Dr Sarah Brewer answers iVillager's questions about the menopause and its symptoms

How do I prepare for the menopause?

Am I menopausal? I am only 30 years old!

Will I be able to conceive if I am just starting the menopause?

Are these symptoms polycystic ovarian syndrome (PCOS) or the menopause?

When will my periods end?

Live discussions on the Sexual Health and Contraception message board

How do I prepare for the menopause?
Q: I was wondering when the menopause really starts, as I am getting nearer 'that age'. When should I start taking alternative therapies to ease the symptoms? Are there any I can take before to make it better?rafflescat

A: The menopause can occur at any age, but usually occurs between the ages of 45 and 55. The average age is 51. Premature menopause can occur at any age, however - in very rare cases it can occur after just a few periods. There is a new dipstick urine test from Vielle that will quickly tell you whether or not any symptoms you're getting are due to the menopause. If you're having problems, your doctor may be willing to do a blood test to check your hormone levels.

Usually oestrogen levels start to fall around ten years before the menopause (last period) so if you're in your 40s, there is no harm in eating an isoflavone-rich diet and taking other steps to improve general health. More information is available in my book, called Menopause - what you really need to know (Robinson), which you can order from bookshops or libraries. For hot flushes and night sweats, one of the best approaches is to take black cohosh and sage leaf extracts, which are available in combined form.

Am I menopausal? I am only 30 years old!
Q: How common is it for someone to get the menopause early? Is there a test that can be done to find out? If you were taking any form of hormonal contraceptive, how would this affect the test and your symptoms?

My acupuncturist suggested I might have the symptoms at 30. I have no periods as am on Depo and I get night sweats, feel confused and experience memory loss and lack of concentration. It could easily be stress, but would like to know a bit more. welovemarmite

A: Yes, it is most likely due to stress. But just in case, there is a urine dipstick test (by Vielle) that was launched last month, and which measures urine levels of hormones to show whether or not symptoms are likely to be linked with the menopause. If clinically indicated your GP may be willing to do a blood test instead. Menopause usually occurs between the ages of 45 and 55, but in some women premature menopause can occur. This often runs in families, so it will help to know when other close female relatives have reached the menopause. Try to get plenty of rest and relaxation if stress is affecting you like this. I know it's easy to say but it is important. When did you last have a good (restful) holiday?

Back to main question page

Will I be able to conceive if I am just starting the menopause?
Q: I'm 42 and was told at the beginning of the year that my follicle stimulating hormone (FSH) levels were too high and to consider IVF. We are now considering egg donation. I also think I may have started my menopause three weeks ago. I've had hot flushes, which have become intense and missed two periods last year. My last period was in April this year.
Can you advise me on the following?
1. What is the likelihood of my getting pregnant naturally now that I have started my menopause?
2. What is the likelihood egg donation will work? srhsssy

A: Natural pregnancy is still very possible, which is why doctors recommend that a woman who does not want a baby continues to use contraception for one year following her last period - as long as this takes her over the age of 50. If she is still under 50 after this time she should use contraception for a total of two years after her period. So, fingers crossed, egg donation is just as likely to be successful in someone of your age as in someone younger because hormone cycles are synchronised using drugs to ensure your hormone levels are optimal.

I wish you every success for the future as 42 is definitely not too old to have a baby. Also menopause can only really be diagnosed in retrospect after you have not had a period for six months, so it is quite possible that stress or some other cause has resulted in an irregular cycle. Have you considered seeing a herbalist, acupuncturist or reflexologist? Often, alternative treatments with an experienced practitioner can produce almost miraculous results.

Are these symptoms polycystic ovarian syndrome (PCOS) or the menopause?
Q: I'm 39 and was diagnosed with PCOS early last year, which was discovered when I had tests for the loss of my son at 20 weeks pregnant at the end of Sept 2002. I was put on Clomid in March of last year and conceived on my second month although I lost that baby at eight weeks. I have found that since my loss last year I have started to get cramps and bloating around ovulation, which can last right up to the time my period starts. My cycle has never been regular but the Clomid has helped a little.

I now find that after ovulation I suffer from hot flushes and night sweats. The hot flushes only happen if I do something physical (like housework) and wear off within half an hour. My cycle is getting longer at 40 to 60 days. I have asked my mum but she didn't have the menopause until she was 48 and my sister who is 45 has not started hers yet. Is it likely just the PCOS or does it sounds like the start of the menopause? Does this mean the end of my fertility or is there something I can do so that I can still conceive? asecondchance

Back to main question page

A: I'm sorry to hear about your problems and wish you every success with your treatment. Do see your GP, who can arrange blood tests to check if the hot flushes and night sweats are due to high levels of FSH, which occur at the menopause. Clomid can cause hot flushes itself, however, so possibly (fingers crossed) this is the cause of your symptoms. It is worth consulting a medical herbalist, as sometimes treatment with the herb agnus castus can help a cycle become regular and help you conceive. It must be stopped as soon as pregnancy is suspected, however. Treatment with the anti-diabetes drug, metformin, can be effective in achieving ovulation in women with PCOS - in a large analysis of published data, it was found that 46 per cent of women taking metformin start to ovulate again compared with only 26 per cent of those not taking metformin.

Clomiphene, is effective in triggering ovulation in at least 42 per cent of women with PCOS but does increase your chance of a multiple pregnancy - most commonly with twins. Clomiphene seems to work most effectively when prescribed together with metformin (ovulation rate increases to 76 per cent). The metformin must be stopped immediately if pregnancy occurs, however, as there is not yet enough information on how it might affect early pregnancy.

Stronger fertility drugs such as gonadotrophins will help up to 95 per cent of women ovulate, but significantly increase the risk of multiple pregnancy (14 to 36 per cent).

If drug treatment does not work, a laser beam may be used to literally drill holes in the surface of the ovaries. This is a quick procedure performed under general anaesthetic using keyhole (laparoscopic) surgery. Why it works is unknown.

Screening for gestational diabetes during pregnancy in a women known to have PCOS is a good idea as the additional strain of pregnancy combined with insulin resistance (which can occur in PCOS) may trigger the development of gestational diabetes.

When will my periods end?
Q: I started getting hot flushes between 41 and 42 years of age. Then, when I was 43 a scan showed that I had very large fibroids. My GP at the time informed me that if she were to send me to see a consultant, he would recommend a hysterectomy. Believing that I had started the menopause early, I declined both the visit to the specialist and the possibility of the operation.

Suddenly last year, my periods stopped without warning and I hoped that this was the end of them. However, eight months later I had a very light bleed, lasting four to five days. This was at the end of March, and since then there has been nothing again. I am taking phyto soya for the symptoms, but would appreciate any advice from you. I am now 50 years old and wondering if this could really be the end of them? kikixxx

A:It does sound as if you have reached the menopause. However, any bleeding that occurs more than six months after you thought your periods had stopped should be reported to your GP. It may be wise to arrange a few tests to ensure the bleeding was due to an additional period rather than to a problem with the womb lining. In addition to the phyto soya, you can add in black cohosh and/or sage leaf extracts, which are good for improving both hot flushes and night sweats. They are available singly or as a combination product.

Back to main question page