Q: My daughter, who is in her late 20s, has been diagnosed as suffering from premature menopause. The doctor thinks it might be because she has been on the birth control pill for many years. When the doctor did a blood test he found that she had no estrogen. I have never heard of this happening to anyone else, so I am wondering if she has something more serious.
A: It is possible for the birth control pill to suppress the function of the ovaries at least temporarily. This is because the pill is made up of a different type of estrogen and progesterone, which fool the woman’s body into thinking that it has enough, so the ovaries stop making it. Usually after a few months of not taking the medication, the periods will return to normal, and she will become fertile again.
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The average age for menopause is 51 years, so that means that half the female population stop having their periods before that date, some even before the age of 40. It is unlikely that your daughter is suffering from a permanent menopause. Is she very thin or extremely athletic? Girls who have little body fat can stop having menses.
This often occurs with the eating disorder anorexia nervosa. In that case putting on weight will solve the problem.
The ovaries are controlled by hormones known as gonadotrophins that are produced by the pituitary gland in the brain. This in turn can be influenced by the neighbouring part of the brain called the hypothalamus.
The hypothalamus is connected to emotions, so it is understandable that even minor stressors or changes of routine can affect some women’s periods. Even a simple thing like going on holiday can be a factor.
Having covered the most likely and least serious causes of low estrogen, there are more serious medical conditions that should be ruled out. If your daughter’s periods do not return to normal within a few months of discontinuing the birth control pill, then more tests should be performed.
Has your daughter ever had a severe head injury? An injury that caused any period of unconsciousness could have damaged the hypothalamus or pituitary gland, leading to a condition known as hypopituitism. A simple skull X-ray could determine if there are any old fractures or an abnormal enlargement of the pituitary gland due to a tumour.
Such tumours are usually benign and not cancerous, but hormones normally produced by the pituitary will need to be replaced. Other medical conditions that should be ruled out are thyroid disease, diabetes and an excess of iron in the blood known as haemochromatosis. These can all be checked with a simple blood test.
If your daughter remains estrogen deficient, she should take hormone replacement therapy to prevent clogged arteries and heart disease as well as osteoporosis and thinning hair. She will need to discuss this with her family physician.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
