How Does Ovulation Work
Before we begin to understand ovarian failure we need to understand ovulation. In brief, a female is born with about 2 million ovarian follicles. As she gets older and reaches puberty she will only have about 300,000-400,000 left. The body does not make any more. These follicles are very important because they mature to be eggs that will be released during ovulation. Now, 300,000 may sound like a lot, but not every follicle becomes a mature egg.
When your menstrual cycle begins, your estradiol levels are low. Your hypothalamus sends out a message to your pituitary gland which then sends out a follicle-stimulating hormone .
This FSH triggers a few of your follicles to develop into mature eggs. Remember only one follicle will be the lucky one to become a mature egg. As the follicles mature they send out another hormone, estrogen. Estrogen sends a message to the hypothalamus to stop producing FSH. If the follicles do not mature and produce estrogen to stop the production of FSH, FSH will continue to produce and rise to high levels.
This is why women with POF are checked for high levels of FSH. Once the levels of estrogen are high enough, the hypothalamus and pituitary gland know that there is a mature egg. A luteinizing hormone is then released this is referred to as your LH surge.
As Menopause Nears Be Aware It Can Trigger Depression And Anxiety Too
“Technically, menopause is only one day in a woman’s life, which is exactly when she has not had a period for 12 months,” she says. “It’s the period of time leading up to menopause that causes all the trouble.”
And it can start earlier than you might think. Many listeners wrote to us in response to our call-out for individual experiences with menopause to say that they struggled to get medical support for perimenopause in their mid-30s and early 40s.
When Edrie went back to her OB/GYN with the fertility clinic’s conclusion, she says the doctor shrugged again and told her that menopause is a normal part of life. She wasn’t satisfied with that answer. “Yeah, it’s a normal part of life, but it would be great if we could talk about it and figure out strategies.”
With that spirit in mind, we reached out to endocrinologists, gynecologists and psychiatrists for advice about navigating this major life transition.
How early can perimenopause start?
It’s quite possible for women to start to notice things changing in their mid-30s. Most women arrive at menopause between the ages of 45 and 55, but perimenopause can start as much as a decade beforehand. And about 1% of women in the U.S. reach menopause at age 40 or younger.
Why Does Menopause Occur
- Natural menopause occurs when levels of oestrogen and progesterone decline naturally.
- Premature menopause is when periods stop before the age of 40 years. This can be due to many reasons including medical conditions such as diabetes or underactive thyroid , and surgery or medications that have affected the blood supply to the ovaries. Genetic factors may also play a part as premature menopause can run in families. Women who smoke are also more likely to go through premature menopause. Sometimes, however, there is no identifiable cause.
- Artificial menopause is a consequence of surgical removal of both ovaries or destruction of the ovaries by some cancer treatments. With artificial menopause there is a sudden drop in hormone levels and menopausal symptoms begin abruptly. Often the symptoms experienced are more severe than those experienced with natural or premature menopause.
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Easing The Transition To Menopause
A genetic test may one day determine a persons likelihood of early menopause. For now, though, only time will tell when youll start your transition.
See your doctor for regular checkups, and be proactive about your reproductive health. Doing so can help your doctor ease the symptoms or decrease your risk factors for early menopause.
Seeing a therapist can also help you cope with any pain or anxiety you may feel during menopause.
How Long Will Menopausal Transition Symptoms Last
Menopause is technically one full year without bleeding, and perimenopause is the stage before the final menstrual period, also known as the menopausal transition. Puberty and perimenopause are similar in that they both involve hormonal changes, and the transitions can take place over several years. Some medical organizations, such as the American Osteopathic Association, refer to perimenopause as reverse puberty in women.
According to NAMS, this phase can last four to eight years, and it comes with symptoms caused by hormone fluctuations, such as mood swings, poor sleep, and hot flashes.
The age at which a woman begins perimenopause can help predict how long the transition to menopause will last, according to research published in the journal Menopause in February 2017. The authors found that perimenopause lasted longer in women who started the transition at a younger age, and the women had more symptoms, such as hot flashes.
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Jameela Jamil Just Reminded Us Why Being Open About Health Issues Is So Important
Every woman at some point in their life will enter this stage. Ive just entered it a little bit earlier. The support group is amazing, its called Daisy. So when I did finally get into that it was brilliant, theres like-minded women on there. Theres a lot of advice. You can understand each other without having to explain yourself, she says.
We cant have a talk about womens reproductive systems. Its a bit of a taboo still, but it should definitely be a discussion we have. You know, its half of the world. Conversation needs to start.
Watch the full video above.
Opinionaging Is A Woman’s Secret Power And The Data Proves It
I wouldnt know how to function outside of a big, generationally anomalous family, where I sometimes identify more with my nieces than my sisters. And Ive loved defying expectations and going my own way whether its not changing my last name, working for myself or reversing traditional gender roles when my husband became a stay-at-home dad a dozen years ago. All told, the experience of zigging where others zag has been tremendous. Ive found my greatest joys by skirting away from the expected.
Thats why Im now thinking early menopause may be my greatest opportunity yet.
First, as a writer who specializes in writing about honesty, this experience offers a chance to speak with candor about a thing so many people dont want to talk about. If the prevailing wisdom is, “Shhh, dont talk about hot flashes,” you can bet Im going to tell everyone about them. I believe we should talk openly about the things that happen with our bodies to combat shame, embarrassment and just plain disinformation.
Dealing with menopause right now also puts me squarely in my body at a time of pandemic threat, where taking care of your health is more important than ever. No symptom is going to escape my watch, and Ill do what I can to keep myself and loved ones safe but active.
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General Recommendations For Ht
Current guidelines support the use of HT for the treatment of severe hot flashes that do not respond to non-hormonal therapies. General recommendations include:
- HT may be started in women who have recently entered menopause.
- HT should not be used in women who have started menopause many years ago.
- Women should not take HT if they have risks for stroke, heart disease, blood clots, and breast cancer.
- Currently, there is no consensus on how long HT should be used or at what age it should be discontinued. Treatment should be individualized for a woman’s specific health profile.
- HT should be used only for menopause symptom management, not for chronic disease prevention.
Before starting HT, your doctor should give you a comprehensive physical exam and take your medical history to evaluate your risks for:
- Heart disease
- Breast cancer
While taking HT, you should have regular mammograms and pelvic exams and Pap smears. Current guidelines recommend that if HT is needed, it should be initiated around the time of menopause. Studies indicate that the risk of serious side effects is lower for women who use HT while in their 50s. Women who start HT past the age of 60 appear to have a higher risk for side effects such as heart attack, stroke, blood clots, or breast cancer. HT should be used with care in this age group.
Women who should not take hormone therapy include those with the following conditions:
Womens Wellness: 5 Things To Know About Early Menopause
So you missed a period. Or two. You think to yourself, Im too young for menopause. Right?
Not necessarily. Early menopause, between the ages of 40 and 45, affects about 5 percent of women. Premature menopause, before age 40, affects about 1 percent of women.
You are said to be in menopause if you have gone a full 12 months with no menstrual period. Thats when your ovaries stop making estrogen and progesterone, the female hormones necessary to maintain your menstrual cycles and fertility. For most women, menopause occurs naturally at about age 51. With increasing life expectancy, many women will spend up to 40 percent of their lives in the postmenopausal stage.
For some women, menopause is induced early because of treatments needed to save their lives, such as surgery, chemotherapy or radiation. For others, its genetic conditions, autoimmune disorders or even unknown reasons that bring about this change.
So, without a big neon billboard saying, Welcome to Menopause, what should you do? Here are 5 Things You Need to Know about Early Menopause:
3. Your family plans may change. If you wish to have a family, you may need to consider options such as freezing embryos or eggs. If you had planned to have children, you may need to allow yourself to envision a new dream, such as building your family through in vitro fertilization with donor eggs, adoption or surrogacy.
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What Conditions Can Cause Early Menopause
Certain medical and surgical conditions can influence the timing of menopause.
Surgical removal of the ovaries
The surgical removal of the ovaries in an ovulating woman will result in an immediate menopause, sometimes termed a surgical menopause, or induced menopause. In this case, there is no perimenopause, and after surgery, a woman will generally experience the signs and symptoms of menopause. In cases of surgical menopause, women often report that the abrupt onset of menopausal symptoms results in particularly severe symptoms, but this is not always the case.
The ovaries are often removed together with the removal of the uterus . If a hysterectomy is performed without removal of both ovaries in a woman who has not yet reached menopause, the remaining ovary or ovaries are still capable of normal hormone production. While a woman cannot menstruate after the uterus is removed by a hysterectomy, the ovaries themselves can continue to produce hormones up until the normal time when menopause would naturally occur. At this time, a woman could experience the other symptoms of menopause such as hot flashes and mood swings. These symptoms would then not be associated with the cessation of menstruation. Another possibility is that premature ovarian failure will occur earlier than the expected time of menopause, as early as one to two years following the hysterectomy. If this happens, a woman may or may not experience symptoms of menopause.
Cancer chemotherapy and radiation therapy
What Are The Effects Of Early Or Premature Menopause
Women who go through menopause early may have or similar to those of regular menopause.
But some women with early or premature menopause may also have:
- Higher risk of serious health problems, such as and , since women will live longer without the health benefits of higher estrogen levels. Talk to your doctor or nurse about steps to lower your risk for these health problems.
- More severe menopause symptoms. Talk to your doctor or nurse about to help with symptoms if they affect your daily life.
- Sadness or over the early loss of fertility or the change in their bodies. Talk to your doctor if you have symptoms of depression, including less energy or a lack of interest in things you once enjoyed that lasts longer than a few weeks. Your doctor or nurse can recommend specialists who can help you deal with your feelings. Your doctor or nurse can also discuss options, such as adoption or donor egg programs, if you want to have children.
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Removal Of The Ovaries
If you have surgery to remove your ovaries , you will experience menopause immediately because the organs that produce hormones and release eggs are no longer present.
Menopause that occurs from the absence of ovaries is known as surgical menopause.
Conditions like endometriosis, tumors, and cancer may require a person to have their ovaries removed.
People who have an oophorectomy will experience typical menopause symptoms however, rather than having them come on gradually as they would with natural menopause, they will experience them all at once, which can be intense.
Hormone replacement therapies can be used to treat menopause symptoms. However, hormone therapy is not recommended for people being treated for breast cancer, as it may increase the risk of recurrence.
How Is Premature Menopause Early Menopause And Primary Ovarian Insufficiency Diagnosed
If you begin to have symptoms of menopause before the age of 40, your healthcare provider will do several tests and ask questions to help diagnose premature or early menopause. These tests can include:
- Asking about the regularity of your menstrual periods.
- Discussing your family history of menopause at an early age.
- Testing your hormone levels .
- Looking for other medical conditions that may be contributing to your symptoms.
Women who have not had a menstrual period for 12 straight months, and are not on any medication that could stop menstruation, may have gone through menopause.
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Other Drugs Used For Menopausal Symptoms
Despite its risks, hormone therapy appears to be the most effective treatment for hot flashes. There are, however, nonhormonal treatments for hot flashes and other menopausal symptoms.
The antidepressants known as selective serotonin-reuptake inhibitors are sometimes used for managing mood changes and hot flashes. A low-dose formulation of paroxetine is approved to treat moderate-to-severe hot flashes associated with menopause. Other SSRIs and similar antidepressant medicines are used “off-label” and may have some benefit too. They include fluoxetine , sertraline , venlafaxine , desvenlafaxine , paroxetine , and escitalopram .
Several small studies have suggested that gabapentin , a drug used for seizures and nerve pain, may relieve hot flashes. This drug is sometimes prescribed “off-label” for treating hot flash symptoms. However, in 2013 the FDA decided against approving gabapentin for this indication because the drug demonstrated only modest benefit. Gabapentin may cause:
Does The Age My Mother Reached Menopause Mean Anything
Most likely your moms age at menopause will provide a clue. When we look at the things that are the greatest determinants for when someone is going to go through menopause, genetics seems to be one of the most important things, says Streicher.
A womans race or ethnicity can influence when she goes through menopause, too, she says. Findings from the Study of Womens Health Across the Nation indicate that women of color tend to begin perimenopause and menopause at earlier ages than white women.
The question I always ask women when they ask when theyre going to go through menopause is, When did your mom go through menopause? because that is very often predictive, says Streicher.
Theres a lot of truth in that. You may follow what happened with your mother if she went through menopause early or late, you may, too, she says.
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Induced Menopause Following Cancer Therapy
Ovarian damage from cancer therapy depends on the age at treatment and on the type of treatment. Women younger than age 40 years and children are at lower risk for ovarian failure than older women however, exposure to higher doses of alkylating agents and higher doses of radiation to the ovary are more likely to induce ovarian failure . Based on the Childhood Cancer Survivor Study , a cohort study of survivors of childhood cancer treated at 25 cancer centers throughout North America between 1970 and 1986, approximately 6% of childhood cancer survivors experienced acute ovarian failure during cancer treatment or shortly after completing cancer treatment . Another 8% retained ovarian function during treatment but later developed premature menopause . This is believed to be an underestimate of the true population incidence of premature menopause because the median age attained in this group at the time of analysis was only 29 years .
Follow-up of childhood cancer survivors has identified an increase in miscarriages, an increase in small for gestational age offspring, and a reduction in live births . Longer term health outcomes, beyond cancer free survival, are not yet available however, these subjects are expected to be at increased risk for osteoporosis, cardiovascular disease, psychosexual dysfunction, and decreased quality of life .
Lifestyle Factors In Controlling The Symptoms And Complications Of Menopause
Many of the symptoms of menopause and the medical complications that may develop in postmenopausal women can be lessened or even avoided by taking steps to lead a healthy lifestyle.
- Regular exercise can help protect against cardiovascular disease and osteoporosis. Exercise also has proven mental health benefits.
- Stop smoking
Which types of doctors treat menopausal symptoms?
The symptoms of menopause are often treated by a womanâs gynecologist. Primary care providers, including family medicine specialists and internists, may also treat the symptoms of menopause.
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