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Early Menopause : How to Cope?

BY: Dr Jyoti Gaur | Category: Women | Post Date: 2009-10-29

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   Dr  Jyoti Gaur
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Menopause is a natural process that occurs because of a decrease in the function of the ovaries, which also control estrogen production. In addition to a decrease in estrogen levels, menopause results in decreased progesterone levels, meaning that any eggs that are released are less likely to be fertilized. Menopause usually occurs between the ages of forty-five and fifty-five, although it can occur much later, or much earlier, than that. The changing lifestyle, work roles and many other factors are responsible for the early menopause in Indian women.

Stages of Menopause
Menopause occurs in a series of stages. While menopause is usually divided into two main stages, perimenopause and postmenopause, it is more accurately divided into the following four stages:

Premenopause refers to the reproductive stage of woman's life; it spans from the time of her first period to her last period.

Perimenopause refers to the years immediately preceding menopause; perimenopause is characterized by hormonal changes which often lead to menopause symptoms and usually occurs between 45 and 60 years of age. It usually lasts for a period of 2 to 6 years.

Menopause occurs when a woman has her final period. Menopause is the permanent termination of a woman's period and her fertility. This stage is confirmed when a woman doesn't have a period for twelve consecutive months.

Postmenopause refers to the stage after a woman's last period; due to a decline in hormone levels, this stage brings with it a new set of health concerns.

To be sure a woman is going through menopause, diagnostic testing can be conducted, including an estrogen or follicle-stimulating hormone (FSH) level test, in addition to a blood test.

Causes of Early Menopause
In some cases, the reason is clear but sometimes the causes are less apparent and can leave you wondering. There are common causes for early menopause:

Autoimmune Disorder
This is a common cause of premature ovarian failure. When this happens, body's immune system mistakenly attacks itself. In effect, body senses part of itself as an invader -- so it sends out antibodies to destroy this perceived threat. In the case of premature menopause, one may have antibodies to ones own ovarian tissue, to endometrium, or to one or more of the hormones regulating ovulation. A family history of autoimmune disorders (such as thyroid disease, diabetes, or rheumatoid arthritis), may be the cause for early menopause.

Chromosomal Irregularity
Some cases of hereditary premature menopause are caused by defects on an X chromosome. Women have two X chromosomes -- and, even though only one of these chromosomes is active, a defect on either one can cause premature menopause. This defect, sometimes called "fragile X syndrome," apparently interferes with the production of eggs. Another related form of genetically-caused premature menopause is called "Turner's Syndrome." In this case, one is born without a second X chromosome or without part of the chromosome. Since it needs two X's for ovaries to develop properly, a missing X or a faulty X leads to deficient ovarian development (called ovarian dysgenesis).

Oophorectomy and Total Hysterectomy
In this case, one experiences premature menopause after removal of both of the ovaries (a bilateral oophorectomy) or removal of the uterus, both fallopian tubes, and both ovaries (a total hysterectomy). Because both of your ovaries are removed, estrogen and progesterone levels plunge, leading immediately to menopause.

Ovarian Damage Due to Other Surgical Procedures
This may happen when the ovary or ovaries are damaged or otherwise affected by procedures as cyst removal or when the surgery damages blood vessels and so interferes with blood flow to the ovaries. In this case, the follicles on the remaining ovary/ovaries slowly die out, resulting in menopause. Similarly, some women experience premature menopause after tubal ligation. Again, this is a result of the surgery interfering with blood flow to the ovaries -- which ends up causing eventual ovarian failure.

Radiation Therapy and/or Chemotherapy
With the rise in cancer treatments has come a rise in premature menopause due to these treatments. Unfortunately, the significant doses of radiation or chemotherapy used to kill cancer can also damage the ovaries -- resulting in premature menopause. In some, low dose/short term treatment, experience temporary menopause due to chemo or radiation therapy. Ovarian function may stop working regularly for a few months after treatment, but then return to normal after four months or so. But often, even when periods return, one remains infertile.

Tamoxifen used to be prescribed after diagnose for breast cancer which runs a risk for premature menopause as a side effect. But recently doctors have begun prescribing Tamoxifen as a preventative to women with a high risk for breast cancer, since it cuts breast cancer rates by about 45 percent. This happens because Tamoxifen takes the place that estrogen would and so acts as an estrogen-blocker. Since body isn't getting the regular amount of estrogen it would naturally get and since low estrogen levels signals body to produce more FSH and body ultimately may react by entering menopause prematurely.

Other causes:
Family History
It's not a hard-and-fast rule, but most (5%)women go through menopause at about the same age their mothers did. So family history is not necessarily destiny, but could be an early indicator if you suspect premature menopause.

Viral Infections
If mother contracts a viral infection while baby is still in her uterus, it can affect baby's ovarian development, causing to be born with lower number of eggs. In this case, since one starts with fewer eggs than most women, runs out of eggs more quickly, which results in premature menopause. Similarly, some studies theorize that a small number of women may experience premature menopause if they have had mumps and the infection spread to their ovaries.

Thyroid Disease:
Both hypothyroid and hyperthyroid often cause symptoms early menopause when hormone levels drops. This is particularly true of hypothryoid which can cause hair loss, weight gain, moodiness, and amenorrhea ,the stopping of periods. Hyperthryoid can cause palpitations and sweats (that may seem like either hot flashes or night sweats). In both cases, though, proper diagnosis and treatment will result in the reversal of symptoms.

This is a disease that is marked by overproduction of prolactin -the hormone that is reponsible for milk production in breasts. Often women with hyperprolactinemia also go through amennorhea. One of the typical signs of hyperprolactinemia is galactorrhea , which is the technical name for milky discharge from the breasts. To determine if this a doctor will need to check prolactin levels. Hyperprolactinemia is often treated with different drugs, such as Parlodel, which typically results in the return of normal ovarian function.

Pituitary and/or Hypothamic Disorders:
Often women with pitiuitary disorders (such as hypothamlic or pituitary failure or pituitary tumors) go through amennorhea. In this case, women will have normal or even low LH and FSH levels, but may have elevated prolactin levels. One may need to get a scan to determine tumor or lesion, which is typically treated through surgery or medication.

Cushing's Disease: This occurs when your adrenal glands are overactive -- resulting in amenorrhea.

Polycystic Ovarian Syndrome (PCOS): Also known as polycystic ovarian disease (PCOD), this can cause skipped periods and a number of other symptoms, including excessive hair growth. This disorder is sometimes diagnosed by checking hormones - as a high ratio of LH (luteinizing hormone) to FSH (follicle stimulating hormone) is often present. This disorder is also sometimes marked by a high level of androgens -- testosterone and DHEA.

Other causes of amenorrhea (stopped periods) include: Excessive weight gain or weight loss; use of certain drugs (such as phenothiazines - which are psychiatric drugs, and certain narcotics); excessive exercise; recent use of birth control pills , uterine adhesions (usually due to infection or d & c procedures).

How to Cope
Bladder Control Problems
Bladder and urethra are formed from the same tissues as vagina. So, just like vagina loses muscular tone and elasticity when estrogen production lags, lower urinary tract does as well. The lining of urethra becomes thinner, and the surrounding muscles become weaker. As a result, stress on bladder through coughing, sneezing, laughing, or strenuous exercising, one may release a tiny bit of urine. And it is usually only a tiny amount, so there's no need to imagine a real disaster, but a greater degree of difficulty can be indicative of another problem -- one that may require drugs or even surgery.

Kegel exercises - exercises specially designed to help strengthen the muscles around the vagina and bladder opening. An added bonus: since Kegels help your vaginal as well as your bladder muscles.

Cut back on caffeine and alcohol, since both make urinate more frequently.

Insomnia/Disrupted Sleep
In the past, doctors believed that interrupted sleep was a consequence of night sweats, but recent studies indicate that many problems with sleep are connected to hot flashes. And research also indicates that women begin to experience restless sleep as many as five to seven years before entering menopause.

Avoid caffeine, alcohol and other stimulants (like cigarettes) before bedtime -- and avoid strenuous exercise close to bedtime.

Keep bedroom cool.

For no obvious reason, heart suddenly starts pounding, racing faster and faster. Sometimes it makes so nervous, it can blow up in to a full-fledged panic attack. They may signal something else though such as hyperthyroidism or mitral valve prolapse . If one had palpitations in the past, she may get worse when begin going through menopause.
The best thing to do is probably the hardest thing to do: Calm down.
In general, try to keep stress at a minimum.
Try relaxation techniques -- such as deep breathing, imagery, etc.
Consider quitting smoking, since that often makes palpitations worse.
Limit the amounts of alcohol and caffeine.

Weight Gain
Weight gain , specifically a thickening in your middle , is another sign of changing hormones. While a number of books and doctors claim that menopause has nothing to do with weight gain, that weight gain occurs in menopausal women because they're older and their metabolism is slowing down , other studies indicate that hormone levels are tied to weight gain and redistribution of fat. According to some studies, this occurs for two reasons: First, your progesterone levels are decreasing -- and progesterone increases your metabolic rate. So with lower progesterone levels, you have a slower metabolic rate. Second, estrogen is produced and stored in fat cells. So as your estrogen levels drop, your body is trying to increase its estrogen by upping its fat cells. Finally, with a drop in female hormones, body starts mimicking male fat distribution ,an apple shape rather than a pear.

In addition, changes in diet and exercise can help rev up body's metabolic rate.
Changes in Skin: Wrinkling and Loss of Muscle Tone

When estrogen levels drop, collagen production usually slows down as well. And, collagen is responsible for keeping our skin toned, fresh-looking, resilient. It gets thinner, drier, flakier, less youthful-looking.

Worst, this sign often shows up early in menopause. Like bone loss, which occurs rapidly in the first few years of menopause, collagen loss is most rapid at the beginning of menopause as well.

Using moisturizers helps somewhat by temporarily plumping up the top layer of skin, but the effect is short-lived. And regardless of advertising claims about "collagen-enriched" creams, and so forth, remember that to really work on skin, collagen must come from within, not be applied from without.

During the early stages of menopause, one may find more and worse headaches. Many women with regular menstrual cycles get headaches just before their periods or at ovulation. These headaches, sometimes called "menstrual migraines" occur when estrogen levels plunge during the menstrual cycle. So, when body begins slowing down its production of estrogen due to premature menopause,one may get one of these hormonally induced headaches. This also can happen when progesterone levels are too high in relation to estrogen levels a common hormone scenario for women at the beginning of menopause. Generally, these headaches diminish once hormone levels stabilize.Over-the-counter remedies i.e. like aspirin or ibuprofen help.
Hormone Replacement Therapy (HRT) is another popular option for providing relief from symptoms of menopause. HRT can be administered orally (in pill form), vaginally (as a cream), or transdermally (in patch form). Because it replaces female hormones produced by the ovaries, hormone replacement therapy minimizes menopause symptoms. HRT can minimize hot flashes and night sweats, and reduce vaginal dryness. It can be used before, during and after menopause.HRT can also help prevent osteoporosis, colon cancer, macular degeneration (vision loss caused by aging) and may delay the onset of

Alzheimer's disease.
Risks associated with HRT include a slight risk of blood clots, ovarian cancer and breast cancer (when used for a period of more than four years). HRT is not recommended for women with liver disease, cardiovascular disease, vaginal bleeding, or a history of uterine or breast cancer.

Natural Ways of Managing Early Menopause
HRT isn't the only method of helping control symptoms, fighting osteoporosis and heart disease risks, and gaining other health benefits. There are a number of vitamins, herbs and other nutrients that can help to manage early menopause, they can help support the benefits of HRT by improving risks of getting osteoporosis or heart disease; and they can help replace vitamins that are sometimes depleted when taking HRT.

Soy: Rich in phytoestrogens, specifically isoflavones, cholesterol-free and containing protein, omega 3 fatty acids, calcium, folic acid, iron and other vitamins and minerals. It can help lower cholesterol, which often rises with menopause , and help coronary blood vessels dilate, both of which are important in fighting heart disease. In addition, it may help lower triglycerides ,which often rise when one takes estrogen. Finally, soy may help prevent osteoporosis. Studies have shown that soy isoflavones help cut down on bone resorption, keep calcium from leaching from bones, and increases bone density and bone mineral content. It's a good idea to aim for at least 25 grams of soy protein daily to help with symptoms.

Flaxseed: Studies have shown that it can help lower LDL (the -bad-) cholesterol. And other studies have shown that it also may help fight breast cancer and other cancers. It can help prevent heavy bleeding , a common symptom with premature menopause and going through erratic periods. And, because it's high in omega-3 acids, it may help ease symptoms like breast tenderness, cramping, and other PMS-like discomfort.
Whole flaxseed at health food stores can be ground, to sprinkle in cereal, salads, and so.

Red Clover is another phytoestrogen which also is high in bioflavonoids. Like the other phytoestrogens, red clover has been shown to reduce hot flashes, help fight osteoporosis, and generally minimize other menopausal symptoms. But there have recently been other studies that found that it wasn't as helpful as initially believed.

Vitamin E and Citrus Bioflavonoids: This combination is a hot-flash buster, with studies showing that taking these two supplements together helps combat hot flashes. 400 IUs of Vitamin E along with 1200 mg of bioflavonoids taken in the morning and again before bedtime has been shown to reduce the frequency and severity of moodiness, anxiety, irritability and other emotional side effects hot flashes. (Vitamin E isn't safe for everyone. If you have rheumatic heart disease, high blood pressure, or diabetes, or take digitalis drugs, Vitamin E can be harmful. So be sure to check with doctor about the appropriate dosage.)

Vitamin E is also good for helping with vaginal dryness (you can even use it as a vaginal suppository.)

Vitamin A or Beta Carotene: If suffering from vaginal dryness or if noticed a change in skin texture, a drying or loss of elasticity, Vitamin A or beta carotene can help. Vitamin A helps maintain tissues, skin, and mucous membranes ,which can help fight back against vaginal dryness and skin changes that often come with low estrogen levels.

B-Vitamins: B vitamins can keep energy levels up; support liver function; prevent vaginal dryness; increase your resistance to infection; help maintain your adrenal gland function , which is where the precursor to estrone (the form of estrogen still produced by body after menopause) is produced. Last, but definitely not least, B vitamins are considered stress fighters so can help to deal with the emotional symptoms that crop up during premature menopause such as anxiety, irritability, mood swings, even insomnia.

Calcium: A definite must to help prevent osteoporosis, calcium can also help lower blood pressure, reduce triglyceride levels (that sometimes rise in women on some forms of HRT.)

Magnesium: Often found in calcium supplements, magnesium is a very important calcium helper and also appears to help fight the crashing fatigue that often comes at the beginning of premature or early menopause by boosting energy levels.

Potassium: Another big benefit: It regularizes heart beat, which can help in palpitations, a fairly common symptom of menopause. In addition, it can help cope with water retention and bloating, both of which are side effects with certain forms of HRT, particularly progestins.

Evening Primrose Oil:A good source of GLA (gamma linoleic acid), evening primrose oil has been used by many women to help fight PMS symptoms, many of which are the same as menopausal symptoms. It's a good bet to help prevent bloating, water retention, breast tenderness, cramps and vaginal dryness.

Kava Kava: Another herb that appears to be a big help in reducing anxiety, fighting depression, and leveling mood swings, kava kava has been shown to be quite effective. One recent study found that women with menopausal symptoms taking 100 mg of kava kava three times a day reported a difference after only one week..

Valerian: If you're suffering from insomnia, a common symptom, valerian may help. It's used widely in Europe to treat sleep disturbances, as well as for nervousness and menstrual problems. It's also known as an anxiety reliever, so may help with mood swings and tension.

**Note- Do not try any medication or therapy without doctor's consultation.

Article Source: http://www.saching.com

About Author / Additional Info: Dr. Jyoti Gaur

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