Menopause Before 40: Coping With Premature Ovarian Failure by Karin Banerd; (Your Health Press: 2004)

If you're under 40, and are going through menopause, you must have this book. Recommended by the Women's Health Concern Clinic and the Sunnybrook and Women's College Health Sciences Centre.

Downloadable Press Release (1.45 MB)

Recommended by the North American Menopause Society and Our Bodies, Ourselves.org.

For more infomation visit Karin Banerd's website at www.kbanerd.com.

Audio
Hear author Karin Banerd and endocrinologist, Dr Elena Christofides, discuss early menopause on the radio show
Premature Ovarian Failure.
Download the MP3 (13.2 mb)

TABLE OF CONTENTS
Preface by Dr. M. Sara Rosenthal
Introduction

PART 1 My Menopause Journey
Chapter 1: Early Beginnings
Chapter 2: Stumbling in the Dark at 35
Chapter 3: Searching for Help
Chapter 4: Finding Answers and Therapies

PART 2 Premature Menopause and Hormones
Chapter 5: When Hormones are out of Whack
Chapter 6: Hormones that Run the Show
Chapter 7: Long-term Risks of Hormone Imbalance

PART 3 Coping Strategies
Chapter 8: Awareness and Attitudinal Change
Chapter 9: Taking Action
Chapter 10: Maintaining a Good Sex Life
Chapter 11: Supplements and HRT
Chapter 12: What Your Health Practitioner Can Do for You

Useful Links
Bibliography
Index

AUTHOR'S INTRODUCTION FROM THE BOOK
Menopause is a journey that sooner or later all women must take. The World Health Organization defines this stage of a woman’s life as 12 continuous period-free months. For most of us the menopause journey begins sometime in our late 40s to early 50s and typically lasts anywhere from one to two years. But for some it can begin much sooner with premature ovarian failure, also known as POF. Mine started before I had even reached the age of 35.

The journey of premature ovarian failure and premature menopause is potentially a much more treacherous one than that of normal menopause for a number of reasons. The traveler frequently journeys alone through largely uncharted territory. She’s often ill prepared for the journey and may receive little medical or societal recognition along the way. As well, the hormonal decline she experiences is more likely to be a protracted bumpy and irregular ride compared to the relatively short and consistent decline for a woman at a typical menopausal age.

With much of my journey now behind me I’d like to share with you my experiences and my insights as I navigated through premature menopause. My story is not meant to be an exhaustive detailing of all the facts and treatment options surrounding menopause, but rather a personal account and a general guide. Now is a particularly good time to be researching the length and breadth of women’s menopause experiences since in the last few years, likely thanks to the baby boom generation, there’s been a deluge of books published on the subject. With this book I simply want to add my voice to the many others speaking out about menopause. My focus is slightly different. I want to profile the unique context of premature menopause and suggest some appropriate coping strategies. My hope is that my story will help you, the family and friends who care for you and the professionals who treat you to understand better the menopause experience in its normal and particularly not so normal manifestations.

I’ve divided my book into three parts:
1. My Menopause Journey
2. Premature Menopause and Hormones
3. Coping Strategies.

In the first Part I talk about my life before the challenge of premature menopause derailed my body and mind. I describe the warning signs of hormonal decline as my body prepared for menopause and the havoc these unexpected changes wreaked in my life. I also highlight the unique context of premature menopause, how it necessitates a different response on a medical and a personal level and my views on what that response should be.

Part 2 gets into the nitty gritty of what exactly premature menopause is and the role that the key female reproductive hormones play in a woman’s physical, mental and emotional states.

Part 3 is the “How to” segment of the book where I present various strategies for maintaining optimum health during the menopausal years, regardless of when menopause takes place. The advantage of premature menopause is that you can start some of these coping strategies earlier in your life. Premature menopause provides a wake-up call to make good choices to preserve our health. Those healthy choices can only have positive long-term benefits when started five or ten years earlier when premature menopause first announces itself. We can reap enormous benefits from educating ourselves and taking early and effective action toward optimum health.

MENOPAUSE BEFORE 40 FAQ
Q. What is premature menopause?
A. Premature menopause has occurred when a woman has experienced the absence of menstrual bleeding for more than 12 months at an earlier age than the typical late 40s to early 50s. Biochemically, this would coincide with a rise in follicle stimulating hormone (FSH) and lower estrogen levels. For some women premature menopause can occur as early as in their late 20s or early 30s.

Thus, a definitive diagnosis of either normal or early menopause can only be made in hindsight – after 12 months of no periods. However, the 12 period-free months mark the end of what might have been a long process of the reproductive system slowly gearing down, which may occur with irregular periods. This gearing-down period is called perimenopause and can last as long as ten years. A woman who has not yet entered perimenopause is referred to as premenopausal. That means that all women, regardless of age, are premenopausal if they have not yet started the menopause transition stage. And finally, the remainder of a woman’s life after menopause is referred to as the postmenopausal period. I will be using all these terms as appropriate throughout the rest of this book.

Q. What is premature ovarian failure (POF)?
A. Premature ovarian failure (POF) is an earlier-than-expected failure of the ovaries to function. It’s a necessary and integral part of premature menopause and is what leads to premature menopause. POF can be a natural occurrence with no apparent trigger other than genetics, or it can be induced (see further). With POF, the ovaries may follow an erratic pattern of producing an egg some months, and not producing an egg other months. Periods may still be occurring regularly or with some disruption to their flow, or their schedule. Menstruation may even skip a month or two. When the ovaries stop producing eggs every month, they also stop producing estrogen at the same level as prior to menopause. This estrogen drop brings with it many other changes.

POF can be a temporary interruption in normal ovarian function, or, it may be, and, in almost all cases, is permanent, whereas premature menopause is always permanent and will never revert back to normal. Basically POF and premature menopause describe two characteristics of the same problem, and the normal expectation is that the ovaries will begin to fail before menopause can actually be defined. POF is easier to diagnose before rather than during menopause by measuring blood levels of certain hormones. A woman may still be cycling and having periods but may not be releasing eggs every month. POF gives a more accurate measure of a woman’s condition during the menopause transition period preceding actual menopause.

Q. What does estrogen normally do in the body?
A. In the body, there are receptor sites that estrogen stimulates, such as the breast, uterus, etc. The following list, while not exhaustive, covers the major effects of estrogen*:

• Decreases libido
• Impairs blood sugar control (counterbalanced by progesterone)
• Increases blood clotting (counterbalanced by progesterone)
• Increases body fat (counterbalanced by progesterone)
• Interferes with thyroid hormone (which is counterbalanced by progesterone)
• Reduces oxygen levels in cells (counterbalanced by progesterone)
• Reduces vascular tone
• Retains salt and fluids
• Slows bone loss (counterbalanced by progesterone, which helps with fat distribution)
• Stimulates glands of the breasts (counterbalanced by progesterone, which stimulates ducts of the breasts)
• Thickens the lining of the uterus (counterbalanced by progesterone).

*Note: when not counterbalanced by progesterone, many of these normal functions can turn into diseases, such as breast cancer or uterine cancer.

Q. What does progesterone normally do to the body?
A. Progesterone blocks estrogen receptor sites, resulting in the action of counterbalancing estrogen. The following list, while also not exhaustive, covers the major effects of progesterone:

• Maintains the uterine lining with secretions
• Helps convert fat into energy
• Works as a natural diuretic
• Works as a natural anti-depressant
• Facilitates thyroid hormone (counterbalanced by estrogen)
• Normalizes blood sugar levels (counterbalanced by estrogen)
• Normalizes blood clotting
• Increases libido
• Normalizes zinc and copper levels
• Restores cell oxygen levels
• Stimulates bone-building cells.

*Note: when it’s balanced, progesterone helps protect against many diseases, such as uterine cancer. However, the recent WHI study demonstrated that progesterone added to estrogen did not effectively prevent breast cancer.

Q. What are the symptoms of estrogen loss?
A. The following are possible physical symptoms of estrogen loss:

• Irregular menstrual cycles
• Urinary incontinence
• Less vaginal lubrication
• Painful intercourse
• Slower sexual arousal and lubrication
• Thinning hair
• Hair growth on face
• Lethargy
• Headaches
• Back pain
• Tender breasts
• Chest pain
• Itchy or crawling skin (formication)
• Night sweats
• Hot flashes
• Premenstrual migraines
• Heart palpitations
• Brittle nails
• Sore muscles
• Pins and needles sensations
• Stiff and swollen joints
• Bloated abdomen
• Constipation
• Heavy/irregular periods
• Itchy vulva
• Loss of libido
• Frequent need to urinate
• Lower voice
• Dry hair, mouth and eyes
• Dry, wrinkled skin
• Restless and interrupted sleep

The following are possible emotional symptoms of estrogen loss:

• Difficulty concentrating or making decisions
• Fatigue
• Depression
• Forgetfulness
• Irritability
• Tearfullness
• Mood Swings
• More pronounced than usual mood swings during PMS