Sometime during their late 30s or early 40s, many women begin to feel that their health is on the decline. Whether it’s difficulty sleeping, feeling sad or depressed, having less energy, etc., these common complaints that may seem like just a normal part of getting older may instead be genuine symptoms of a condition called premature menopause. To learn more, Better Health spoke with Dr. Pansak Sugkraroek, a board certified obstetrician and gynecologist specializing in reproductive endocrinology.

Sometime during their late 30s or early 40s, many women begin to feel that their health is on the decline. Whether it’s difficulty sleeping, feeling sad or depressed, having less energy, etc., these common complaints that may seem like just a normal part of getting older may instead be genuine symptoms of a condition called premature menopause. To learn more, Better Health spoke with Dr. Pansak Sugkraroek, a board certified obstetrician and gynecologist specializing in reproductive endocrinology.

Better Health: When is menopause considered to be premature?
Dr. Pansak: For Thai women, the average age for reaching menopause is about 50. Their hormone level will have dropped significantly around five years earlier. Once that happens, women begin to experience symptoms that can impact their everyday living in a number of ways. However, if these symptoms appear before the age of 40, they are considered to be experiencing premature menopause.

Better Health: What causes premature menopause?
Dr. Pansak: First of all, it’s important to look at the three factors that promote healthy menstruation – the follicle-stimulating hormone (FSH), the health of the uterus, and the woman’s overall health. As a woman sleeps, her pituitary gland produces healthy amounts of FSH which stimulates healthy follicle growth. When the ovaries are properly stimulated, sufficient amounts of the hormones estrogen and progesterone are produced, resulting in healthy ovulation. Healthy ovulation and a healthy uterus result in healthy menstruation. Women’s modern lifestyles often lead to long working hours, unhealthy eating habits, lack of sleep, and little or no exercise, all of which are harmful to overall health. When a woman’s health is compromised, her hormone system is affected, and this can upset the normal process of ovulation and menstruation. Since normal menstruation is a result of FSH stimulating proper ovulation, premature menopause is often the end result of poor FSH levels for an extended period of time.

Better Health: How can a woman know for sure that shehas premature menopause?
Dr. Pansak: Most women actually don’t know. Sometimes it can help to observe the people around you, like work colleagues or family members. If they don’t interact with you as much as before, it may signify a change in your behavior that is related to menopause. Women may notice feeling less emotionally stable, depressed, or more easily irritated, while at the same time they may notice their menstrual period becoming irregular. When a woman visits her doctor, the doctor will typically ask about her lifestyle, health history, and what medications she may be taking, then conduct a physical examination plus a blood test to measure hormone levels. All of this information helps a doctor determine if her symptoms are related to a decline in hormone levels. Once that is known, the doctor can formulate a plan for treating and managing the symptoms.

Better Health: Does lifestyle modification help reduce the symptoms?
Dr. Pansak: Making healthy lifestyle changes is always good. But successfully reducing or reversing the symptoms also depends on how much damage, if any, has already occurred. Some women may have a hormone deficiency but don’t yet show any bone damage. For them, lifestyle modification will probably help. But when the hormone deficiency has reached a more serious level, to the point where damage – such as thinning of the bones and skin and/or hair loss – has been caused, the doctor may recommend hormone replacement therapy, assuming the patient has no other medical restrictions such as the presence of cancer or problems with blood clots.

Better Health: What do you recommend for women who are approaching menopausal age?
Dr. Pansak: In the past, the most common advice was for women to seek professional help when symptoms appear. But I think the more helpful message today is to view professional help as a continuing process throughout each stage of life. At the age of 40 or 45, even if they don’t have symptoms, I recommend women consult their doctor to discuss the best ways to achieve better health. Good care doesn’t always mean treating or curing an illness; it’s also about “preventing the preventable” and “delaying the inevitable.” People can benefit from changing the way they think about healthcare. Don’t just see your doctor when you feel sick. Think of your doctor as someone who can help you avoid illness. A doctor’s role shouldn’t be limited to giving “sickcare,” it should also be about promoting “healthcare.”