Who Should Be On My Childs Care Team For Turner Syndrome
Treatment for Turner syndrome depends on each childs specific symptoms and development. A coordinated care team can provide the most comprehensive, effective care. The team will look at the whole picture and tailor a plan that works for your child.
Usually, children with Turner syndrome work with their pediatricians. They also receive evaluation and monitoring from pediatric endocrinologists. These hormone specialists can provide recommendations on how to treat hormone deficiencies.
Other pediatric specialists may include:
- Speech pathologist.
Parents can help the care team by keeping growth charts and tracking other symptoms. Its also a good idea for families to get genetic counseling.
Diagnosis Of Primary Ovarian Insufficiency
If you have irregular periods or have stopped your periods for more than three months, please see your doctor and make sure your doctor includes hormone tests to exclude early menopause.
Your doctor will need to do a full physical examination and investigate the cause of your symptoms.
The criteria for a diagnosis of POI are:
- at least three months without a period
- two blood tests to confirm whether the levels of follicle-stimulating hormone are more than 40IU/l the two tests need to be performed on the third day of your period and at least one month apart.
A doctor is likely to perform the following tests:
- pregnancy test, FSH and Oestradiol
- prolactin this is the hormone usually involved with breastfeeding, but when raised, it causes periods to stop
- transvaginal ultrasound this is an internal ultrasound of the vagina and uterus to check for evidence the ovary is functioning by:
- counting the number and size of the follicles or eggs in the ovary
- measuring the volume of the ovaries
- assessing the thickness of the lining of the uterus or endometrium
- checking for any blockage that is stopping menstrual blood flow.
Can It Be Prevented
Many things can contribute to early menopause, so it is difficult to pinpoint definitive ways to prevent it. There is some evidence that certain things may affect when you experience menopause, so while there is no guarantee, you can make lifestyle changes to better your chances of avoiding early menopause. Pay attention to the following:
While there is no guarantee you can prevent early menopause, you can manage symptoms by consulting a doctor that specializes in endocrinology, like a certified menopause practitioner. You can work with the doctor to come up with a plan that may include hormone replacement therapy, medication, or lifestyle changes. Hormone therapy is usually recommended for premature and early menopause to protect the bones and heart.
What Is Premature & Early Menopause
‘Premature menopause’ is when the final menstrual period occurs before a woman is 40. ‘Early menopause’ is when the final menstrual period occurs between 40 and 45 years. Up to 8% of women have had their final period by the time they are 45. The number of women reaching menopause by this time may be increased in relation to treatment after cancer, or removal of the ovaries.
This may happen because:
- periods stop spontaneously due to primary ovarian insufficiency this affects up to 1% of women
- menopause is induced by a secondary cause such as:
- surgery when ovaries are removed surgically
- chemotherapy or radiotherapy treatment for cancer.
This video explains the causes of and treatments for premature and early menopause.
Why Do Women Go Through The Menopause And How Genetics And Lifestyle Choices Can Bring It On Early
- London-based medical journalist Thea Jourdan explains why it exists
- Experts believe better nutrition is causing the menopause to happen later
- However an early menopause can also be triggered by lifestyle choices
- But genetics may be the biggest single thing that determines the timing
06:50 EDT, 7 October 2016 | Updated:
The menopause, which simply means stopping menstruation, marks the end of a woman’s reproductive life.
In fact, it is a universal feature of all mammalian females. But why does it exist?
Some people believe that the menopause frees older women from hormonal upset and childrearing, so they can pitch in and look after the grandchildren.
Others argue that it is simply set by how long a species needs to raise infants to the age of independence, or to avoid the increased dangers of childbirth in middle age.
On a basic biological level, to understand exactly why it happens when it does, we need to go right back to the beginning, before birth.
London-based medical journalist Thea Jourdan explains why the menopause exists and what causes it to happen when it does
WHAT HAPPENS AT BIRTH
From the moment of conception, chromosomes define a baby’s gender.
An X and a Y chromosome means a boy. Two Xs mean a girl.
At around four months in the womb, a female foetus already around seven to 20 million primitive eggs in her ovaries.
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Cancer Risk And Age At Menopause
According to the American Society of Clinical Oncology, women who experience late-onset menopause have an increased risk of uterine and breast cancer. This is due to having an increased exposure to hormones such as estrogen. As women menstruate longer, they have more ovulations which also increases the risk of ovarian cancer. Women with a long reproductive life, menarche before the age of 12 years and menopause after age 55 years have an increased risk of these hormone-dependent cancers. A pooled analysis of data from more than 400,000 women found for every year older a woman was at menopause, breast cancer risk increased by approximately 3%.
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Aging Accelerates After Menopause
Mankind has long been searching for a cure for aging. Unfortunately, studies have shown menopause contributes significantly to the aging process in women, and in fact, accelerates it.
Research indicates menopause boosts cellular aging by an average of 6 percent, which starts to add up over a lifetime. Biologically, a woman who went through menopause at age 42 would be a full year older by age 50 than a woman who started menopause at age 50.
To add to this, the same research indicates that insomnia, which often accompanies menopause, also speeds up our biological clock. Women reporting restless sleep, repeated night-time awakenings and difficulty falling asleep tended to be older biologically than women of similar chronological age with no symptoms.
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How Long Does Menopause Last After Monthly Cycles End
Symptoms typically increase during the first year after menopause begins . Hot flashes, chills, mood and sleep issues, and weight gain are all likely to increase during this time period. However, the exact onset of these symptoms can vary, with some women experiencing them during the six years prior to the loss of a monthly cycle. On average, these symptoms can last for around four to five years after the beginning of menopause.
Can Mumps Be Prevented
Mumps is a highly preventable disease because of the effectiveness of the MMR vaccine. Children are usually vaccinated against mumps between 12 and 15 months of age and then again between the ages of 4 and 6.
Mumps is considered a rare disease, with only a few hundred cases each year in the United States. Still, outbreaks occur in the United States on a regular basis, especially in places where there is close human contact, such as schools and dormitories. Therefore, it is important that your child be vaccinated to reduce his or her risk of contracting the disease.
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Osteoporosis More Likely With Early Menopause
The relationship between estrogen and bone, or more correctly the formation of bone, is complex. One of the main actions of estrogen is to prevent the resorption of bone tissue, which is when osteoclasts break down bone tissue and release minerals such as calcium into the blood.
Menopause brings about a decline in the production of estrogen which can have a significant effect on long-term bone health. A study that followed the same group of women for three decades found that those who went through menopause before the age of 47 were almost twice as likely to develop osteoporosis as those who went through menopause at or after the age of 47. In addition, an earlier age of menopause also correlated with a greater risk for fracture and an overall increased death rate.
Maintaining a good body weight and dietary calcium levels, exercising, not smoking, limiting alcohol intake and careful sun exposure can all help reduce the risk of osteoporosis. Medications such as bisphosphonates and hormones can help maintain bone density. Talk to your doctor about ways to maintain your bone density if you have gone through early menopause.
What Causes Early Menopause
As mentioned previously, menopause before the age of 40 are considered to be in premature, or early, menopause. One medical causes of premature menopause is known as premature ovarian failure. Technically, premature ovarian failure is not the same as premature menopause. In premature ovarian failure, the ovaries stop functioning normally before the age of 40. Women with premature ovarian failure may still occasionally have menstrual periods, but they typically experience infertility. Premature ovarian failure is usually accompanied primary ovarian insufficiency. Premature ovarian failure is usually accompanied by the symptoms of premature menopause.
Premature menopause can also be caused by treatments for cancers or other conditions that involve chemotherapy and/or radiation therapy to the pelvis. These treatments can damage the ovaries and result in ovarian failure.
Surgery to remove the ovaries, either for benign or malignant conditions, results in premature menopause if both ovaries are removed. Surgery to remove the uterus results in menopause only in the sense that menstrual bleeding does not occur. In that case, the ovaries will continue to produce hormones.
Other infrequent causes that may lead to premature menopause include drugs, chronic diseases, pituitary and hypothalamic tumors, psychiatric disorders, and other relatively rare or undefined conditions.
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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:
Induced Menopause Following Prophylactic Bilateral Oophorectomy
Approximately 1 in 9 women aged 35â45 years has undergone hysterectomy, with 40 percent undergoing bilateral oophorectomy at the same time, resulting in the abrupt onset of menopause . The practice of prophylactic oophorectomy has increased over time and more than doubled between 1965 and 1990 . Meanwhile, reports now link induced menopause from bilateral oophorectomy with serious health consequences including premature death, cardiovascular and neurologic disease, and osteoporosis, in addition to menopausal symptoms, psychiatric symptoms, and impaired sexual function.
4.2.1. Mortality and cardiovascular disease
The Mayo Clinic Cohort Study of Oophorectomy and Aging involved a population-based sample of 4,780 women and reported increased all-cause mortality in women who underwent prophylactic bilateral oophorectomy before age 45 years . The increased mortality was mainly observed in women who did not take estrogen after the surgery and up until age 45 years . Cardiovascular mortality was also increased in the women who underwent bilateral oophorectomy before age 45 years and did not take estrogen .
In summary, data consistently show an increased risk for cardiovascular disease in women who undergo bilateral oophorectomy inducing premature menopause or early menopause. Estrogen replacement proximate to bilateral oophorectomy appears to be particularly important for reducing premature coronary heart disease and death in this group of women.
4.2.2. Neurologic outcomes
Here’s What Women Need To Know About Early Menopause Which Occurs Between Ages 40 And 45 And Premature Menopause Which Occurs Before Age 40
For Leslie Mac, it started with irregular menstrual periods. Mac, a digital strategist and organizer, didn’t think much of it, but once she started going months without menstruating, she decided to see her doctor. “Something must be wrong,” she remembered thinking.
“I didn’t even know it was possible to start the process so early,” Mac explained. By 34, she received a diagnosis of menopause, which is officially diagnosed when a woman goes a year without a menstrual period.
Menopause is a normal part of a woman’s life and signals the end of the reproductive years. In the U.S., this typically occurs around age 51, but 5% of women have early menopause, which occurs between ages 40 and 45, and 1% experience premature menopause, which occurs before age 40.
While age of diagnosis may differ, premature and early menopause follow the same process as usual menopause. As women age, the levels of the hormones estrogen and progesterone in their body begin to decline. In premenopausal women, the ovaries produce these hormones in a regular cycle, and they’re important for both reproductive and overall health.
“You have estrogen receptors everywhere in your body,” explained Dr. Barb DePree, director of the Women’s Midlife Services at Holland Hospital, founder of MiddlesexMD and a member of HealthyWomen’s Women’s Health Advisory Council.
How Do I Know If I Am Going Through Early Or Premature Menopause
You know you have gone through menopause when you have not had your period for 12 months in a row. If you think you may be reaching menopause early, talk to your doctor or nurse.
- Your doctor or nurse will ask you about your symptoms, such as hot flashes, irregular periods, sleep problems, and vaginal dryness.
- Your doctor or nurse may give you a blood test to measure estrogen and related hormones, like . You may choose to get tested if you want to know whether you can still get pregnant. Your doctor or nurse will test your hormone levels in the first few days of your menstrual cycle .
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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.
Experts Dispel Myths Surrounding Early Menopause And Risks Of Hormone Therapy
Brand JD, et al.Diabetes Care. 2013 doi:10.2337/dc12-1020. Christianson MS, et al.Menopause. 2013 doi:10.1097/GME.0b013e31828ced7f. Ryan J, et al.BJOG. 2014 doi:10.1111/1471-0528.12828. Sarrel PM, et al.Am J Public Health. 2013 doi:10.2105/AJPH.2013.301295. Stuenkel CA, et al.J Clin Endocrinol Metab. 2015 doi:10.1210/jc.2015-2236. Svejme O, et al.BJOG. 2012 doi:10.1111/j.1471-0528.2012.03324.x. Wellons M, et al.Menopause. 2012 doi:10.1097/gme.0b013e3182517bd0.
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Menopause typically brings with it a host of symptoms that can be unpleasant, at best, and at worst, can increase the risks for heart disease and early death. For women who go through early menopause those symptoms and health risks can be compounded, whether the transition is natural or due to surgery.
Early menopause affects a minority of women. About 1% of women younger than 40 years experience what is known as either premature menopause or primary ovarian insufficiency , whereas 5% of women younger than 45 years experience what is defined as early menopause. But for women in this group, the stakes are raised when it comes to health risks. Research indicates that early menopause, which results in the loss of estrogen and other hormones, increases the risks for cardiovascular disease, osteoporosis, type 2 diabetes, sleep disturbances, dementia and all-cause mortality.
Estrogen is key
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Late Menopause And Living Longer
Reaching menopause later in life means that a woman had reproductive hormones flowing through her body for more time than women who reach menopause early or at average ages. This means that those who reach menopause late have an increased chance of getting reproductive cancers like ovarian, breast and uterine cancer. However, reaching menopause later does not greatly increase your risk for these cancers. For example, late menopause increases breast cancer risk by one percent.
Even though women who reach menopause later at are a higher risk for reproductive cancers, they are statistically likely to live longer than then their counterparts who go through menopause within the average or early age range. This is because women who go through menopause late are at a lower risk for heart disease and stroke. Women who experience late menopause also tend to suffer less from osteoporosis, have stronger bones, and fewer fractures.
Women who experience late menopause have longer exposure to the hormone estrogen, which is partially responsible for creating the elasticity in skin. This means that these women tend to have fewer wrinkles and younger looking skin.