Hannah Dahlen

When the ‘change of life’ comes too earlySarah’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