Monday 18 June 2018

Early menopause or something else? how to spot the signs

Flora McKnight started to experience symptoms in her thirties

Flora McKnight at the Forty Foot in Co Dublin - she says that a cold swim helps to manage her symptoms. Photo: Frank McGrath
Flora McKnight at the Forty Foot in Co Dublin - she says that a cold swim helps to manage her symptoms. Photo: Frank McGrath

Arlene Harris

Most women will become menopausal sometime towards the end of their forties or early fifties. But some experience symptoms a lot earlier and not only can this present emotional and physical hurdles, but according to new research, can also make women more prone to stroke and heart disease.

Led by the University of Oxford, the study suggested that women who had early menopause or issues with 'reproductive health' should be screened for cardiovascular disease.

Dr Angie Brown, Medical Director of the Irish Heart Foundation, agrees and says more emphasis should be put on the danger of heart disease for women.

"There are several studies showing that women who go through early menopause are at a significantly increased risk of heart disease and stroke," she says.

"When they reach the menopause, their cardiovascular risk catches up with that of men so we advise women to attend regular check-ups and make lifestyle changes to prevent increased risk. Remember, it's usually not the fancy stuff that makes you live longer, it's about the basics: weight, cholesterol, blood pressure, being active, quitting smoking and knowing your family history.

"And because women who have an early menopause are particularly susceptible, we would advise them to see a specialist to discuss the appropriateness of HRT and have earlier and regular CV risk assessment and treatment of risk factors as needed."

Flora McKnight is 42 years old and although she doesn't fall into the menopausal age category, the Wexford woman has actually been experiencing symptoms of menopause for the past decade.

"When I was in my early thirties, I started getting really bad night sweats," she says. "My periods also became quite erratic and I began to experience mood swings and would feel anxious for no reason. I started thinking that something was going on and felt a bit freaked out about it to be honest, but I felt as though my doctor was implying that the symptoms were all in my head and there was nothing to worry about.

"Naturally I wasn't happy with that answer and went back again a few months later, this time, having done some research; I said that I thought I was going through early menopause. But again I was told it wasn't possible and was instead tested for endometriosis. This came back negative and when I asked what I could do next, I was told I just had to learn to live with the symptoms."

As time went on and her condition worsened, Flora, who works as a supervisor in an oil company, changed doctors and once again voiced her opinion that she may be menopausal.

This time, she was "taken seriously" and tests were done to determine whether or not this was the case - and, sure enough, at 38 years of age, she was told that she was indeed going through the menopause.

"My FSH [follicle stimulating hormone] levels came back as really low and this was the deciding factor that I was going through menopause," she says.

"I had been suffering for six or seven years and to be honest, it was actually a relief to be given a diagnosis. I was told that if I wanted children, I could have some treatment to slow the menopause down so I could get pregnant, but I didn't want to, so I declined the offer. I also turned down HRT as I had been coping for so long on my own that I didn't think it was necessary.

"So instead I started drinking a variety of different teas to help with the symptoms, eating more healthily and doing more regular exercise - sea swimming in particular, which really helped with the night sweats and sleepless nights."

Impressed with how the cold water helped her hot flushes, Flora, who now lives in Dun Laoghaire, decided that she was going to treat the menopause like a challenge and would seek out the cold to counteract the heat raging inside her.

"Not long after I was diagnosed, I thought to myself that I could either give in or view the menopause as one of life's adventures - and this is what I did," she says.

"Over the years, I would find myself seeking cold air from the fridge at night time, so the cold water swimming helped enormously. And for my 40th birthday I decided to go to Antarctica to get a real blast of cold air and fight back the emotional and physical aspects of menopause.

"I didn't want to take medication; I know it helps others, but it's not for me - so instead I went on the first of many cold adventures. Since Antarctica, I have also been cross-country skiing in Finnish Lapland and to Kilimanjaro and this year I am heading to Sweden to go dog-sledding - the sub-zero temperatures really help with the night sweats and planning the adventures takes my mind off the menopause."

Having endured menopausal symptoms for almost a decade, Flora is hopeful that the end is in sight, but would reassure other women that while menopause is not fun, it can be managed with a positive outlook.

"Because I started the menopause so early, the worst part is not the symptoms but the fact that I have had to deal with it for so long," she says. "I realised early on that it was just another challenge I had to face in life, so was determined to get on with it as there's no point in curling up in a ball and letting life pass you by.

"So although I still have night sweats [although not as bad as they were] and back pain for three out of every four weeks, the swimming helps with most of the symptoms. And after 10 years, I really hope things will wrap up soon and I can get on with life after menopause.

"But because I faced it head on, it's not all bad and in the words of Ernest Shackleton, 'difficulties are just things to overcome'."

Dr Shirley McQuade, medical director of the Dublin Well Woman Centre, says Flora is dealing admirably with her early menopause, despite not taking medicine, but not all women find it so easy to cope.

"For some women menopause is seen as a welcome release from period problems and worry about the risk of pregnancy," she says. "However, particularly when it occurs much earlier than expected, it can cause feelings of sadness and loss.

"Some of the emotional feeling is due to the physical drop in hormones caused by the slow-down in ovary function and this can be improved by taking HRT.

"Talking to close friends about what is happening and how you are feeling can also help. A specialist forum like the Daisy Network in the UK is staffed with women who have reached the same life stage so it may be useful to contact them."

Dr McQuade says while not all changes in menstrual cycle are related to early menopause if this is the case, medication is recommended.

"There are many reasons why periods might have stopped and most have nothing to do with the menopause," she says.

"Early menopause is diagnosed on previous medical problems, current medication and also blood tests to check levels of ovarian hormones and other hormones produced in the pituitary gland in the brain, which have an effect on the ovarian cycle.

"If a woman is not producing enough ovarian hormones, particularly oestrogen, then she needs to have hormone replacement therapy (HRT) because we know that oestrogen protects against heart disease and osteoporosis. And women who have a very early menopause are at increased risk of heart attack and bone fractures unless they have oestrogen medication in the form of either tablets or patches.

"In general, the benefits of HRT outweigh the risks for the vast majority of women."

EARLY MENOPAUSE OR SOMETHING ELSE? HOW TO SPOT THE SIGNS

* The menopause is part of the natural ageing process and occurs when our ovaries gradually stop producing eggs. Pre-menopause, our ovaries produce eggs approximately every four weeks. As we age, our sex hormones change and rebalance. The production of oestrogen, the hormone that regulates our ovaries and periods, gradually decreases and our ovaries fail to produce an egg each month. This fall in oestrogen levels can cause the physical and psychological symptoms of the menopause.

* Most women stop having periods between 50 and 51 but there is a wide variation so anywhere from 45 to about 55 is normal.

* 15pc of women go through the menopause below 45.

* Menopausal symptoms include a change in menstruation either erratic or no periods, lethargy, hot flushes and night sweats, moods swings, general aches and pains and stiffness.

π If a woman has had no periods or has had a change in period pattern for three months she should see a doctor.

* However, if the change in period pattern coincides with stopping a contraceptive pill, she should wait six months unless she has additional symptoms such as hot flushes.

* Hormone replacement therapy (HRT) is effective in treating several of the most common menopausal symptoms, including hot flushes and night sweats, vaginal symptoms and cystitis, according to the HSE.

As the name suggests, HRT works by replacing oestrogen, which naturally begins to fall in the approach to menopause, causing menopausal symptoms. There are three main types:

- oestrogen-only HRT, for women who have had their womb and ovaries removed

- cyclical HRT, for women who are experiencing menopausal symptoms but are still having periods (you take both oestrogen and progestogen)

- continuous HRT, for women who are post-menopausal

* For more, see wellwomancentre.ie; daisynetwork.org.uk; and irishheart.ie

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