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When the ‘change of life’ comes too early

Early menopause

Sarah’s story
Sarah was twenty-nine years of age. She had a loving husband and a beautiful daughter. “My life couldn’t have been more perfect,” she says. Sarah had reached that place in her life when she was ready to consider a sibling for two year old Grace. She and her husband Brad were surprised when they did not get pregnant straight away, as they had done with Grace, but they put it down to being older and busier.  What made it even harder was Sarah’s periods were getting irregular. She would miss a period and do a pregnancy test, only to find it came up negative. When Sarah went to her doctor she was told she was probably getting stressed and it would all happen in good time. But things kept getting worse.  Sarah started getting depressed and her mood swings became extreme. “It was when the hot flushes started that I got really concerned,” says Sarah. “My mum had just gone through menopause and I would joke with her that my body was going out in sympathy. Little did I know that it was nothing to joke about.”  Sarah even went to a counsellor thinking that she was experiencing some delayed form of postnatal depression. The counsellor put the hot flushes down to anxiety attacks and Sarah was referred to a psychiatrist and put on antidepressants. Finally after a year of trying to fall pregnant with no luck Sarah was referred to a fertility specialist and diagnosed with early menopause. “Here I was, having just turned 30 and my body had virtually shut down,” says Sarah. “I had caught up to my mum who was 24 years older than me. I was embarrassed and ashamed and it took a long while for me not to feel like I was this old, dried-up, useless woman that had cheated her family out of a future.” The worst times for Sarah were playgroup mornings with other mothers who would inevitably be announcing their pregnancies and then they would ask when she would give Grace a brother or sister. “No more for me,” Sarah would say brightly - too brightly, burying her face in her coffee cup to hide the tears.  It took a long time before she stopped seeing herself as a young woman in an old woman’s body. “I had to do a lot of work on my attitude,” said Sarah, “before I came to accept that I was actually lucky. At least I have a child and a husband that loves and supports me. It could have been much worse.”

Menopause is the permanent end of menstruation and therefore fertility for women. It is a normal and natural event that occurs in most women’s lives between the ages of 40 and 58, with the average age being around 51 years of age. In some women menopause occurs early, before the age of forty. This is called ‘early menopause’. It can occur naturally when the ovaries stop working, sometimes referred to as Premature Ovarian Failure (POF). It can also occur as a result of surgery, where a woman has had her ovaries removed, or following chemotherapy or radiotherapy for cancer. Around one to two percent of women experience menopause before the age of forty but this increases when menopause is the consequence of gynaecological surgery, chemotherapy and radiotherapy.

Diagnosing early menopause
In the early stages of menopause several patterns of menstruation may be seen. Some women may get very heavy, irregular periods while others get their periods with increasing frequency. Some women get infrequent periods, greater than two monthly and others simply stop having periods altogether. The symptoms of early menopause are the same as for natural menopause. Women can experience hot flushes and night sweats, aces and pains, crawling or itching sensations under the skin, headaches and vaginal dryness. Women may experience a reduced libido (sex drive). They can be tired, irritable, experience depression and difficulties sleeping. Forgetfulness is common and lack of self-esteem is also very common. Women don’t necessarily experience all these symptoms. Some women have several symptoms, with hot flushes being the most common.

Early menopause is diagnosed when periods have been absent for at least four months and blood tests show a low level of a certain hormone, called follicle stimulating hormone. Most often a pregnancy test and an ultrasound are done as well just to exclude pregnancy and other possible causes.

Predicting early menopause
There is evidence that women with one or more first-degree relatives (eg. mother, sister) with early menopause are more likely to experience it themselves. For women in this situation this information should make them consider starting their families early so they don’t risk missing out. It is therefore worth-while knowing the age that your female relatives reached menopause. The one thing that has been proven to affect a woman’s age at menopause is smoking, with smokers reaching menopause two years earlier than non-smokers. The majority of early menopause is not predictable and women experiencing any of the symptoms described should see their doctor for hormone testing.

Health effects of early menopause
The health effects of early menopause mainly result from not having the hormone oestrogen around for as long as most women. The average life expectancy for Australian women is around eighty-three, which means women going through menopause before the age of forty will spend more than half their life with low levels of oestrogen. This means the risk of developing osteoporosis (thinning of the bones) is higher, putting these women at an increased risk of fracturing a bone. The risk of heart disease is also higher without the protective effect of oestrogen. Alzheimer’s disease is also more likely. Reduction in libido is commonly reported by these women.

 Managing early menopause symptoms
There are many ways of reducing the unpleasant symptoms of early menopause. Eating a healthy diet with a wide variety of foods is helpful. Risks of heart disease and osteoporosis can be dramatically reduced by having a good diet. Women need to include plenty of fresh vegetables, fruits, cereals and whole grain foods in their diet. Phytoestrogens (plant oestrogens) should also be included as they replace some of the natural oestrogen lost during menopause and they can help reduce symptoms. The best sources of phytoestrogens are soy, linseed, tofu, whole grains and legumes. Drinking plenty of water (6-8 glasses a day) and cutting back on caffeine (coffee, tea, cola and chocolate), alcohol and smoking are also ideal. Women need to make sure they have enough low fat, high calcium dairy products in their diet. Postmenopausal women should consume 1,200 to 1,500 mg of elemental calcium daily. Lean meat is also needed to help maintain iron levels.

Regular exercise (30 minutes most days) is recommended to maintain general health but also weight bearing exercises (walking briskly, dancing, aerobics and tennis) help keep bones healthy and prevent bone loss. Exercise is also important for helping maintain a feeling of relaxation and well-being. Exercise produces ‘feel-good’ brain chemicals called endorphins, which can reduce negative thoughts and feelings of depression. Some women also report having fewer hot flushes when they exercise.

Hormone replacement therapy
Women who experience early menopause need to consult their doctor and hormone replacement is usually recommended. This is the group of women who most benefit from hormone replacement therapy. Hormone replacement can reduce many of the unpleasant effects of the menopause symptoms and minimise the long term health effects.  Often women are prescribed hormones that follow the naturally occurring hormonal cycle. This optimises the chance of getting pregnant. Periods can occur with this therapy and if they are missed then a pregnancy test should be done. Other hormones such as androgen and testosterone are also used sometimes to help with energy, libido and general wellbeing. Women ideally take these hormones until they reach their 50’s when menopause would onset naturally for most women.

Some women would rather not take hormones and prefer the concept of natural therapies which can be of benefit. Make sure you seek the care of a registered naturopath if this is the way you want to go. Natural therapies can often be taken in conjunction with hormone replacement. Let both your doctor and naturopath know what you are on so they can provide you with the best care.

Psychological considerations
While early menopause is a physical condition, the emotional impacts can be immense. Having a supportive family and friends will make this life crisis easier to deal with. Whether or not a woman has completed her family will also impact on her emotional response to early menopause. If there is a history of depression and anxiety this can re-emerge during periods of stress such as the diagnosis of early menopause. The physical symptoms experienced can also further impact on how women respond emotionally.

It is quite common for women to experience a range of emotions when they are first diagnosed such as shock, disbelief, numbness, sadness, fear and anxiety. Often it feels like there is no one to share your feelings with. Girlfriends may not understand because they are not experiencing it and mothers may not have even been through menopause yet. Many women are unaware that menopause can happen early so this adds to the shock they experience. It also depends on whether the early menopause experienced is a naturally occurring event or as a result of treatment for cancer. Women may be dealing with both the shock of being diagnosed with cancer and losing their fertility. Women can go through periods of depression, with feelings of loss of control, low self-esteem and grief. Eventually they begin acknowledging their life change and focusing their energies on a need to change their lifestyle and look after their health.  Having lots of support and receiving good information in a sensitive way will help make this unexpected life transition easier.

Early Menopause and children
In around half of women with early menopause there is some functioning of the ovaries and in around one in ten of these women a pregnancy can occur. Pregnancy has occurred for some women years after the diagnosis. There is no known treatment that will restore ovulation in women with early menopause, although a number have been tried. Women’s choices are really Donor Eggs or adoption. Some couples decide to accept the chance off being childless and allow more time for the possibility of spontaneous ovulation and pregnancy. Women that were not sure they even wanted children still feel a sense of loss because the choice has been taken away from them. For many women loss of fertility means loss of femininity. Women need to focus on all the other things that make them feminine and desirable.

Early Menopause and relationships
Early menopause can impact significantly on how a woman views herself so it is understandable that this will have an impact on relationships. Some women have not found a partner yet when early menopause affects them and this can be very difficult. It is difficult to tell a new partner that you have gone through menopause already and can’t have children. Couples may need to re-define their goals, expectations and dreams for the future. A relationship where communication is open and honest will help in handling this stressful life event. Taking your partner along to gynaecology appointments and/or going to a counsellor can be very helpful.

Even more distressing than hot flushes and night sweats can be vaginal dryness as this can make sexual intercourse painful. Women who have never had a problem with sex before may now have to rely on lubricants. As well as the physical discomfort of intercourse, women may be dealing with feelings of not being a complete woman, or somehow being inadequate. Some women don’t feel as attractive or desirable anymore, or they worry about how they will look when they get to their fifties. A common comment is that they feel like a young woman trapped in an older woman’s body.

Women experiencing early menopause need special care and support. Most importantly they need understanding. A diagnosis brings many changes and challenges that need to be dealt with by women in their own way and own time. Taking action early and seeking sensitive, appropriate help can make them feel more informed and in control. Keeping healthy and active is a great way to optimise health and keep negative feelings at bay. Most importantly women experiencing early menopause need to know they are not alone and there are support groups and networks that can help them.

Useful resources

  • Jean Hailes for Women's Health
    Free phone: 1800 JEAN HAILES (1800 532 642)
    www.jeanhailes.org.au and www.earlymenopause.org.au
  • The International Premature Ovarian Failure Association, Inc.
    www.pofsupport.org
  • Early menopause Australia support group (03) 9569 5332
  • The Premature Menopause Book, by Kathryn Petras 
  • Early Menopause Guidebook, by The North American Menopause Society


Updated 3/10/2012

Dr Hannah Dahlen is the Associate Professor of Midwifery at the University of Western Sydney. She has been a midwife for more than 20 years. Hannah is also an executive member of the Australian College of Midwives, NSW Branch. She has researched women's birth experiences at home and in hospital and published extensively in this area. Hannah's website is www.hannahdahlen.com.au

Comments

1 comment(s) on this page. Add your own comment below.

Sharon
Apr 11, 2013 9:06pm [ 1 ]

My 16 year old daughter has just been diagnosed with Premature Ovarian Failure. It's devastating on so many levels but our journey to understand and deal with this condition has only just begun. Thank you for sharing this information.

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