• I’ve got a lot of the symptoms I’ve seen listed. What tests should I ask my doctor for if I think I’m going through early menopause?

The key test to determine whether or not you are in menopause is an FSH test -- which measures the blood levels of your FSH (follicle stimulating hormone). Your FSH levels rise when your ovaries stop producing enough estrogen, so high FSH levels can signal that your body is entering menopause. FSH levels above 10 to 12 mlu/ml show that your ovaries are starting to fail. At this point, you might notice physical symptoms, but you’re may still getting your period fairly regularly. Higher FSH levels -- levels about 35 to 40 -- are usually taken to signal ovarian failure, or menopause. (You might still be getting periods with your FSH levels this high, but, even so, it’s a sign that your body isn’t producing enough estrogen to maintain regular ovarian function.) The best time to get an FSH test to get the most accurate reading is on the third day of your menstrual cycle, if you’re still getting periods.

Another test you might want to ask for is a blood test of your estradiol levels. Estradiol is a form of estrogen in your body -- and the levels of it drop when your ovaries start to fail. So low estradiol levels may indicate that you’re entering an early menopause. Generally, if your estradiol levels are below 36, you are considered menopausal. If your estradiol levels lower than 50 picograms per milliliter, you may still be having a period, but also may be experiencing symptoms of low estrogen -- including hot flashes, vaginal dryness, and sleep difficulties.

The FSH and estradiol tests are the two key tests given to see if you’re entering menopause, but there are other tests you can get in addition to these: levels of other ovarian hormones (like progesterone, testosterone, and luteinizing hormone (LH)); thyroid (because many symptoms of thyroid disorder overlap with menopause symptoms). Some doctors also recommend saliva testing to measure hormone levels. This isn’t as widely used as blood testing, but advocates clam that it is quicker, less expensive and reliable.

In addition, it is very wise to get a thyroid test.  Many of the symptoms of premature and early menopause are the same as those for thyroid disease -- so it's a good idea to determine whether your symptoms are due to thryoid problems or menopause.  (See Hormone Tests for more information on this.)

• What about getting an ultrasound of my ovaries?

In some cases, your doctor may perform high resolution ovarian ultrasound to view your ovaries. This will determine whether you still have any eggs and follicles. However, generally, this information doesn’t help that much. According to a British study, up to two-thirds of women diagnosed with premature ovarian failure do indeed have remaining follicles. The problem is, even when eggs are detected, attempts to stimulate ovulation through hormones have been relatively unsuccessful. However, ultrasound may make sense if you are in the early stages of premature menopause and are intending to pursue an aggressive fertility program.

• I’m still getting periods -- but I’ve got a lot of symptoms like hot flashes and night sweats. Is this normal?

Yes, it is. Even though the technical definition of menopause is not having your period for at least 6 months to a year, it’s not uncommon for young women going through early menopause or premature ovarian failure to get their periods fairly regularly. For example, my FSH level was up at 158, yet I was still getting my period.

Your hormones often fluctuate like crazy at the beginning stages of early or premature menopause, so you may be producing enough estrogen to get periods -- even while your FSH levels are high. Many times, your periods will be "anovulatory" -- in other words, you aren’t producing an egg. But you are producing enough estrogen to build up your uterine lining.

• How long will my symptoms last?

That’s a tough question. . . because there’s really no definite answer. Some women get symptoms for only a short time; others get intense symptoms for years (like me, unfortunately!). Most women get symptoms for a few years, then they fade out. But the real key to making your symptoms go away now is by either going on hormone replacement therapy (HRT) or by using alternative treatments, like phytoestrogens, herbs, and vitamins.

• Does going through menopause early mean I’m aging more quickly?

Absolutely not!! Going through menopause years before you expected it -- and years before most other women go through it (age 51) -- doesn’t mean you’re suddenly older. It does mean that your ovaries aren’t functioning the way as those of most women in their 20s and 30s. But early or premature menopause doesn’t mean that you’ve got a shorter life span, or that you’ve fast-forwarded to the body of an older woman. Yes, there are certain health risks that you now face -- like the threat of osteoporosis; you might notice your skin getting drier or a change in your body shape. But if you go on HRT or replace your hormones through natural methods, you can minimize those risks, reverse those symptoms....and feel like yourself again!

• I’ve heard people talking about seeing an RE. What is that?

An RE is a reproductive endocrinologist -- a doctor who specializes in infertility and hormonal disorders.  Many women with premature ovarian failure prefer seeing REs because they're specialists. .. and are particularly helpful if they're hoping to pursue a pregnancy. 

 ABOUT DIFFERENT SYMPTOMS: (For a list of common symptoms, see symptoms)

• I’m crying for no reason, my moods are all over the place....is this normal?

It definitely is. One of the most upsetting aspects of early or premature menopause is the emotional fallout -- mood swings, tears that come out of nowhere, anger, and a general feeling like you’ve lost your grip on your emotions. But this is totally normal. It’s yet another symptom of fluctuating hormones. You’re not going crazy; it’s just one of the ways your hormones are affecting you.

• Sex is very uncomfortable for me now. What can I do?

This is a common symptom -- and often occurs when your estrogen levels are low. Your vaginal tissues get dryer, sex becomes uncomfortable, it takes longer for you to become lubricated, and many times your sex drive will start sagging because of the discomfort.

But there are some things you can do about it: First of all, boosting your hormone levels -- either through HRT or natural supplements -- should reverse this condition. In addition to standard estrogen replacement therapy (by pills or patches) you can also use a vaginally-inserted estrogen cream specifically to deal with vaginal dryness and atrophy. And there are some natural remedies that can help as well. Among them: Vitamin E -- both taking it normally...or actually inserting the capsule directly in your vagina; Vitamins A, B, C and the mineral selenium -- all of which help restore vaginal tissues; and phytoestrogens (like soy and flaxseed) -- since they have estrogenic properties, they can help raise your estrogen levels, which, in turn, can help with dryness.

In addition, the following may help:

-  drinking lots of water -- helps keep your tissues (all over your body....including your vagina) hydrated,

-  having more sex (okay, this is an odd thing to recommend since you're in pain now, but ultimately this actually helps prevent vaginal dryness). If you reach orgasm once or twice a week -- either with a partner or through masturbation -- you increase blood flow to your vagina and keep its muscles toned, all of which helps keep the vagina in shape. And some scientists believe that sex may actually help stimulate estrogen production in the adrenal glands.

-  using lubricants -- such as Astroglide, Lubrin, or KY Jelly, or a product that enhances vaginal moisture such as Replens.

-  avoiding anything that can irritate or dry your vagina -- including perfumed bath oil or bubble bath and perfumed toilet papers. Also avoid antihistamines and certain decongestants -- these are designed to help dry out mucous membranes in your respiratory system, but also will dry out mucous membranes in your vagina.

• How can I get my libido back?

Often your sex drive will drop when your estrogen levels are low -- so going on HRT often helps boost it back to normal. And you may lose interest in sex because it’s so uncomfortable. . . so taking care of your vaginal dryness may make a difference. But if you still don’t notice any improvement, you many want to consider testosterone. It’s the male hormone that we women produce small amounts of, especially in our ovaries. In fact, if you’ve had your ovaries surgically removed, there’s a good chance your testosterone levels are pretty low. There are a number of different testosterone replacements available -- including Estratest (which is estrogen and testosterone) and testosterone cream.

• I’ve started losing hair. Is this connected with premature menopause?

This is yet another symptom often connected with low estrogen levels. When estrogen levels drop, so do your collagen levels.....which can result in thinning hair or hair loss.

But hair loss can also be due to other problems, such as thryoid disease, low iron levels in your blood, a low-protein diet, or unhealthy eating in general (such as extended crash dieting).

If you're noticing hair loss -- and if you've ruled out any other cause --  taking estrogen may help since it replenishes the collogen in your body.  In addition, certain vitamins many help combat hair loss:  vitamin A, B-complex and C, plus the minerals manganese, selenium and zinc.  And Omega-3 (which you can get in flaxseed oil capsules) and Omega-6 fatty acids also are a good bet, as they help lubricate the hair shaft.

ABOUT HORMONE REPLACEMENT THERAPY (HRT):

• What are the different types of HRT available to me -- and which one works best?

There are a wide range of different HRTs – patches and pills, natural and synthetic, combinations of estrogen and progesterones, and individual estrogen and progesterones. And different women find different forms of HRT work best. Some people think the patch is the best because it delivers a steady stream of hormones into your blood, mimicking your natural hormones. Others like pills better because it’s easier. Some women swear by the old standbys Premarin and Provera; others like the natural, plant-based hormones more. So there’s no "one size fits all" prescription....unfortunately! In fact, you may wind up trying different forms of HRT until you find the one that works best for you. (For a list of the widely prescribed forms of HRT, see the table Available Forms of HRT, and if you live in Europe, see HRT (UK).)

• What’s the difference between synthetic HRT and natural?

These are terms you’ll hear so often -- and it can get really confusing (so what else is new when it comes to early menopause?!?) Anyway, here’s a brief explanation of the terms as they’re usually used:

Natural HRT refers to estrogens and progesterone that are actually man-made -- but from natural plant sources.  Most important, they are naturally ocurring and bioidentical to the hormones your body makes.  In other words, they don't just mimic your hormones; they have the exact same chemical structure as the hormones made by your ovaries.  (Natural estrogens include Estrace, Estratab, and all of the estrogen patches such as Climara, Vivelle, etc.  Natural prescription progesterone includes Prometrium and Crinone.)

Synthetic HRT is, as you’d expect, hormone replacement made from synthetic sources. But (here’s where it gets tricky), Premarin -- which is made from a natural source (horse urine) isn't technically considered a "natural" because it isn't exactly the same as the estrogen that is made in your body.  The synthetics -- particularly synthetic progesterone, or progestin -- seem to cause a higher number of side effects.

But, all in all, it's really a personal choice.   Many people feel that natural hormones are preferable.  Because they're the same was what we make, our bodies can work better with them.  We can more easily metabolize them and break them down so our livers and kidneys can excrete them once they've done their work, and so they don't accumulate in the body and cause side effects. In addition, natural progesterone may help grow bone in addition to just preventing bone loss.

But others prefer the synthetics -- primarily because they've been more widely studied. (Most studies about HRT have been done using Premarin and medroxyprogesterone acetetate -- the progestin, widely prescribed under the brand name Provera).  And many women don't suffer side effects from the synthetics.

So it's really a matter of what you feel more comfortable with -- and what works best for you.

• Will HRT make me gain weight?  (For more information on this topic, see Weight Gain.)

This is one of those questions that so many women ask -- and one that definitely worried me a great deal!  It's especially worrisome because it's very common to put on weight when you're first experiencing early menopause.  

As your estrogen levels drop, your body tries to keep as much estrogen as possible circulating.  Since estrogen is both stored and produced in fat cells, your body may try to increase its fat content.  To make matters worse, you also often tend to put weight on in your middle -- winding up with a disappearing waistline and tummy bulge.

The good news?  HRT may actually help. This is what a number of studies have found -- women on HRT tended to gain less weight than those who weren't on it.  In fact, when you raise your estrogen levels via HRT, you may actually notice a weight loss. (This happened to me.)  You're getting the estrogen your body expected to have, so it doesn't need that extra fat any more.   Plus your weight redistributes back to its normal pattern -- so your waistline reappears and your tummy may flatten a bit.

But some women do say they notice weight gain while on HRT. One culprit may be synthetic hormones, particularly the progestin "medroxyprogesterone acetate" or MPA (most common brand: Provera). This is because some women suffer side effects from this, including bloating and water retention.   Natural progesterone doesn't seem to have this side effect.  And other women have found that lower dosages of estrogen and progesterone helps keep bloating down.   Finally, others report good luck with patches instead of pills. 

• My doctor put me on birth control pills. Is there a difference between bcps and HRT?  (For more information, see BCPS or HRT?)

This is another of those areas about early menopause that gets very confusing....

Birth control pills are often prescribed to women in perimenopause -- that time when they're getting symptoms, but still are getting periods.   Bcps are synthetic hormones and often, even with the lower dose pills, you're getting more estrogen than you would with regular HRT.

The jury is out as to whether its best to take bcps or regular HRT.  Many people feel it's safer to opt for regular HRT because your options are wider (you can take natural hormones, for example) and because the dosages tend to be lower.  But others feel that they need the extra punch of the stronger synthetic estrogen (most commonly, it's ethinyl estradiol). 

Again, this is one of those cases where it makes sense to do a little research and decide what you feel works best for you.

• Will I keep getting a period on HRT?

Actually, it depends. (How’s that for a clear answer!) If you go on cyclical HRT -- that is, you take estrogen every day and progesterone for a few days each month, then, yes, you probably will keep getting a monthly period. (One side note, though: Some women -- like me -- do stop getting periods, or they’ll only spot a bit, even on cyclical HRT. It’s not common, but it can happen.) If you’re on continuous HRT -- you take both estrogen and progesterone daily, then you usually will stop getting a period. It may take several months before your periods stop completely, but generally you’ll be done with them after a little while.

• I’m on HRT and I feel miserable. Now what?

Don’t give up! First, it sometimes takes a few weeks to notice a marked difference -- so it may make sense to wait a little while to see if the HRT helps you. Second, often switching forms of HRT -- from a synthetic to a natural, or from a pill to patch -- can make a difference. Our bodies are all different, so different forms of HRT may work better for you than others. Talk to your doctor, explain that you’re not satisfied and that you're interested in trying something new....and remember:   It's your body -- and you're entitled to feel good!

• What if I can’t take hormones? Is there anything I can take to help with my symptoms?

There are a number of different things you can try -- herbs, vitamins, and other supplements. Probably the one form of alternative treatment that’s getting the most attention is soy, as well as other phytoestrogens like flaxseed. Phytoestrogens are plant estrogens. They work somewhat like human estrogens, but they’re much weaker.  They can help to minimze symptoms and boost your estrogen levels without side effects.

A number of different herbs and vitamins can also help.   For example, taking Vitamin E and citrus bioflavanoids has been shown to help with hot flashes.  The herbs chasteberry and black cohosh can fight a number of symptoms. I list many other alternatives in my book, but for a few specific suggestions right here, see Natural Ways of Managing Early Menopause.