WOMENS-HEALTH Messages for April, 1997: Re: Advice Needed About Early Menopause 30 y/o

Re: Advice Needed About Early Menopause 30 y/o

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Sun, 13 Apr 1997 13:01:01 -0500 (CDT)

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In reply to: barbara: "Advice Needed About Early Menopause 30 y/o"

At Sun, 13 Apr 1997, barbara wrote: >
>I have a friend whose 35 y/o niece went into menopause after the birth
>of her first child five years ago. ..Her mother and aunt
>(my friend) have Both had breast cancer five years ago and her maternal
>grand-mother died of ovarian cancer at age 68.

Barbara-

Your friend has "premature ovarian failure" (POF) which is not a "normal" condition, since the average age of menopause in the U.S. is about 51. About 1% of women will experience menopause prior to age 40. Since the number of eggs in the ovary is far in excess of the number needed to produce children, I disagree with the statement that POF is due to depletion of all of the eggs. Since it happened after childbirth I wonder about Sheehan's syndrome, where decreased blood supply to the pituitary gland, usually from brisk postpartum bleeding, causes part of this gland to die off, leading to hormonal deficiency. Generally, she would not have been able to breastfeed had this been the situation.

Possible causes include autoimmune problems (kind of similar to thyroid problems, which are actually more common in women with POF), chromosomal problems, radiation therapy that damages the ovaries, some chemotherapy, and, of course, the most common "cause" which is the "we don't know why" cause! The workup depends on symptoms, and can include a karyotype of her chromosomes and a search for autoimmune and other conditions. Generally, an elevated FSH level confirms the diagnosis. Treatment is by either hormone replacement therapy (estrogen and progesterone) or birth control pills. Given her family history and the debate about hormones and breast cancer, she is understandably concerned about breast cancer. This is a personal decision. However, she is at a huge risk for both heart disease (10 times more common, and just as deadly, as breast cancer) and osteoporosis (also a potentially devastating disease). Also, with decreased estrogen she is at risk for vaginal dryness, loss of bladder and vaginal tone, hot flushes, mood swings, etc, just like older women with menopause. She should take 1500-2000mg of calcium a day, get some excercise, consider breast self examinations, have routine health care, and obtain mammography as suggested by her doctor. She should really discuss these issues with a gynecologist experienced with POF or a reproductive endocrinologist. The latter may be more appropriate is she wishes to have more children.

My best wishes to her.

Ashley

--
Ashley Hill
D. Ashley Hill, M.D.
Assistant Director, Department of Ob/Gyn
Florida Hospital Family Practice Residency
Orlando, FL
dahmd@gate.net

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In reply to: barbara: "Advice Needed About Early Menopause 30 y/o"

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