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Is taking HRT until 'normal' menopause age essential?


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3- Sweats In The City.

In late April 2009 the World Health Organisation declared its first ever "public health emergency of international concern" in relation to the informally named 'Swine Flu' outbreak (later declared a pandemic). I remember travelling to work on the London Underground every day and seeing an increasing number of people wearing surgical face masks, there was definitely an underlying sense of fear and panic. It was rather inconvenient, not to mention embarrassing, that right around that time I started experiencing bouts of sweating on a scale I'd never known before. I have always been warm blooded but these unpredictable episodes completely threw me. I became adept at knowing exactly where to wait on the platform so that when the tube arrived, I could take pole position next to the adjoining carriage door and pull the window down. After this had happened a few times I dressed accordingly, no not in a bikini but rather numerous thin layers (no man made fibres!) so that I could de-robe quickly if I needed to. People would look suspiciously at me and I just knew they thought I must be sick.......Swine Flu!!!!! These were hot flashes I was having, one of the more obvious symptoms associated with Menopause.

'Hot flashes are mostly caused by the hormonal changes of menopause, but can also be affected by lifestyle and medications. A diminished level of oestrogen has a direct effect on the hypothalamus, the part of the brain responsible for controlling your appetite, sleep cycles, sex hormones, and body temperature. Somehow (we don't know how), the drop in oestrogen confuses the hypothalamus — which is sometimes referred to as the body's "thermostat" — and makes it read "too hot."

The brain responds to this report by broadcasting an all-out alert to the heart, blood vessels, and nervous system: "Get rid of the heat!" The message is transmitted by the nervous system's chemical messenger, epinephrine, and related compounds: norepinephrine, prostaglandin, serotonin. The message is delivered instantly. Your heart pumps faster, the blood vessels in your skin dilate to circulate more blood to radiate off the heat, and your sweat glands release sweat to cool you off even more.

This heat-releasing mechanism is how your body keeps you from overheating in the summer, but when the process is triggered instead by a drop in oestrogen, your brain's confused response can make you very uncomfortable. Some women's skin temperature can rise six degrees Centigrade during a hot flash. Your body cools down when it shouldn't, and you are miserable: soaking wet in the middle of a board meeting or in the middle of a good night's sleep.'
Source- www.breastcancer.org

FRI.29th MAY 2009
'I KEEP GETTING WAVES OF HOT FLASHES. I CAN'T REMEMBER THE LAST TIME I DIDN'T WAKE UP BECAUSE I WAS OVERHEATING. MY HORMONES ARE CRAZY TOO AS I'M LATE ON MY PERIOD, GOODNESS KNOWS WHY, I'VE BEEN FAR MORE STRESSED THAN THIS.'

The night sweats were unbearable! I took to keeping a water spray bottle by the bed and I would douse myself and the sheet I was laying on, then switch on the fan and point it directly at me. The initial relief was bliss but then of course when your body temperature changes so dramatically and the flash passes, then the covers need to go back on as you get cold. Asleep, awake, covers on, covers off and so on and so on! Bizarrely though, as I look back, I am grateful for these flashes as they were the main reason that I went to see my doctor. Although I had skipped a couple of periods which was most unlike me (plus there was zero chance of being pregnant) I had attributed that to stress but the flashes were unexplainable and unnerving. My journal entries at that time followed a definite pattern of feeling teary, low moods and raging hormones. Finally, ten weeks past when my period was due I went to see my doctor. He said it was unlikely to be menopause because of my age but thank goodness he did refer me to the hospital for blood tests just to see if a cause could be determined. It took just under two weeks to get the results and as I was away visiting family at the time, my mind restless and preoccupied, I decided to speak to the doctor over the phone.

FRI.14th AUGUST '09
'THE RESULTS ARE BACK. THE DOCTOR EXPLAINED I HAVE A LOW OESTROGEN COUNT AND HIGH HORMONE COUNT (I discovered later this was the *FSH count) WHICH IS AN INDICATOR OF MENOPAUSE. BECAUSE OF MY AGE I'LL BE REFERRED TO AN ENDOCRINOLOGIST (hormone specialist). IT'S EITHER A HORMONE IMBALANCE WHICH IS FIXABLE OR EARLY MENOPAUSE WHICH ISN'T. I WAS A BIT TEARY AFTERWARDS AND IT'S A SHOCK ALTHOUGH MENOPAUSE HAS BEEN AT THE BACK OF MY MIND.'

You'd think that the mention of menopause would have seemed completely ridiculous to me but I wasn't surprised. Although my mother experienced it in her fifties so as far as I knew it wasn't hereditary, somewhere in the recesses of my mind it had been lurking. Put it this way, I didn't find myself instinctively fighting the possibility. Then began the waiting game, the hospital appointments, the further blood tests, the numerous scenarios that were playing themselves out in my head, it was all consuming.

Meanwhile, my best friend was pregnant for the first time. I have to point out here that the term 'best friend' really doesn't do her or our relationship justice. She is like another part of me, a sister, a soul-mate and we have been in each other's lives since we met at college back in 1990.

TUES.18th AUGUST '09
'CLAIRE HAD ANOTHER SCAN TODAY, THE BABY WAS MOVING AROUND AND PUT ITS THUMB IN ITS MOUTH. BLESS HER, SHE HESITATED SENDING ME A PHOTO OF IT BECAUSE OF MY RECENT DILEMMA.WHO KNOWS WHAT WILL COME OF MY SITUATION BUT IF IT'S THE WORST CAST SCENARIO I WILL SERIOUSLY HAVE TO REEVALUATE WHY I'M HERE AND WHAT MY 'BIGGER PLAN' IS.'


The latter part of that journal entry might seem strange to some people. I just always felt that giving birth, nurturing and raising another human being was something I was destined to do. With the risk of contradicting myself, having entertained the possibility of an early menopause it's worth mentioning that I never imagined it would actually be the outcome! I was encouraged when my period made a reappearance months after it had vanished...


TUES.13th SEPTEMBER '09
'I FEEL CRAP AND ON EDGE BUT I THINK THAT'S BECAUSE OF TOMORROW'S APPOINTMENT WITH THE SPECIALIST. I CAN'T IMAGINE IT WILL BE UNFORTUNATE NEWS BUT THEN 1 IN 100 WOMEN AGED BETWEEN 30 AND 40 GO THROUGH EARLY MENOPAUSE AND I BET NONE OF THEM IMAGINED IT WOULD HAPPEN.'
-The following day.....
'I HAD THE WORST NIGHTS SLEEP,ONLY A COUPLE OF HOURS. I WAS SO NERVOUS LEADING UP TO THE APPOINTMENT. I HAD MY WEIGHT CHECKED, BLOOD PRESSURE, URINE SAMPLE AND THEN I SPENT HALF AN HOUR ANSWERING QUESTIONS WITH A MEMBER OF THE DOCTOR'S TEAM. IN LIGHT OF THE EXTREME PHYSICAL AND EMOTIONAL YEAR THAT WAS 2008 AND BEARING IN MIND I'VE HAD A COUPLE OF SMALL PERIODS RECENTLY, AS THE RESULTS AREN'T CONCLUSIVE I'M TO HAVE MORE BLOOD TESTS DONE NEXT YEAR AND GO BACK IN FEBRUARY.'


February 2010 brought with it the news that I was experiencing premature menopause, however there was still a teeny glimmer of hope as far as freezing some eggs.

'Premature menopause is not to be confused with perimenopause. Perimenopause lasts several years on either side of your last menstrual period. Vague symptoms you may not have connected may become significant when viewed as part of perimenopause. It is during this time that you notice the most physical changes, when your periods may become irregular and hot flushes and night sweats may start. During this stage you are still fertile and may conceive although the chances of getting pregnant are often negligible. Perimenopause is the time during which your ovarian hormones start to change and your egg production is significantly reduced. One of the key indicators of this change is the rise of the Follicle Stimulating Hormone levels.'
Source- www.daisynetwork.org.uk

I was about to turn 36 in a few weeks, I had been single for a long time and although I would occasionally ponder the subject of harvesting eggs, there was a bigger part of me that believed it wasn't necessary. There was one final blood test that I could have (**AMH), it wasn't available on the NHS (National Health Service) but I didn't hesitate for a second to pay the money if it meant I could gain more information about what my body was going through.

On March 4th Claire gave birth to a beautiful baby girl. Holding her for the first time was so bitter sweet that it's hard to know how to articulate it. A moment so beautiful, so precious yet tinged with sadness. This was a difficult time for my friend too, she was sensitive to how I must've been feeling and amidst her array of emotions, she felt guilty. I'll revisit this subject in more detail another time as it's worthy of its own blog!



MON.8th MARCH '10
'I'M NOT CONSCIOUSLY THINKING OF STUFF BUT THERE'S A HEAVINESS IN MY HEART, A SAD CLOUD. I NEED MORE ANSWERS SO I CAN START TO FIGURE OUT WHAT TO DO AND HOW TO MOVE ON.'

TUES.23rd MARCH '10
'FELT VERY TEARY AT WORK, I DON'T WANT TO BE THERE AT THE MOMENT, I DON'T WANT TO BE HOME, I JUST WANT TO BE NOWHERE...FLOATING IN SPACE. GOD HELP ME.'


THURS.25th MARCH '10
'WHAT A COUPLE OF DAYS I'VE HAD. I CALLED IN SICK TODAY, I NEEDED AN EVENING AWAY AS THIS WEEK HAS BEEN A STRUGGLE. I GOT MY TEST RESULTS FROM THE HOSPITAL. MY OVARIES HAVE GIVEN UP, THERE'S NO HOPE OF EGGS, NO OPTIONS FOR ME AS FAR AS ME HAVING A CHILD THAT IS BIOLOGICALLY MINE.....
IT'S SO SURREAL, I DON'T NOW WHETHER I CAN QUITE BELIEVE IT. HOW DO I START THE HEALING PROCESS? WHERE DO I BEGIN?

To be continued.........


*FSH Follicle-stimulating hormone
This one definitely does what it says on the tin! It stimulates the growth of ovarian follicles and is used to help encourage the growth of eggs in women and sperm in men. FSH levels rise when your ovaries stop producing enough oestrogen (however it is normal for FSH levels to fluctuate slightly throughout your menstrual cycle). I never appreciated that once you enter the world of menopause, your periods don't just stop permanently over night. Numerous tests may be taken to get an average reading. To summarise in very basic terms, a normal FSH level is usually under 10 iu/ml (international units per millilitre of blood), levels above 10-12 indicate that your ovaries are STARTING to fail, an abnormal level is considered anything above 25 and 30+ indicate the ovaries ARE failing. The first reading of mine that I actually saw on paper was from April 2010.....FSH of 104! Since my diagnosis it has peaked at 119 and dipped no lower than 63.1. With such a ridiculously high level right from the start it just baffles me how I never had any idea that my body was going through such a change. Apart from the hot flashes that only lasted for months, not years compared to some women and some absent periods, I know I didn't miss anything that would've prompted me to seek information sooner (even with the power of hindsight!). Feeling low or on edge wasn't enough for me to worry as there was plenty going on in my life at the time to justify feeling more emotional than usual. There are various factors that can determine why Premature Menopause occurs but in my case, the reason remains unknown.

**AMH Anti- Mullerian hormone.
This hormone is produced by the egg follicle that the ovaries grow to prepare an egg for release in to the Fallopian tube. These levels don't change with the menstrual cycle and a blood test determines ovarian reserve, telling you if your ovaries are still releasing eggs and indicating the quality of those eggs. The higher the level, the better (your level naturally decreases with age). A normal reading would be 1.5-4.0 ng/ml (nano grams per millilitre), low/normal 1.0-1.5. My results showed a level of 0.65.

It is imperative I state here that whilst researching these figures, I found slight variations online as far as 'normal' hormone levels are concerned. I must also mention that there are many ovarian hormones and I could list numerous other tests and results I received. I have mentioned the two above as they are key factors in the diagnosis of P.O.F.



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