Menopause at 36 - A Missed Diagnosis

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Section: Talk to the Doctor I swear I'm having symptoms of menopause, including hot flashes and missed periods, but I'm only 36. Can this be menopause?
You may be experiencing premature ovarian failure (POF)-sometimes called premature menopause-which affects about 1 in 100 women between the ages of 15 and 40. In addition to irregular menstrual periods, women with POF experience menopausal symptoms such as hot flashes, night sweats, insomnia, and vaginal dryness.

You're right to be concerned. POF can have seri- ous health consequences.

Why Is This Happening?
In POF, the ovaries stop working either because there are fewer eggs to begin with or because the follicles don't function properly. In most cases, why this happens isn't clear. There may be a tendency toward early menopause in some families.

But in a few cases, POF can be brought on by a metabolic disease such as diabetes, a genetic abnormality, an immune system disorder such as rheumatoid arthritis, or an infection. Women who have undergone chemotherapy or radiation to the pelvic area for the treatment of cancer are especially at risk for POF.

Getting the Right Diagnosis
It's not uncommon for a diagnosis of POF to be missed because doctors don't consider the possibility that a woman under 40 whose periods come and go and who is also having hot flashes or night sweats could be experiencing menopause. I find it tragic that these women's symptoms are being ignored. It's not unusual for them to suffer for 3 to 4 years until a correct diagnosis is made. And it's not hard to make that diagnosis.

If I suspect that a woman has POF, I measure her level of FSH, or follicle-stimulating hormone, with a simple blood test. If it's above 40 mIU/mL, then it confirms to me that her ovaries are no longer producing sufficient amounts of estrogen.

Special Health Concerns
Once a woman is diagnosed with POF, she needs to ask some important questions.

• How will this condition affect my future health? Premature ovarian failure puts a woman at increased risk for early osteoporosis and heart disease. So I encourage a patient with POF to consider hormone replacement therapy (HRT) within 2 to 3 years of her diagnosis to protect her bones and heart. HRT will also help relieve hot flashes and other symptoms of menopause. (If you're not planning to become pregnant, another option for symptom relief is a low-dose oral contraceptive.) It's also important to keep up to date on your annual pelvic exam, Pap test, blood pressure readings, and cholesterol checks.

If you don't already exercise at least 5 days a week, follow a low-fat diet with lots of fruits and vegetables, and take a multivitamin/mineral supplement-including calcium-start now.

• Will I be able to get pregnant? For a woman who has not completed childbearing, POF can be a devastating diagnosis. Some women may still conceive, however, due to a lag time between the start of menopausal symptoms and complete ovarian failure. Also, ovulation can return intermittently. If you're not finished having your family, talk with your doctor about ways to maximize your fertility. In vitro fertilization using a donor egg usually results in high rates of pregnancy in women with POF. So there's no reason why you can't still become a mom.

PHOTO (BLACK & WHITE): Don't let early menopause take you by surprise.

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By Mary Jane Minkin,, MD, a board-certified obstetrician-gynecologist in New Haven, CT, clinical professor at Yale University School of Medicine, and coauthor of What Every Woman Needs to Know about Menopause (Yale University Press, 1996).

Adapted by MD

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