Can irregular periods cause vertigo?

Question

Hello doctor,

I have been experiencing vertigo for the past five to six months. Some suggest it might be perimenopausal, but my FSH levels do not indicate this. I have belly fat that has not reduced despite going to the gym for seven months. I do not know why it is not improving. Could it be related to a bulky uterus?

I have not had regular periods for the past three months. Last year, I experienced menorrhagia (heavy bleeding), and an ultrasound (USG) revealed fibroids. My doctor removed the fibroids hysteroscopically, but the bleeding became worse. I was prescribed Tranexamic acid to control the bleeding, but it did not help initially. Eventually, the bleeding resolved, and my periods returned to normal. Recently, I have started experiencing irregular periods again, requiring Norethisterone 10 mg to induce withdrawal bleeding.

Furthermore, a recent ultrasound (USG) shows fibroids again. Some doctors recommend a total hysterectomy (removal of the uterus), while others advise against it.

Currently, I am on Levothyroxine for hypothyroidism. I have been taking Clonazepam 0.25 mg (a benzodiazepine) and Duloxetine 15 mg for the past 20 years to manage anxiety. I also take nutritional supplements, including calcium, vitamin D, and iron. Additionally, I use Carboxymethylcellulose eye drops for dry and itchy eyes, which provide relief.

My laboratory results showed the following:

HbA1C: 5.9%.
Recent TSH, CBC, and lipid profile: Within normal limits.
Bilateral fundoscopy: Normal.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Fibroid recurrence after hysteroscopic removal is not uncommon and can cause irregular periods or heavy bleeding. Hormonal fluctuations due to perimenopause might also be contributing, even if FSH (follicle-stimulating hormone) levels are within the normal range.

Belly fat may be linked to hypothyroidism, managed with Levothyroxine, though optimizing TSH (thyroid stimulating hormone) levels remains essential. Hormonal imbalances, potential insulin resistance, and fibroid-related bulkiness should also be considered.

While vertigo may be associated with perimenopause, vestibular causes (for example, benign paroxysmal positional vertigo) or other systemic factors need to be ruled out. Furthermore, menorrhagia, previously treated with Tranexamic acid and hormonal therapy, was resolved but could recur with new fibroids.

Next steps for evaluation:

Gynecological assessment: Conduct a transvaginal ultrasound to assess fibroid size and impact. Consider an endometrial biopsy to rule out serious conditions like hyperplasia.
Metabolic and hormonal workups: Reevaluate thyroid function to ensure TSH levels are optimized for weight management. Consider testing fasting insulin or glucose tolerance for potential insulin resistance. Additional hormonal evaluations, including FSH, LH (luteinizing hormone), estradiol, and prolactin, may help clarify ovarian status.
Vertigo investigation: Consult an ENT (ear, nose, and throat) specialist to rule out inner ear issues. Additionally, perform vestibular function tests if symptoms persist.

Treatment options include:

Medical management for irregular periods: Continue progesterone therapy (for example, Norethisterone) as needed under medical supervision. Alternatives like Ormeloxifene may help, but side effects need monitoring.
Surgical consideration: A total hysterectomy may be appropriate if symptoms are severe or if childbearing is complete. Seek a second opinion before proceeding, especially from a fibroid specialist.
Vertigo management: Vestibular rehabilitation exercises may help if vertigo is inner-ear-related.

Get well soon, and feel free to follow up with any questions.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I recommend you consult a specialist, so we can discuss it properly again.

Thank you.

Regards.