This was flagged up in two separate national newspapers recently, in the Times on earlier onset of menstruation and the Daily Mail on early menopause, but in fact they are not two separate incidents but are linked. It started with the first use of the Pill as a contraceptive and on up to the role of HRT at menopause. Doctors may be baffled but this is not a new topic. When the late Dr John Lee used to visit over 15 years ago London to speak on the role of bioidentical natural progesterone I facilitated several of his lectures and the evening always ended with taking questions from the floor. One of them concerned a young girl of 13 who was exhibiting signs of menopause and his answer was to draw a picture of how hormonal disruption that has been passed from mother to daughter over the generations.
He explained how iI the 1960’s a young girl on the Pill was subject to synthetic progestins that affected her hormone balance and he believed this was passed to her daughter/s. That next generation not only had the Pill, but also the newly launched HRT, which initially was oestrogen only until the dangers were realized. Sadly instead of adding in the natural hormone they went for a synthetic progestin so two different chemical disruptors in one lifetime was the result and this has continued on to affect the hormone picture down to the the third and fourth generation of girls.
It was Dame Dr Shirley Bond who drew The Times article to my attention with the comment that she couldn’t imagine why Doctors were baffled when the results of oestrogen dominance and the continued use of synthetic hormones were to her very obvious. She stressed that most of the problems that women have after very early menopause are NOT due to the early menopause but are due to long term use of chemical hormone replacement. In her opinion they would do far better if given bio-identical HRT to replicate more accurately what the body is missing.
It is estimated that at 1 in 20 women are hit by early menopause and the Daily Mail quoted ‘Doctors baffled at rising numbers of under-40s affected.’ The case they quoted was that of Amanda whose periods stopped at the age of 21. Her doctors put it down to stress and over-training following an intensive diet and exercise regimen and she spent four years with mood swings, fatigue and depression and finally was diagnosed with a premature menopause. Blood tests revealed that her levels of oestrogen and progesterone showed that she had been through the menopause, but they couldn’t tell her why. She was put on HRT but still suffered from exhaustion, low libido, and headaches. and a tingling sensation in her head.
Health Risks Of Early Menopause
Early menopause is accepted to be one that occurs before the age of 40 – the average age being 51 – and there are serious health risks associated with it..
There is a growing body of evidence on the ill effects of early menopause on women:
- new research from the U.S. has reported that women who go through a premature menopause are also more likely to suffer a potentially fatal brain haemorrhage, or stroke. The younger a woman is when she becomes menopausal, the greater the chances of a cerebral aneurysm.
- they are 50 per cent more likely to die and 80 per cent more likely to suffer from heart disease than women who go through the menopause between the ages of 52 to 55.
- a study by Imperial College London found that women who had early menopause were also twice as likely to have a poor quality of life in health terms.
- a study by the Mayo Clinic in the U.S., found that such women had a greater risk of dying early, developing heart disease, neurological disorders, including Parkinson’s and Alzheimer’s, psychiatric disorders and osteoporosis
So What’s The Answer?
Dr Kevin Harrington, a consultant gynaecologist at the Bupa Cromwell Hospital in London, believes it lies at the door of falling oestrogen levels and the thyroid gland. Certainly there has been a positive epidemic of women being diagnosed with low thyroid as Dr David Jockers has written about elsewhere on this site, but there is also another possible avenue that is not being sufficiently explored.
Research has previously suggested a link between premature menopause and PFCs, the chemicals found in non-stick pans and food packaging but the role of another chemical – progestins – has been largely ignored. HRT is still the preferred medication for early menopause but it could be adding to the problem rather than solving it.
Doctors who have been working in the field of bioidentical hormones see a much simpler explanation. Someone else, like Dr Bond, who is not at all baffled by Amanda and her premature menopause is Dr Tony Coope and he explains why here:
“Amanda’s story is a revealing one, as it shows that, in spite of the excellent work of groups such as the Daisy Network, women with POF (Premature Ovarian Failure) are still being less than adequately diagnosed and treated. This still adds up to an unacceptable amount of misery, disappointment and ill-health, but even if best practice were to followed I believe this would only resolve part of the problem.
Why do I say this? It is because of a very large elephant in the room, one known about for the last 50 years, but still apparently invisible to mainstream understanding. This elephant’s name is Progesterone.
My perception of what has happened to Amanda is this:
1. Her periods stop at the age of 21 due to to ‘the stress of an intensive diet and exercise regime’. Exercise-induced amenorrhoea is well-known to afflict a significant percentage of athletes and her progesterone production will already have been declining prior to this. Once ovulation no longer occurs and the post-ovulation surge of progesterone is lost, then matters head rapidly downhill.
2. For 4 years she suffers from ‘see-sawing’ hormone levels as her stress levels rise and her system struggles to find a point of balance. Her depleted progesterone levels mean an interruption of the metabolic pathways that produce estrogen, testosterone, aldosterone (the body-fluid regulation hormone), and the stress hormone cortisol. The mood swings and depression she suffered during this time are the inevitable consequences of this.
3. Amanda is finally diagnosed with premature ovarian failure, realises the implications of this in relation to her fertility, and loses her boyfriend because of it. She also has to take on board the risks to her future health. Her sense of security and self esteem plummet further and she experiences a new level of stress, exacerbated by lack of support (‘no one seemed to listen’).
4. By now, in addition to depleted levels of progesterone, the loss of ovarian function is reducing estrogen production to levels usually found post menopause. Her symptoms of mood swings, depression, panic attacks, low libido and exhaustion reflect her hormonal state, which is extending to adrenal exhaustion and an underfunctioning thyroid, which also has a link to progesterone deficiency.
5. She is put on synthetic HRT to replace the lost estrogen, but ‘struggles to find an estrogen replacement that didn’t make her feel ill’. At this point alarm bells should have been ringing, as this, with her new symptoms of breast tenderness and extreme bloating, is a sign that she is already ‘estrogen dominant’ even with postmenopausal levels of this hormone. How can this happen? Easily, – when the progesterone level is even lower, leading to an imbalance of estrogen in relation to progesterone.
6. She spends heavily on IVF with donor eggs and falls pregnant, but miscarries at 3 months. Unfortunately, this is perhaps not surprising, as one of the main causes of miscarriage is an inadequate level of progesterone in the early months of pregnancy before the placenta has reached the full production required for the maintenance and completion of a successful pregnancy.
From the beginning of this sad story, the relative lack of progesterone has influenced the progression of a downward spiral. Efforts to restore her estrogen levels with synthetic HRT in order to prevent future health problems, particularly in relation to bone and cardiovascular health, carry with them a ‘double bind.’
The synthetic progestins that must necessarily accompany estrogen to counteract the risk of uterine cancer from estrogen alone carry the same cardiovascular risks that are hoped to be prevented by prescribing HRT in the first place! They also tend to increase symptoms of depression, and of course act against conception rather than support it as bioidentical progesterone does without any of the same risks or side-effects.
Could Amanda’s outcome have been different? I very much believe so; and that it is still not too late both to improve her present health and prevent potential problems in the future, and also of those of the thousands of other women who, as Amanda said in the Mail article are not finding the answers they deserve.
Early menopause may be unavoidable due to a number of factors but ignoring a major element in a woman’s hormonal health – progesterone – is not the way to establish and safeguard future good health.