Finish Line for the Big-M Was in Sight. Guest post by Sarah Bowen Shea
When writer/author Sarah Bowen Shea first pinged me on Twitter about her post, I was a bit skeptical. I had never had a conversation with her nor had she ever been on my radar. And let’s face it; I get a lot of daily solicitations because of Flashfree and my interest in menopause. However, when I clicked on the link, I discovered that not only did I love her writing, but that I loved her post. Moreover, a lot of you have been asking for posts on early menopause.
I hope that you’ll show Sarah some love after reading this post and head over to her blog, Another Mother Runner and check it out; if you are interested in running, you may find some gems lurking in the lines!
Despite being the one behind our sometimes-outrageous TMI Tuesday status updates (hotel sex, anyone?) on our Facebook page and writing the chapter in The Book about peeing, pooping, passing gas, and periods, I’m hesitant to pen this post. It’s about…menopause. My top three excuses? 1. My mom never had “The Talk” with me, so I’ve never been fully comfortable talking about, ahem, menstruation (or lack thereof). 2. There isn’t enough good slang for menopause (let’s rectify that, ladies!). 3. I am not 100% comfortable with being 45 years old…and getting dogged with early onset menopause. (There, I typed it. A first step, right?)
But I’ve decided to broach the topic because several fans have told us they wish we’d talk about it. Here goes: I’ve suspected for several years that early onset menopause might be coming my way because I had secondary infertility due to elevated FSH (follicle stimulating hormone) levels. My doc said the two aren’t necessarily linked but they often are. Always a glass-half-full kinda gal, I didn’t dwell or worry—until last summer, when I started bleeding like crazy. If I’d gone swimming in shark-infested waters, I would have been fish-food: Heavy bleeding for a week, then 10 days off, then another heavier-and-longer period, then an 8-day reprieve, then another bleeding session…you get the bloody (literally) picture. Never one to rush in for medical advice, I merely grumbled, contemplated buying stock in Playtex, and fared forward until a good running friend urged me to see my OB/GYN. The doc did some bloodwork and said nothing was wrong except that, well, lookie there, my hormone levels showed I was already in menopause. (Gulp!) But she said menopause was a slippery thing: The real marker was absence of a period for one year.
Read MorePuffing away the years: smoking and early menopause
A few years ago, I wrote a post linking cigarette smoking to early menopause. And yet, questions remained about duration of smoking and the quantity of cigarettes in terms of their influence on timing. Hence, I thought that it might be worthwhile to take a closer look at the issue and see if there was more information.
A few facts:
It’s estimated that by the year 2030, there will be over 1 billion menopausal women in the world, with roughly 47 million women entering menopause annually. Yikes! That’s a whole lotta hot flashes, night sweats, mood swings and the like. And, what this means is that information is power (and empowering). Importantly, research has also shown that early menopause is associated with greater mortality, heart disease cases and osteoporosis. In fact, for every year that menopause is postponed, there is a 2% reduced chance of death due to heart disease. On the other end of the spectrum is late menopause, which is also associated with health issues, including an increased risk for breast, ovarian and uterine cancer.
So, what are the factors that appear to determine the timing of menopause? Well, things like obesity, alcohol consumption, mother’s age, social class, long menstrual cycles, multiple childbirths, oral contraceptive use and even exposure to pesticides have been linked to later menopause, while smoking has been shown in multiple studies to increase the likelihood for early menopause. This issue may be even more relevant for the late Boomer generation who came to age in the 70s, a time when cigarette and marijuana smoking were the norm and not the exception. That generation, by the way, is my generation.
Here’s what we know:
In a thorough review of 109 published studies, researchers have found the following:
- Current smokers appear to enter menopause anywhere from 2.5 months to 2.5 years earlier than non-smokers and have 1.3 to 1.7 times greater odds for early menopause
- Former smokers appear to start menopause as much as 2 years earlier than non-smokers, with the risk ranging from 30% to as high as 80%
- Although there is not a lot of information on the severity of smoking habit and menopause (i.e. number of cigarettes smoked daily), there is some indication that women who smoked more than 20 cigarettes daily were likely to start menopause as much as 2 years earlier than women who smoked 11 to 20 cigarettes daily
- The relationship between number of years having smoked and early menopause is unclear
There are numerous reasons why smoking may lead to earlier menopause, including interference with estradiol levels, an increased loss of eggs and an increase in the levels of androgen hormones, which counteract activity of estrogen in the body. And, despite the differences between the studies that the researchers examined, they say that a clear link was demonstrated between smoking and starting menopause at an earlier age. The impact of quantity and time (or years) smoking is less consistent and still not completely clear.
The overriding message is that if, like me, you are a former smoker, you might find yourself in a position of starting menopause a wee bit earlier than expected. Consequently, there’s no time like the present to start taking preventive measures, like increasing calcium intake, changing your dietary habits or improving your exercise regimen. Mind-body exercises like meditation or yoga can ameliorate stress and improve overall wellbeing. And black cohosh? Personally, I swear by it. In concert, these steps might shut down or at least keep the magic menopause dragon at bay.
Read MoreEarly menopause – don’t drink the (PFCs) water
Some rather disturbing news is coming out of the West Virginia University Department of Community Medicine, where researchers are saying that women found to be exposed to high levels of perfluorocarbons (PFCs may be at risk for early menopause.
PFCs are manmade chemicals that have been historically used in a variety of products found in the household, such as food containers, clothing, furniture, carpeting and paints. Often used to repel stains and for water proofing, PFCs have unfortunately found their way into our water, the air we breathe, the soil, plant life and animals. And as the researchers report in the March 16 online edition of the Journal of Endocrinology and Metabolism, these chemicals have a long half-life, meaning that their presence in our lives appears to be ubiquitous.
In this particular study, the researchers examined data that had been collected from 25,957 women residing near Parkersburg WV who were between the ages of 18 and 65 and were believed to have been exposed to PFCs via their drinking water. After excluding women who had had hysterectomies, and accounting for factors such as smoking, age, body mass index, alcohol use and physical activity, they found that women with high blood levels of perfluorooctanoic acid (PFOA) and Perfluorooctane Sulfonate (PFOS) — both types of PFCs — were significantly more likelier to experience menopause at an earlier age than their peers with lower exposure levels. Moreover, exposure to high levels of PFOS in particular appeared to negatively effect concentrations of naturally occurring estrogen (i.e. estradiol), with higher levels of the chemical associated with lower estrogen levels, an event that occurs naturally in menopause as reproductive hormones start to wane.
Premature menopause has been associated with increased risk for a variety of conditions and due diligence is recommended. An increased of heart disease due to declining endogenous estrogen production is probably the most frightening and the one that experts appear to be most worried about. Conversely, women who maintain their estrogen levels for the longest period of times reportedly have a 20% decreased risk of dying from heart disease. And, the researchers point to another often disregarded issue, which is, that “the onset of accelerated decline in ovarian function and menopause is believed to be fixed,” i.e. early menopause equals an accelerated decline in fertility before age 32.
Of note, this study is a cros-sectional study, meaning that the researchers were unable to tease out factors that might affect their findings, such as length of time of exposure, or that PFC concentrations are higher in postmenopausal women because menstrual flow actually eliminates some of the PFC toxin in blood (blood is replaced faster than the toxin) and that since these women are no longer losing blood, the PFC remains. Still, lead researcher Dr. Sarah Knox believes that a danger exists, stating that “if PFCs are causing early menopause, then these women are at an increased risk for heart issues [since PFCs affect blood lipids]. If they aren’t, there are still toxins accumulating in the body that shouldn’t be there.” In other words, it’s bad news anyway you slice it.
Knox recommends that individuals, especially women, start taking precautions to eliminate or at least reduce exposure to PFCs, including:
- Selecting hardwood floors over stain resistant carpeting in the home
- Wearing cotton rather than synthetic clothing
- Using an air popper or stove to make popcorn rather than a microwave
- Microwaving food in glass rather than plastic containers, and,
- Using cast-iron cookware instead of non-stick coated cookware.
I strongly believe that more research is needed on this issue and we need specific facts on how PFCs affect reproduction, if age plays a role or if menses and blow flow are important variables. Meanwhile, all women should start taking care to reduce exposure to environmental toxins and even more importantly, engage in heart-health-boosting measures that include diet, exercise and being mindful of alcohol consumption.
Don’t drink the water? Well, you might want to stick with the bottled version once it’s all figured out. The PFOA link in this piece directly leads you to more information on the Environmental Protection Agency website.
Read MoreCan early early life influence age at menopause?
Back in June, I posted about a blood test that can may be able to help predict when you start menopause. However, research suggests that there are specific early early life (i.e. while in the womb) factors that allow for such a prediction without the pin prick.
Back in the 50s and 60s, many of our pregnant mothers were prescribed a synthetic estrogen commonly known as DES (diethylstilbestrol). DES had been frequently used for at least four decades to prevent miscarriage and other common complications of pregnancy, that is, until it was taken off the market in 1971 after being linked to a rare vaginal cancer in girls as young as 8 years, called clear cell adenocarcinoma (CCA). My own personal experience with DES and this cancer is that a very close friend whose mother used DES back in the 50s was recently diagnosed with CCA, and while she remains alive and healthy, she continues to battle the challenge of deciding whether or not to expose her uterine area to ongoing radiation and risk damage to organs other than her vagina.
So what’s so important about DES when it comes to menopause?
It appears that women who were exposed to DES while in the womb may actually speed up the rate that they are losing eggs by as much as a year. As I written previously, a woman’s egg supply increases from about 20 weeks after conception and steadily increases to age 14, and the declines steadily until menopause. However, exposure to DES while in the womb may cause an earlier than average (i.e. ~ages 50 to 51) menopause. Conversely, women whose mother who were 35 years or older at the time they were born may start menopause a little later.
Other factors, such as birth order, being exposed to cigarette smoke while in the womb or having been breast fed (or not) does not appear to influence age at menopause.
My friends at Reuters Health covered this story a few weeks and I encourage you to read their piece for more information. Quoting the lead study investigator, they note that this is importantly mainly because as we continue to unravel the mysteries of menopause, we are learning that there are many factors that come into play and that early life events, and not just behaviors during our adult years, can indeed influence what happens later, including timing.
Read MoreWednesday Bubble: the crystal menopause ball
Can you predict the age you will start menopause?
Most women and many experts say that there is a link between when their mothers started menopause and when they will likely start menopause. In fact, the ‘mother’ hypothesis has been explored in numerous studies, with explanations ranging from hormones to genetics to evolutionary selection. However, are there any other determinants or factors that also may come into play? Indeed, it appears that there are. And why is it important? Studies have shown both early (<age 45) and late (>age 56) menopause to be associated with increased health risks, such as heart disease.
Recent data from a study of over 1,000 women, almost of half of which were postmenopausal, show that weight gain and weight loss in the perimenopausal years may play an important role in determining the age that you start menopause.
After evaluating body mass index and height, and the women’s history of weight loss and gain in body mass index from age 25 to menopause, the researchers found that women with a history of losing 11 pounds or more between age 25 (excluding weight gain or losses due to pregnancy) and menopause or gaining roughly 1 pound or more per year during the same time period were more likely to start menopause later than the average age of 50 or 51. The greater the loss or gain, the later menopause began. Other factors that also appeared to influence a later menopause included the number of bleeding days between ages 20 and 30 (with “more” associated with “later”), use of an IUD, a later year of birth and how a woman perceived her economic status. On the other hand, women who smoked or had type 2 diabetes before transitioning to menopause and who had a mother who started menopause earlier than age 50, were more likely to start menopause earl
Wondering why this is important?
Clearly, the more information we have about when menopause might start, the greater our ability to start instituting effective strategies, such as exercise, relaxation, diet, etc, to stave off the numerous health issues that arise as our hormones decline. Some of these strategies might also serve a dual purpose of ameliorating vasomotor symptoms like flashes and night sweats.
Is the crystal ball accurate? Only time will tell. But knowledge is power. Always.
Read MoreDon’t put all your eggs in one basket
Actually, you may not have a choice! Did you know that a woman’s egg supply peaks as early as 20 weeks after conception? While still in the womb, a female will develop several million eggs. Up until age 14, the eggs will continue in number and then they steadily decrease until menopause (around age 50 or 51).
Using computer modeling of data taken from about 325 women, researchers determined that by the age of 30, 95% of women will only have 12% of their egg reserves remaining. By age 40, only 3% remain. What’s more, age remains the primary influencer of the number of eggs up until about age 25. Then as a women grows older, other factors, including smoking, body mass index, stress and previous pregnancies start to play more important roles.
Why is this important? Afte rall, most readers of this blog are of the age where pregnancy is no longer a consideration and our number of eggs in reserve, pretty irrelevant. However, by establishing how the ovarian reserve of eggs is established and then diminished, researchers hope to be better able to predict when menopause will start individual women. By having a better idea of when menopause will start, you may be able to take appropriate steps in a timely fashion to both stave off vasomotor symptoms such as hot flashes and night sweats and maintain body weight and physical health. What’s more, imagine the possibilities in terms of mood swings and depression. The potential rewards are endless.
According to the researchers, they might also be able to predict which women treated for cancer are at highest risk for early menopause as the result of treatment. Since many of these women are young, this might provide opportunities for proactive family planning.
So, all those eggs in one basket? You might not be able to control how many but you may be able to control certain outcomes. Nice!
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