Question: I am completely and utterly confused and disgusted! I am 32 and had a complete hysterectomy at age 27. For the last five years I have struggled with the symptoms and struggles of forced menopause. I have been on Premarin, varying doses, and Estradiol, the patch. I have tried natural supplements like soy, yam, black cohosh and lotions. The only time I didn’t struggle with hot flashes, weight gain and absolutely no sex drive was while on Premarin. But, I did have painful joints, swelling, nightmares and mood swings.

I have yet to find a doctor that is willing to take the time to actually figure out what will work. Maybe they don’t know either. But I am sinking into depression, and I fear it’s because of trying to fight what seems like an endless battle. I don’t want perfect, just manageable. My weight is sky rocketing, my patience is gone, I have no sex drive and I suffer from constant hot flashes, day and night. I do not know what to do. I have a 7-year-old son and I feel like I am missing out on his life and mine because of what my body is doing. Thank you for any help you can offer. — Stephanie

Dr. Pat: Not knowing the circumstances that led to you having a complete hysterectomy with the removal of both ovaries at the young age of 27, I can offer some general advice and suggestions. It certainly sounds as though this surgical and sudden menopause has had a terrible impact on the quality of your life. It is hard to imagine how you have found the resources to deal with your physical and emotional symptoms and care for a child who was only 2 years old when you had this life-altering surgery.

It is unlikely that natural supplements will offer you much relief based on the significant symptoms you describe. It is unfortunate that, by your history, you have failed to improve with Premarin or Estradiol, delivered by mouth or the patch.

It seems that you, like many patients, could benefit from the collaborative care of doctors who have a special interest in menopausal patients. This would include not only a gynecologist, but also an endocrinologist and perhaps a nutritionist to work with the gynecologist to see if you have other endocrine problems such as low thyroid or metabolic syndrome (weight gain due in part to insulin resistance).

You need a diet that will not only help you with weight loss, but also a new way of eating that will prevent the roller-coaster effect of energy highs and lows and the agitation associated with eating the wrong foods. You need to get up and get out, even if it is just 10 minutes of walking to start with. Ask someone to be your buddy. We all need help in some part of our lives and often don’t get it because we just don’t ask. I find that friends and neighbors often want to do something meaningful for others, and you can give them this opportunity.

Join a support group at the local hospital or community center for women who feel overwhelmed. There are groups that provide child care so you can have some time to care for yourself.

The depression needs to be evaluated. While you may benefit from work with a counselor, your gynecologist may refer you to a psychopharmacologist who could choose to prescribe a low-dose anti-depressant that helps some women with hot flashes as well as mood disturbances.

Alternative healers may be very helpful. Ask for recommendations for a certified acupuncturist and mediation teacher. Meditation can lift the mood, quiet the agitation, and help with sleep and focus. There is a growing body of literature supporting its benefits in many chronic diseases.

There are new hormonal preparations that may be helpful. These are transdermal (hormones delivered through the skin) products. They come in gel form and a new spray form. The advantage of these FDA-approved products is that you can control the dose. Under a gynecologist’s care, you can begin with 1/8th of the dose generally prescribed for menopausal syndrome. It is quite possible that you need a much lower dose than you were able to get with the hormone products that you listed in your question.

Don’t expect that any hormone product will take away all symptoms. Your goal should be decreased hot flashes, improved sleep and energy, and perhaps a decrease in the depression. I suspect that this depression you describe of five years duration will require some treatment before you recover from your menopausal trauma.

I realize that I have provided what may seem like an overwhelming amount of information to address your situation, but I want you to have hope. You have had years of disappointment from doctors and traditional medicine, but you have to restart your life. Ask for help now. Every day you lose is precious.

You didn’t say where you live, but the North American Menopause Society (NAMS) provides lists of practitioners who have a special interest in menopause. Most of these practitioners are in the United States and Canada, but there’s also a list of clinicians in other countries. NAMS also provides links to discussion groups, and you may find one in your area. The referral page for both practitioners and discussion groups is available here: http://menopause.org/consref.htm

You might also find this NAMS Early Menopause Guidebook helpful. The sections are available for free online. Best wishes to you.

* * * * *
Dr. Patricia Yarberry Allen,
director of the New York Menopause Center, is a gynecologist affiliated
with New York-Presbyterian Hospital and a board certified fellow of the
American College of Obstetrics and Gynecology.
Have a question about sex, women’s health or the menopausal transition? Write to askdrpat@womensvoicesforchange.org.

Leave a Reply to Wulf Utian Cancel Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  • Wulf Utian August 7, 2007 at 1:57 pm

    I followed the question of the young woman with an early hysterectomy and removal of both ovaries, and your response with interest. I agree with all your recommendations. There is considerable medical data to confirm that young women losing their ovaries while in their reproductive years are more likely to suffer more serious menopause-related symptoms. Clearly this will negatively impact quality of life.
    Perhaps of equal importance is that the loss of the ovarian hormones will also place such women at higher risk of problems like bone loss and fracture, and earlier onset of heart attack risk.
    The recommendations for the alleviation of the symptoms might also include the use of anti-depressant drugs. In this particular instance, starting a low dose of an anti-depressant might reduce the frequency and severity of the hot flashes, thereby enhancing sleep and sense of well-being. The anti-depressant effect would obviously also be of help.
    Reduction of risk for osteoporosis and heart disease for the population with premature menopause would probably best be addressed by the use of estrogen therapy, at least up to the usual expected age of menopause at around 50. A low dose product, as you wisely recommend, would be the best starter. It is also likely that there is a deficiency of androgen, but regrettably there is little available that is FDA approved. Perhaps an attempt at the use of half-strength Estratest might be a consideration.
    The rest of your advice about healthy living, eating, exercise, non-smoking, etc. is critical to maintaining good health.
    Wulf H. Utian MD PhD
    Executive Director, and Honorary Founding President, NAMS

    Reply
  • Cecilia Ford August 7, 2007 at 12:16 pm

    Dear Stephanie,
    Adding to what Dr. Pat said about treatment for your depression, I strongly urge you to pay attention to this aspect of your care. Psychological responses to major physical changes are universal. There are many complex feelings that accompany menopause in particular because it involves the loss of functions that help define us as women, and mourning these losses is an important part of the menopausal transition. In addition to the hormonal changes that put women at increased risk for depression, loss of libido, weight gain, etc., there are powerful psychological forces at work as well. The change in identity, loss of one’s sense of femininity, fear of ageing (and even death) are profound issues that can accompany this stage of life. However, unlike you, most women have years to complete this transition; by the time menopause proper has begun, they have been perimenopausal for years (changes in the menstrual cycle that herald the beginning of menopause). Furthermore, their acceptance of the ageing process has had a chance to build gradually, and importantly, in tempo with their peers and their sense of their expectations for life’s plan. This gradual process has been denied you because of your early surgery. Furthermore, you have the demands and challenges of being a mother to a young child, a task that most menopausal women have completed years before.
    Given all this, it is quite understandable that you feel depressed, especially when you add in the severity of your physical symptoms and the lack of support that you have felt from the medical community. Understandable as it may be, however, it is important to get professional help. Left untreated, depression often takes hold and worsens. There is evidence that the longer one is depressed, the harder it becomes to recover. Consulting with a psychotherapist is the place to start. He or she can determine whether therapy alone or therapy and a course of antidepressants is indicated. Meanwhile, I agree with Dr. Pat that meditation can be a mood enhancer, and I would add that exercise, even in small amounts, can be a big help in combating your symptoms.
    Cecilia M. Ford, Ph.D.

    Reply
  • Margret Avery August 6, 2007 at 6:48 pm

    I am so pleased to read all of the information that Dr. Pat Allen gives on menopause. I am sending this to all of my girlfriends who are are looking for guidance while going through menopause and have the depression symptoms, weight gain etc. and need to feel comforted that there are ways to deal with it – thank you!!!

    Reply