands). All other types are famous for breakthrough bleeding in women still menstruating.
Question: I am 43 year old female who just had a complete hysterectomy. I had uterine prolase and endometrosis. My Doctor did a vaginal hysterectomy. He has me on evista because of breast cancer is in my family. What can I expect to happen to me now. I have hot flashes already and soy milk helps. Will I have a drastic weight gain? I weight 126lbs. He also told me he wants me to take a baby aspirin a day. Can you give me any advice on what to expect in the future?
Answer: I suppose that also the ovaries are removed. Otherwise evista cannot be used, because no experience with evista exists in women with ovaries, and you can expect ovarian cysts and maybe other troubles. Hot flashes are experienced by many women after ovariectomy and evista is not the best therapy with preexisting flashes. Soy milk helps because of the phytoestrogens, but again no studies are done with a combination of evista and soy. Evista will not cause weight gain. You can expect a change in weight distribution from gynecoid fat to android fat without ovaries. With estrogens this does not occur but with evista this is unknown. With hot flashes a possible solution is: use of estrogen. There is no extra risk for breast cancer because of family history, unless BRCA1 mutation exists (in that case other counseling is required). Your original risk is lowered by ovariectomy and with estrogens, you have again the same risk of breast cancer as without your operation. Also, in the first 5 years there is hardly any extra risk for breast cancer with HRT. Change the medication after about 5 year to evista. Usually the period of hot flashes is over and before you get the risk of estrogens you will have the same situation as on this moment.
Question: I am 50 years old, very healthy and active, had four children. I will be starting HRT tomorrow. I went a year having periods about every six weeks to two months then last year I skipped a few months but had one last December and in April. Anyway my question is that I have completely fell apart in the last six months. I have had complete physicals and am fine except for the indication that I need some estrogen. My joints ache all the time, but my main problem is that my skin has become so thin that all my veins are bulging and almost over night I have developed "age spots" on my hands. Will the HRT make me more healthy looking? I am thin and tall, active and healthy but I look like I am tired all the time. My breasts have almost disappeared! Can the HRT reverse all of this?
Answer: Yes, it can. Try it.
Question: I am 48 years old and suffer perimenopausal symptoms such as, night sweats, hot flashes, memory loss, general "driftiness" and lack of concentration. During the perimenopausal phase, should a woman be put on HRT? I was under the impression a woman should be free of periods for a full 12 months before being considered in menopause. My Dr. would not recommend HRT for me. She stated that to do so would cause a woman to have excessive bleeding. In your opinion, what is the correct approach?
Answer: HRT is also good for women in perimenopause with irregular periods. But be aware that there are two kinds of regimen: sequentially combined HRT (everyday estrogens and 10-12 days every month of progestagens) and continuous combined HRT (every day a combination of the two hormones). Continuous combined is NOT appropriated when still menstruating. It will cause bleeding all the time. With sequentially combined HRT, the menstrual cycle can be regulated. This is also possible by taking birth control pills. At the start, sometimes there are bleeding problems because the ovarian production and the treatment cycle are not synchronous. The best way to start is: first a course of progestagen for 10 days (to neutralize and remove the uterine lining) and then the HRT. Many women experience the hottest of the perimenopause symptoms before 12 months of amenorrhea. And also for them HRT is a very good treatment.
Question: I am a 49 year old woman just beginning to go through menopause. I have had trouble with ear ringing since October of 1999. The ear ringing is cyclical and my doctor and I now think it may be related to my hormone levels. I have been keeping track of it. For the last 3 months the ear ringing has stopped on approximately the 6th day of my menstrual cycle and started up again on about the 20th day of my cycle. Whatever hormones that are present during day 6 through day 20 is what I need. I would like to take a natural hormone supplement if something is available before I try something stronger through prescription. The trouble is I don't know what hormone I'm low the last 10 days and early part of my period. So I don't know what to ask for when I go in to the store. Do you have any suggestions of anything I could try for this problem?
Answer: I have no suggestion at all for this complaint. The symptom is unknown to me. Maybe an ear, nose and throat specialist knows more about that.
Question: I am 47 years old, and I started to have menopause 3 years ago. I have been on estrogen replacement ever since. I am currently on the medication called Prempro. I also used Premphase before. However, after using the medication for a while, I have found my face skin has some brown spots, and they tend to get bigger. I am not sure if they are definitely related to the medication. Please advise. Also, what is the best Estrogen replacement medication available for me?
Answer: As with the contraceptive pills there is a suspicion, however never proved, that hormone replacement therapy also can darken pigmented spots. Recently, a study is done in women with preexisting brown spots and no one experienced darkening of the spots. The suspicion becomes very unlikely with this observation. So, I think that it is not related. You can try it with trial and error: stop with HRT, see what happens and after a while start again and conclude. Be aware that the circumstances of the trial has to be the same: sunlight will influence dark spots. So, not the first part of the trial in summer and the second one in winter.