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Could you be going through early menopause?

Living
 If you're nowhere near age 45 years, menopause is probably very far from your mind, but perhaps you had better start paying attention to your body

Katie was 38 when her gynaecologist told her: “You are going through early menopause.” It was almost a moment of disbelief.

“Do you mean I cannot have children of my own?” she recalls asking the doctor.

It was anti-climactic, she felt, to have flown high in her career life and to be denied the right to have a child.

“It is hard being a woman,” she says. “On one hand you want to reach the apex of your career life and on the other, you also want to have children before it is too late.”

The two seem to be out of sync, she says. “You have to choose one from the two.”

But do you?

“First, menopause is not a conspiracy theory,” Dr Wanjiru Ndegwa says. “It is real and occurs in all women.”

Dr Ndegwa is a fertility specialist at Footsteps to fertility Kenya. Many of her female clients – women struggling to conceive naturally – are aged within Katie’s range: “Around 38 and 40 years,” she says.

Menopause is the climactic point in a woman’s life when menstruation ceases and reproductive functions grind to a halt.

“Menopause typically occurs between age 45 and 55,” Dr Ndegwa says. But like with every biological construct there are outliers and Katie was an outlier. “There are women who go through early menopause,” she says.

Early menopause, the medic notes, can be a misfortune for the woman hoping to still bear children.

And then, there is fertility menopause.

Dr Ndegwa explains: “Fertility menopause can occur five to ten years before actual menopause. Basically, a woman would be ovulating and experiencing menstruation no symptoms of menopause but the eggs are not viable and their quality compromised, making it difficult for them to conceive.”

How does menopause take place?

To understand how menopause occurs, one has to understand how mensturation works.

Dr John Ong’ech, an obstetrician and gynaecologist, says menstruation represents the cyclic nature of a woman’s fertility.

“Every month, a woman ovulates and the egg (sometimes eggs) travel through the fallopian tube to be fertilised by a sperm,” he says. “If the egg is not fertilised, it disintegrates and the process repeats itself in another one month.”

Girls are born with about 400,000 eggs. When the girl reaches puberty, these eggs, Dr Ong’ech notes, start getting released with every menstrual cycle during ovulation. He adds that 20 to 30 eggs are released in every cycle.

“By the time the woman is reaching menopause, nearly all her eggs have been released. Any remaining eggs at that time are not viable and cannot lead to a pregnancy,” he says.

Why do some women go through menopause early?

In some cases, Dr Ong’ech says, women who suffer from early menopause are suffering from an autoimmune disease that attacks the ovaries, causing premature ovarian failure.

In other cases the woman’s body is imbued with toxins that curtail ovary functions. For instance, Dr Ndegwa says, research shows that chain-smokers are at a higher risk of encountering early menopause.

In particular situations, because of disease, a woman has her ovaries removed – effectively placing her in a menopausal state.

But then some women are born with fewer eggs than the average woman.

“It is mostly a genetic predisposition,” she says. “If the women in your lineage were born with fewer eggs then it might be the case for you as well.”

Fewer eggs means the woman runs out of eggs faster. Some, Dr Ndegwa says, as early as age 28. But even at that age, the woman would still experience full-cycle menopause with the same symptoms as a woman who has it at the typical age.

What does menopause feel like?

The most common symptom of menopause, Dr Ndegwa says, is hot flushes. “You feel heat from the top of your head to the soles of your feet,” she says.

Jardine Mwangeka, 62, still remembers the first episodes of hot flushes she experienced.

“They were horrible,” Mwangeka says. “It feels like someone pouring a steady stream of hot water on you but from inside your body.” At the very least, she says, the hot flushes were uncomfortable. “You sweat profusely: in the morning, in the afternoon, at night – all the time.”

Mwangeka was 55 when she suffered her first hot flush. This, she believes, is the time she hit menopause. The hot flushes, she says, went on for about four years.

How will I know it is menopause?

According to Dr Ong’ech, menopause can be diagnosed clinically, since it is driven by hormonal changes.

“Oestrogen levels go down while FSH (follicle stimulating hormone) goes up. Blood tests can therefore show elevated levels of FSH.”

Another symptom of menopause is the stoppage of menstruation – crossing the red rubicon so to speak – since there are no more viable eggs to be released by the ovary.

According to Dr Ndegwa, menstruation has to not have occurred for six months to one year straight for doctors to correlate it with menopause.

Even so, in very few cases, a woman (some in their 60s) may still experience menstruation even after menopause.

“This means that their ovaries are still releasing eggs. But those eggs are not viable: their quality is severely compromised,” she says.

What if my menopause comes early?

Mwangeka, a mother of four, had dreaded menopause when she turned 30.

“At that time, I was struggling with conception. I had been married for maybe five years yet I had not gotten pregnant,” she says.

She feared that she would reach menopause before ever having a fair shot at motherhood.

After medical intervention, she gave birth to her first child at age 33.

The standard advice Dr Ndegwa gives young women is: “If you would love to be a mother, have those children as soon as possible. When you are younger, your chances of conceiving are better.”

Both Dr Ndegwa and Dr Ong’ech say that a woman is physically ready to carry a healthy pregnancy in her early 20s.

“Because of career and education, ages 25 to 35 would be an optimum period to carry a pregnancy,” Dr Ndegwa says.

Beyond 35 – heading towards 40 – a woman’s eggs start losing quality. Loss of quality, Dr Ong’ech notes, increases episodes of miscarriage and possibility of the baby being born with deformities.

Is menopause so terrible?

Dr Ong’ech says it is important that women don’t view menopause as a scary experience. The symptoms present in various degrees for every woman.

According to Dr Ndegwa, some women don’t even show symptoms – at all.

In Mwangeka’s opinion, menopause can also be positive. “You may be terrified because you are growing older. But then you also grow wiser,” she says.

For some women, not having to deal with menstruation every month may feel good. For others, the freedom of enjoying sex without the fear of pregnancy (assuming you no longer want children) might be a positive thing.

Today, Dr Ong’ech observes, menopause symptoms can be greatly reduced through treatment as prescribed by a gynaecologist.

What about men? Don’t men go through menopause too?

Men’s menopause is termed Andropose, says Dr Ong’ech. “Andropose occurs anywhere after 70 years. It is signified by a diminished testosterone.”

Unlike menopause, andropose, the gynaecologist adds, is not open ended and may not be exact. As a man ages, Dr Ong’ech says, spermatogenesis (sperm production) may decline.

Dr Ndegwa notes that, unlike menopause, andropose does not have major fertility effects on men per se.

“It is marked by low libido because of low testosterone. However a man’s fertility is rarely affected. At that age, most men still produce good quality sperms,” she says.

Andropose, Dr Ndegwa says, is not similar (not in the slightest) to menopause. The symptoms of menopause, like hot flushes, don’t afflict men.

Symptoms of menopause

A 2013 study conducted among a group of rural community women in Kerala, India, provided clues on physiological and psychological symptoms of menopause.

The study, published in the journal of Mid-life Health, evaluated menopause symptoms in 106 women, with the mean age (of women in menopause) being 48.26 years.

The study found that nearly all the women suffered from one or more of the following menopausal symptoms:

Emotional problems (crying spells, depression, irritability) 90.7 per cent Headache 72.9 per cent Lethargy (lack of energy and enthusiasm) 65.4 per cent Dysuria (painful or difficult urination) 58.9 per cent Forgetfulness 57 per cent Musculoskeletal problems (joint pain, muscle pain) 53.3 per cent Sexual problems (decreased libido, dyspareunia - painful sex) 31.8 per cent Genital problems (itching, vaginal dryness) 9.3 per cent Changes in voice 8.4 per cent

 

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