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FrontRangeLiving.com -> Family/Health -> Shock of Early Menopause
The Shock of Early Menopause
By Sally McGrath
Premature silvery hair can be flattering and fashionable. Premature
menopause is never greeted so enthusiastically. Yet millions of women will
reach menopause before the average age of 51. Our writer will help you
understand the signals your body may be giving.
When Geraldine Ferraro ran for the vice presidency 16 years ago, the question
whispered around the Beltway, was, "Has she gone through menopause
yet?" No one wanted a V.P. who broke out in sweat at state dinners or who
couldn't control her moodiness.
Eight years later, author Gail Sheehy broke the menopause silence and tried
to shatter myths about the mysterious taboo in "The Silent Passage"
--a book that became a best seller. it also became the most shoplifted book in
America that year, illustrating the shame that surrounded the female rite of
passage.
Around the same time, feminist author Germaine Greer railed against negative
stereotypes about menopausal and aging women in her book, "The
Change." She urged women to resort to behaving like crones as a way to
register their visibility: "You're expected to be dreadful. So you might as
well act it."
Historically, from Aristotle to Freud, the thinking has been that only one
sex fully evolved out of the primal hormonal broth, the sex that
urinates standing up.
Today, a new attitude is beginning to bubble out of the old female hormonal
swamp, and there are signs of growing acceptance of the female body.
Bookstores have a couple dozen books on menopause, many with conflicting
information. Without a doubt, secrecy, shame and ignorance are still present,
but the glass ceiling is beginning to life. Menopause is finally receiving the
attention it deserves from the medical community, the pharmaceutical industry
and the National Institutes of Health, which is funding major studies of women's
health issues.
Doctors are beginning to understand that women ride a hormonal roller coaster
years before menopause, and most importantly, that it has a single underlying
but treatable cause.
PERIMENOPAUSE, THE PRE-MENOPAUSAL SHOCK
Although the American medical establishment since the 1970s has recognized
perimenopause, many doctors had not heard of it before the 1990s. There are
still some doctors who dismiss perimenopausal symptoms as hysterics.
Despite great strides, many women are still being blindsided when they learn
they are "perimenopausal" -- the period when the hormonal roller
coaster ride takes off and women begin to notice something in their body is off
track. When a women reaches her late 30s, her body begins the transition to
menopause, which occurs, on average, at age 51.
Perimenopause can masquerade as insomnia, migraines, moodiness, forgetfulness
or depression. Other symptoms include wacky menstrual periods, worsening PMS,
breast tenderness, bloating, irritability, weight gain and low libido. Some of
the symptoms are similar to those that occur during menopause, but they come
earlier and last longer.
Unlike menopausal symptoms, which are caused by low estrogen, perimenopausal
symptoms are caused by fluctuations in hormones as the ovaries are gearing down.
It's like puberty in reverse.
"When I started becoming menopausal, I started having anxiety attacks
and couldn't sleep," said Roz Bard, director of individual counseling at
The Counseling Center and a private practitioner in Boulder. "My periods
were getting longer, then shorter, then longer. I was having palpitations. I had to shave my legs a lot less frequently.
Oh -- the hot flashes, I'd be lying in bed, just drenched."
Bard counsels many women who are exhibiting symptoms of perimenopause but
don't have a clue about what's going on.
"They come in because other things are going on in their lives that they
don't understand," Bard said. When Bard tells clients their symptoms may
indicate perimenopause, their reactions span the board.
Some say they're too young to be menopausal. Others, she said, are relieved to hear a possible explanation for
their mood swings and related symptoms.
EARLY MENOPAUSE -- AN EVEN GREATER SHOCK
The shock is even greater for the thousands of women in their thirties and
even late twenties who find themselves in the throes of menopause, said Kathryn
Petras, author of "The Premature Menopause Book."
The devastating health challenge is not just physical: the hot flashes, mood
swings and insomnia, according to Petras, who became menopausal in her thirties,
delivers a harsh emotional blow as well. "They fast forward from 29 to
59," Petras said.
"Our perception is that once you are in menopause, it's over," said
Carol Dalton, a women's nurse practitioner at Wellspring for Women in Boulder
who has been working with menopausal women for decades. "The balls all get
thrown up in the air. It's a confusing time for a lot of women."
Premature menopause is technically defined as menopause that occurs before
the age of 40. You stop ovulating, and your periods stop completely years before
the normal age of menopause.
Boulder psychotherapist Maril Senterfit said many women grieve the loss of
their fertility, even if they've never wanted children. Some women also mourn
the loss of their periods, "even if they hated their periods all their
lives." she said. "There's a sense of loss of being a full woman,
especially in a youth-focused culture where aging is not a pretty sight. There's
a sense of being out of control. And we live in a culture where we want to
control everything."
HOW DO YOU KNOW WHEN YOUR HORMONES ARE BERSERK?
Unfortunately, there is no definitive test to determine when a woman is
perimenopausal because hormones are jumping so wildly from day to day that an
accurate measurement is impossible, Dalton said.
Instead, look at symptoms: hot flashes, irregular menstrual bleeding, lower
sex drive, memory lapses, headaches, dry skin, mood swings, urinary
incontinence. Some women experience few or no symptoms. Others are not so lucky;
they suffer a wide range of ills.
Menopause, however, can be determined by a blood test of "follicle
stimulating hormone" or FSH.
FSH, which is secreted by the brain's pituitary gland, stimulates eggs to
mature. If your ovaries are not producing enough estrogen, your pituitary brain
pumps up its response, emitting more FSH in an attempt to get the ovary to make
estrogen. Eventually, there is an abnormal amount of FSH in your bloodstream.
FSH also indirectly dilates blood vessels, which can produce a feeling of
warmth and may cause hot flashes.
During childbearing years, a normal FSH level is under 10mlU/ml. When it gets
over 20-30, the suspicion of ovarian slowdown is confirmed. A FSH level above 30
is the most reliable indicator that a woman is menopausal.
When ovulation stops, progesterone, which is secreted from ovaries following
ovulation, stops being released because no ovulation occurs. Progesterone
stabilizes the uterine lining and signals when to slough it off. Without it,
women miss periods. Progesterone also affects moods. The progesterone dip varies
from one woman to the next.
Levels of estrogens, which rocket up tenfold during puberty, fall by that
same tenfold once a woman passes through menopause.
WHAT YOU CAN DO
Physicians and counselors say women should start by closely observing what's
going on in their bodies and educating themselves about what to expect.
It makes sense to avoid alcohol and spicy foods to minimize hot flashes.
Swearing off caffeine can lead to better sleep.
Weight-bearing exercise, including walking, stimulates the production of new
bone and helps with moods.
Beyond these simple steps, treatment advice varies greatly. Because of the
wild estrogen fluctuations, treating perimenopausal symptoms is much more
difficult than treating menopause.
In recent years, the most frequent treatment has been low dose birth control
pills, according to Dr. James Huston, author of "Menopause: A Guide to
Health and Happiness."
These pills, like Mircette and Lo-estrin, even out hormone levels, but still
contain enough estrogen to suppress ovulation.
If perimenopausal women are suffering from a dearth of estrogen, they need a
different treatment. Hormone Replacement Therapy can kick estrogen levels back
up, but many doctors are wary about putting pre-menopausal women on Hormone
Replacement Therapy because of the risk of increasing breast cancer. A
federal study called the Women's Health Initiative was halted after five years
rather than the eight years planned because it indicated that a mixture of
estrogen and progestin together increased the risks of heart disease, breast
cancer and stroke. A study of menopausal women on estrogen indicated that it may
increase the risk of ovarian cancer.
Dalton recommends a variety of ways to treat symptoms ranging from medical
treatments to natural ones. She advocates increasing soy and vitamins E and B
complex. She also suggests herbs, such as licorice root and black cohosh.
But the market is so under-regulated you can't be sure what you are getting.
A surer bet is to obtain phytoestrogens from foods like soy and flaxseed oil.
One of the most important things to do is to recognize perimenopause so you
can treat it as a wake-up call, an advance warning that you are approaching the
next stage of your life. It's time to give up cigarettes, eat right and
exercise. That way, when you go through menopause, you will be in your best
shape.
And you can educate yourself about the much larger health risks that could be
on their way--osteoporosis and cancer. That decision centers on Hormone
Replacement Therapy that is the
subject of fierce debate in the medical community and may open the way for new
preventative drugs.
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