Menopause at 24?!?!

[PreciousTreasures]

I know that you smart and wonderful mamas have some kind of info for me...

My sister hasn't had a period for about two years. She's 24 and has been ttc for like 7 years. She has a son so thank God she's had at least one baby but in all those years she's never had even a maybe pg. Now the doctors are telling her that she's gone through menopause. That just doesn't sound right to me...she's soooo young! She's been been irregular her whole life. Then here about 8 days ago she had a full 6 day long period.
Anybody got any idea what's going on?

UPDATE UPDATE UPDATE!!! Please go to last post by me in thread!!! Need advice!!!

[mischievium]

What are the doctors basing your sister's diagnosis on?

Not having periods (amenorrhea) or having extremely irregular periods can be caused by a lot of different issues (click here for a list of the most common).

I would hope that they wouldn't tell a 24 year old that she was experiencing premature menopause without thoroughly evaluating her first, but just in case, have they checked her FSH level?

From MedicineNet:
"... the most important test used to diagnose premature menopause is a blood test that measures follicle stimulating hormone (FSH). FSH causes your ovaries to produce estrogen. When your ovaries slow down their production of estrogen, your levels of FSH increase. When your FSH levels rise above 30 or 40 mIU/mL, it usually indicates that you are in menopause."

FSH is a simple blood test, if she hasn't had it done, she should get it done ASAP.

Also, here is a list of major causes of premature menopause (also called premature ovarian failure), if you scroll down there is a section called "Other Disorders That May Cause Menopausal Symptoms." If your sister hasn't been thoroughly evaluated, I would have her look at each of the disorders/syndromes listed and go talk to her doctor (or talk to an new doctor, preferably either an OBGYN or a reproductive endocrinologist) to get evaluated for these different causes.

I hope this info helps, and to your sister.

[kristenok18]

Ita with pp. Has she gotten a second opinion? Are they simply basing her dx on the fact that she hasn't had a period in so long? I have pcos, and on the pcos support site there are several women who do not have periods on their own or ovulate. They are able to control this through diet/exercise and/or medications.

[J's Mombee]

Abington Reproductive Medicine is great, and they might be a better 2nd opinion option. It is near NJ and Philadelphia, PA. Is your sis near there?

I hope that the doc is wrong, but ARMeds is great.

[PreciousTreasures]

I've talked to her more about what the doctor said. (This was a fertility specialist). He told her that her hormone levels were really high (42-45) (I can only assume that meant FSH). And when he did an internal ultrasound he said her ovaries were so small that he had trouble finding them on the US. He told her she probably started menopause at 16!!!! and at this point she is POSTmenopausal. I'm just in shock. I can't believe that such a thing can be.
But now....now she's had a regular, normal, 6 day long period and we have no idea what that means. Is it her body having one last hurrah? Is it her body healing itself (I've had her doing some natural therapies and we've been doing LOTS of praying). We're just confused by AF since it's been so long and since the doctor said what he said.
Any ideas?

[kristenok18]

Oh, wow. I wish I had some advice to offer, but I'm stuck. Has she read "It's My Ovaries, Stupid!" or "Screaming To Be Heard: Hormone connections women suspect but doctors still ignore" by Dr. Elizabeth Lee Vliet? Maybe her works can give her some insight? I hope someone else here has somee advice to offer.

[YummyYarnAddict]

I'm so sorry your sister is going through all of this and you're an awesome sister for being so empathic and trying to help her.

My first two thoughts are that your sister needs to get a copy of her medical recs from this doc and find a second -- or even third -- opinion. The thing that stands out to me first and foremost is this recent period, if this doc is correct and she is postmenopausal, that means this is postmenopausal bleeding and nothing to be taken lightly. BUT... since it was more like a "normal" period... there's a chance this doc was wrong.

A question I have is whether or not this doc, this "fertility specialist", is an OB/GYN who fancies himself a fertility specialist or if he's a board certified Reproductive Endocrinologist. There's a world of different between the two in terms of expertise and knowledge but there are many OB/GYNs who lack the specialized training that REs have yet hang their shingle out as "fertility specialists."

About her test results... you cannot look at FSH results in isolation. The FSH test has to be done on a particular day of the cycle (preferably cd3), since your sister hasn't had a cycle, adjustments and considerations has to be made and it's of utmost importance that they also look at e2 (estrogen), LH (leutenizing hormone), and other levels. Another thing that they should look at is whether or not it might be worthwhile to look at her inhibin-B. The test is still in the beta stage, but it's supposed to be a check of ovarian reserve. It's a bit controversial and researchers either love it or hate it. I personally didn't find the results to be accurate for me, but lots of other women I've come across on boards have found it accurate. I might just be off the curve though. I wouldn't put 100% stock in the findings of a u/s ... the results can vary by the person doing the u/s -- and, let's face it, docs aren't ultrasonographers (I love my RE dearly, but she's not an ultrasonographer, for certain things she defers to the u/s tech and other things, like the hysteroscopy, she's the expert).

I'll keep thinking on this since and will come back and post more.

Oh, and acupuncture. I found that my ovarian response improved vastly after treatment by a acupuncturist. Even if she doesn't want to go through treatment with one, it may be worth seeing one for a diagnosis. Just be sure to see one who has expertise in fertility.

[PreciousTreasures]

I'm putting my comments in red. Thank you mamas for so much wonderful information! I knew y'all could help!

Originally Posted by YummyYarnAddict

I'm so sorry your sister is going through all of this and you're an awesome sister for being so empathic and trying to help her.

My first two thoughts are that your sister needs to get a copy of her medical recs from this doc and find a second -- or even third -- opinion. The thing that stands out to me first and foremost is this recent period, if this doc is correct and she is postmenopausal, that means this is postmenopausal bleeding and nothing to be taken lightly. BUT... since it was more like a "normal" period... there's a chance this doc was wrong. That's what I think and what has us all thrown for such a curve ball. I told her that she needs to to another doctor but in the mean time she needs to behave as if everything is normal and take advantage of the timing with her husband just in case she actually ovulates this month. She can't afford to wait on tests and then find out later that she did. By then it'll be too late, kwim?

A question I have is whether or not this doc, this "fertility specialist", is an OB/GYN who fancies himself a fertility specialist or if he's a board certified Reproductive Endocrinologist. There's a world of different between the two in terms of expertise and knowledge but there are many OB/GYNs who lack the specialized training that REs have yet hang their shingle out as "fertility specialists." Wow! I didn't know this! I'm going to call her and tell her this. She may know but then again she may not. This is great information!

About her test results... you cannot look at FSH results in isolation. The FSH test has to be done on a particular day of the cycle (preferably cd3), since your sister hasn't had a cycle, adjustments and considerations has to be made and it's of utmost importance that they also look at e2 (estrogen), LH (leutenizing hormone), and other levels. Another thing that they should look at is whether or not it might be worthwhile to look at her inhibin-B. The test is still in the beta stage, but it's supposed to be a check of ovarian reserve. It's a bit controversial and researchers either love it or hate it. I personally didn't find the results to be accurate for me, but lots of other women I've come across on boards have found it accurate. I might just be off the curve though. I wouldn't put 100% stock in the findings of a u/s ... the results can vary by the person doing the u/s -- and, let's face it, docs aren't ultrasonographers (I love my RE dearly, but she's not an ultrasonographer, for certain things she defers to the u/s tech and other things, like the hysteroscopy, she's the expert). I don't know all the tests that they did on her but I know that her original obgyn had her on clomid for 9 rounds and testing her hormones. According to her hormone tests he said she never ovulated, however I question that because she got one of those lipstick tube looking microscope thingys (sorry for the technical terminology there) where you put saliva on it then wait for it to dry then look for "ferning"...anyway, according to that thing she ovulated at least once during all of the clomid sessions but the doctor still said she didn't. WTHeck?

I'll keep thinking on this since and will come back and post more.

Oh, and acupuncture. I found that my ovarian response improved vastly after treatment by a acupuncturist. Even if she doesn't want to go through treatment with one, it may be worth seeing one for a diagnosis. Just be sure to see one who has expertise in fertility.

She'll try just about anything. She wants a baby so badly. I feel so sorry for her, though she is moving into the area of acceptance. Unfortuneately acceptance (of infertility) has gone out the window some because of this latest period. It seems to be a glimmer of hope but she has had hope defferred for a very long time.

[YummyYarnAddict]

Originally Posted by PreciousTreasures

I'm putting my comments in red. Thank you mamas for so much wonderful information! I knew y'all could help!

She'll try just about anything. She wants a baby so badly. I feel so sorry for her, though she is moving into the area of acceptance. Unfortuneately acceptance (of infertility) has gone out the window some because of this latest period. It seems to be a glimmer of hope but she has had hope defferred for a very long time.

Oy vey ist meir! She was on clomid for 9 cycles?! Do you know if they were 9 consecutive cycles? Clomid does fine by some women, but for others that stuff is practically poison and REs talk about how they have to undo the damage done by OB/GYNs who prescribe the stuff like candy. Do you know how long ago that was by any chance? Clomid is notorious for screwing up cycles and throwing off blood levels. Also, it can take a long time for the body to detox and recover from Clomid. That period may have very well been her period returning after detoxing from Clomid, or trying to detox.

Docs tend not to closely monitor women during clomid cycles so I don't put much stock by an OB's word when he says she didn't ovulate. Call me a cynic ("cynic!") but... I think the jury is still out.

Instead of the saliva fertility test, she should stick with the tried and true OPKs or even do them at the same time. (I used to use the electronic fertility monitor and the regular OPKs during the same cycle.)

And, seriously, think about finding an acupuncturist who knows about fertility. I know that it doesn't work for some people (but there's no one size fits all for anything), but it really does help a lot of people. A friend of mine was told that she had high fsh at the age of 39 and that her dh had poor motility and absolutely horrid sperm counts and she just gave birth a month ago at the age of 43. She conceived after both of them were treated for 16 months by an acupuncturist. I have a family history of premature menopause and had been given "the speech" while ttc #2 and I had 34 eggs retrieved w/my last fresh cycle after seeing my acu for 6 months. I have an 18mo son from that batch of embies and 18 frozen (this was a better response than I had when I was 4.5 years younger).

I pray there's an answer to be had for your sister to realize her dreams.

[lucky_mia]

It happened to me. I was diagnosed with premature ovarian failure (early menopause at 23 years old. It was a complete shock. My FSH is really high - maybe 75-80 and my ovaries are near impossible to find as they are so tiny. I know my diagnosis is correct. I have seen about 6 reproductive endocrinologists across 3 states and they have all confirmed it. My current RE is an expert in POF and I have been part of a medical study at Mass General Hospital where I had many u/s and never ovulated. I have also had unprotected sex for about 16 years and never once even thought I was pregnant. I don't get my period at all now but when I was first diagnosed I did get it a few times. Some people ovulate occassionally with POF which is one of the things the study I was part of was looking at. Mine is autoimmune most likely.

Tell your sister to get to a good reproductive encrinologist as this condition needs to be managed for her overall health.

[PreciousTreasures]

Yes, it was for 9 consecutive cycles. I didn't know that Clomid was so toxic! Is there a website you can forward me to about this? I'd love to be able to give her more info. The clomid cycles were about a year or so ago.

I didn't trust the doctor's evaluation of her not ovulating either, especially when the saliva thing said she did at least once, even if it's not all that accurate.

If she's detoxing from clomid then this could be a first period after that thing. We're not sure but she's behaving as if this is a real honest to goodness period with the probability of ovulation and we're all praying hard it is.

What about the U/S of her ovaries? Should we put any stock in that?

She says she doesn't know if the "fertility specialist" was a reproductive endocrinologist or not. She stopped seeing him after such bad news. She felt she needed some time to recover.

Back to the clomid for a minute...she was put on those by a regular obgyn and her hormones were tested by him so I'm thinking that she should throw out anything he told her? Does that sound right?

What she has been doing for the last year is she just started counting one day as "day one" of a cycle and pretended in her mind as if she was actually menstrating then she started using natural progesterone cream on days 14 to 28 then stopped after day 28 and counted that day as one. She decided to do this when her doctors told her her estrogen was so high. She read about progesterone and thought she needed a balance and decided that she'd do it that way since she was so young. All with the idea that maybe she could balance her hormones herself and prove the doctor wrong. As I write this out it seems kinda crazy but she didn't know what else to do. And I didn't really know what to tell her. What she said made sense to me. Does it to anybody else?

I'm completely new to all this so I appreciate all the info you can give. TIA!

[lucky_mia]

I was thinking about this some more. Really your sister needs to go see two different doctors. One RE to diagnose if she really has POF. I don't think it matters what day of her cycle they measured it, if her FSH was that high it is an indication of a problem for a woman of her age. Many REs won't even do IFV if you FSH is over 10 or 12 (although I know people have gotten pg with FSHs that are higher under certain conditions but not when it is that high). If she really has it, she needs to get treatment as early menopause puts a woman at increased risk for heart problems and bone density problems. She also needs to be monitored for thyroid conditions because typically if you have POF it is just a matter of time until you get a thyroid issue (both are a result of a your body attacking the endocrine system).

Then if she wants to get pregnant she can find another RE who specializes in fertility. The ones who manage endocrine conditions usually are not the same ones who do fertility treatments. It is like a specialty within a specialty. I really don't think she should be trying to treat this on her own.

Here is a link to a support group where she might be able to find more information.
http://www.pofsupport.org

[RunnerDuck]

Originally Posted by PreciousTreasures

Back to the clomid for a minute...she was put on those by a regular obgyn and her hormones were tested by him so I'm thinking that she should throw out anything he told her? Does that sound right?

Even if the doctor is a moron... blood work is blood work. Most schools of thought seem to say you are only as good as your worst FSH - it's not like cholesterol or something where it can be high but you lower it and it's OK now. FSH being high indicates low ovarian reserve which indicates low numbers and/or low qualities of eggs. You are born with all the eggs you ever have. As those numbers go down the brain puts out more and more FSH to stimulate the ovaries so it's like if your numbers are EVER really high, it shows there's a problem. There are people who argue with this theory and there are certainly women who get pregnant despite high FSH - but it's really not good news to ever have it.

Are you saying this recent period is the result of NPC? If so you can't really tell anything by it - it has been artificially induced and is not an indication that the body is doing anything on its own.

As for clomid being "toxic"... it's debatable. Clomid works by blocking estrogen receptors which in turn tells the brain to put out greater levels of LH and FSH. (Don't blame the high FSH on clomid though - even on clomid it should never get that high!!) These hormones in turn cause ovulation. For the most part... clomid will either work or it won't. I don't ovulate on clomid. One of the reasons a woman is told only to do so many cycles of clomid is, well, if it's not working, it's not working. You start at the 50mg dose, work up to 100, 150, and some go as high as 200 or 250 - but if it hasn't worked by 150, really, you're probably beating a dead horse. Move on.

If you are ovulating but not getting pregnant, still it's thought best to move on after so many cycles because clearly it's not enough.

So there is a rule of 6 cycles in part for that reason - and if you don't O at all, 6 is even too many. I only tried 3 before moving to injectables. If you O on clomid, may as well give it a little longer...

There are two other problems with clomid, though.

1. Speculation is MAY increase rates of ovarian cancer. Hasn't been proven, and there is reason to think the infertility itself is a risk factor in cancer - so cancer shows up in women who use clomid not because they use clomid but because they needed clomid in the first place. make sense?

2. Since clomid is anti-estrogen, you can have side effects that HINDER conception - mainly drying up of cervical fluid needed for sperm to travel and a thin or inhospitable uterine lining. IUI is one way around the lack of fluid and estrogen supplements can plump up the uterine lining. These problems are not insurmountable - but they need to be looked for it they are to be addressed. There seems to be some debate as to whether or not the problems are limited to the cycle in which clomid is used or if they are problems that can occur even in cycles after the clomid is stopped - but either way they can be looked for and they can be dealt with.

Bottom line is I wouldn't freak out TOO much about her having used clomid 9 cycles - but I wouldn't use it any more, either. Clearly it's not working - anything problems beyond that are secondary.

eta - you also mention her estrogen is high. This is also not good and it's not something you can balance out by adding progesterone. There is actually a test called the clomid challenge test where estradiol and FSH are measured on day 3 and then again on day 10, after taking clomid. High levels of either at either point indicate low ovarian reserve.

Your sister really needs to get a knowledgable doctor for this - an RE, not an ob/gyn. It's possible donor eggs will be her best bet - based on what you are saying her own chances aren't looking so good. She needs a thorough evaluation to know all she is dealing with and all her options.

[PreciousTreasures]

UPDATE Need new advice!

Okay, so I told y'all that my sister was acting as if this was a normal period. She went and got an opk and has been faithfully testing since around day 9. Yesterday afternoon her test line went pretty dark, not quite as dark as the control line but darker than it's been yet. Then she did another stick last night just to see. It was even darker. She dtd and is dtd everyday with her dh and we're all praying for a miracle.

Question is: what do you think in light of this opk now? Is there a chance that the drs are wrong, it's not menopause but something else? If so what could it be?

She's looking for an RE and an acupuncturist. But right now she's got to take advantage of any possibilities immediately.

TIA!

[PreciousTreasures]

Lots of questions!!! We need advice!!!

Okay, My mom went to my sisters and she looked at the opk too. So now sister, her dh, and my mom all say for sure that the test line on that opk was definately as dark as the control line.
Also the opk she did the next day she said was WAY lighter than the last opk test line and lighter than the control line. We have concluded then she MUST have had an LH surge.
1.)Does this sound like an LH surge to you?
2.)Is there any reason a post menopausal woman would have an LH surge?
3.)Is there any reason that the test line would go dark other than an LH surge?

Also here's another thing: she was doing the cm testing thing and said she definately changed from watery and clear to cloudy and egg-whiteish suring this time. She also says that she did the same thing last month (BEFORE this normal period). Certainly that sounds like she's ovulating, right?

I think she needs to start using progesterone cream about 3 dpo and keep it up until around 32 dpp then poas and see (while we pray real hard!)

How's that sound?

[RunnerDuck]

Puzzling...

If your sister is truly in menopause I'm pretty sure she would not be having LH surges. So I guess issue number 1 is was the blood work every run again to rule out the possibility of lab error?

As for whether or not the dark line on the OPK means an LH surge... well... maybe. Maybe not.

Women with PCOS can have chronically high LH and/or random LH surges throughout the month that don't mean ovulation. You sister has not been diagnosed with PCOS but she could have it or some other hormonal issue causing her to have LH surges or spikes that don't mean anything.

The other thing is, OPKs will detect HCG as well as LH. HCG is the hormone produced when a woman is pregnant. Chemically, they are very similar - HCG is like LH + an additional component. For simplification... Let's think of LH as cherry jello. HCG is like cherry jelly with fruit cocktail. An OPK is looking for cherry jello so it will turn positive in the presence of LH *or* HCG. A pregnancy test is looking for both the cherry jello AND the fruit cocktail so will only turn positive in the presence of HCG.

Now normally a woman will not have HCG in her system unless she is pregnant - so this is not a problem, a positive OPK test can be assumed to be positive due to LH.

But an OPK will turn positive if there is HCG in the body. If a woman is not pregnant there are, I think, pretty much 2 explanations for this.

- HCG trigger shot used in fertility treatments (acts like an LH surge)

- HCG producing tumor (rare, but not impossible)

So the short answer is... yeah, it sounds like an LH surge... but given your sister's possible menopause... I have no idea. It's weird. She really needs to see a doctor to straighten this out.

I am not sure what you mean by 32dpp... did you mean to type dpo? NPC at 3dpo is not a bad idea althouh I personally am wary of the stuff... I bleed like a stuck pig when I use it. So it would depend on how she reacts. But 32dpo is a long time to use it... if an hpt is - at 14dpo she can *probably* assume the cycle is a bust. FWIW my personal favorite test is Answer... they are the same as First Response, super sensitive, much cheaper. (I detected a chemical pregnancy with a beta of 4 on an Answer test)

[PreciousTreasures]

I am so grateful for all you MDC mamas for all the good info. Please keep it coming.
She is trying to find a good RE where she is (Shreveport LA) but while she's looking we've got all this other stuff going on and she doesn't want to miss it if it's her last chance.

So here's the latest...
She's done another OPK and the line is dark again?!?!?!?!?
What is going on? If the pp is right and it can detect HCG as well as LH then she could (in theory) be pregnant but if she just ovulated and dtd then it certainly wouldn't show up the next day, right? I mean, that's not remotely possible, is it? But if it's not that then what could it be? The OPKs were light for a week then dark for one day then light one day now dark again.
This is so weird.

If anyone knows a good RE and/or fertility acupuncturist in Shreveport please let me know.
TIA for all the good info.