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Netdoctor Q&A March 2017

By: | Tags: | Comments: 0 | June 1st, 2017

  1. Premature menopause – how common is it in younger women? What would the usual treatment be? Can these women ever become pregnant?
  2. PCOS – what are the tell-tale signs, and are there any non-drug treatments to help get your cycle back on track?
  3. Excessive exercise – how could this affect your cycle?
  4. Can stress could stop your periods, and if so, does it need to be excessive stress? Why does this happen? Any self-help tips?
  5. Extreme weight loss – e.g. anorexia: why does this affect your cycle, and what does it do to your body/hormones? Can it harm your cycle or fertility permanently?
  6. Poor nutrition – can eating unhealthily affect your cycle? If so, why?

Premature menopause refers to menopause at or before 40 years of age which can be surgically induced by removal of both ovaries at the time of surgery or due to loss of ovarian function resulting in ovarian failure. This loss of ovarian function is largely due to abnormally low levels of estrogen and high levels of FSH ( follicle stimulating hormone) resulting in ovarian failure and rarely because of chemotherapy and/ or radiotherapy as treatment of cancer. It can also occasionally be due to auto-immune disorders. Approximately 1-2% of women will experience premature menopause due to premature ovarian failure (POF).
The usual treatment is hormone replacement therapy using a combination of estrogen and progesterone. Usually these women will need a higher dose of estrogen replacement compared to women who menopause later in life. Testosterone supplement may also be considered to help with libido. Rarely some women with POF will establish normal menstrual cycle and can get pregnant.

Some of the tell-tale signs of PCOS are weight gain (mainly central obesity) or inability to easily lose weight, menstrual irregularities, hirsutism, adulthood acne, type 2 diabetes etc. PCOS is diagnosed as per the Rotterdam Consensus Criteria when a woman has two out of three of the following: polycystic ovaries, lack of ovulation and signs of hyperandrogenism (excessive levels of androgens in the body). PCOS is relatively common and affects around 20% of women. It is important that women adopt a healthy lifestyle to reduce the long-term health risks associated with the condition. This can involve eating a balanced diet and taking regular exercise.

Excessive exercise can cause you to lose weight and hence give you scanty periods and if you lose too much weight too quickly, your periods could also get progressively delayed or stop.

Stress can impact on the hypothalamic/pituitary axis which control the feedback to the ovaries in producing the menstrual hormones and hence any alteration in your stress levels can impact your menstrual cycles causing them to get delayed or stopping altogether. Using relaxation techniques to cope with stress, like yoga or other alternate therapies may be helpful in reducing your stress levels.

Extreme weight loss in anorexia nervosa (AN) and bulimia result in hypopituitary hypogonadism resulting in hypoestrogenic state secondary to hypothalamic dysfunction. This results in amenorrhea or oligomenorrhea and anovulatory cycle resulting in sub-fertility. Once appropriate weight gain (90% of the predicted weight for height) is achieved and maintained, periods often resume within a year. Establishing regular menstrual cycles is an important milestone for women recovering from AN. Fertility is often restored with appropriate treatment of the eating disorder; however, persistent amenorrhea remains more common in women who have recovered from AN than in the general population. Resumption of menses is best assessed biochemically with a rise in serum estradiol levels.
Restoration of appropriate signaling in the hypothalamic-pituitary-ovarian axis appears to be facilitated by a variety of hormones. In women with AN, elevations in baseline cortisol are predictive of increased body fat content, has shown to be a good indicator of menstrual recovery in anorexic adolescent girls. The initial serum concentrations of follicle-stimulating hormone, inhibin B, and anti-Müllerian hormone may also correlate with the degree of ovarian suppression and may predict the resumption of ovulation with weight gain.

Poor nutrition can affect your cycles. Malnutrition can result in delayed and irregular periods in both pubertal and adolescent women and unhealthy diet resulting in obesity similarly can result in anovulatory cycle and influence ovarian/pituitary/hypothalamic axis due to insulin resistance. Lack of a balanced diet resulting in low intake of protein and fat will result in metabolic dysfunction and also impact on menstrual cycles.