Premature Menopause

In the U.S., the average age of onset for "natural" menopause is 51. However, because of genetics, illness, or medical procedures, some women go through menopause before the age of 40. Menopause that occurs before this age, whether natural or induced, is known as "premature" menopause.

In addition to dealing with hot flashes, mood swings, and other symptoms that accompany menopause, many women undergoing premature menopause have to cope with additional physical and emotional concerns. For example, because menopause signals the end of a woman's fertile years, a woman who wishes to get pregnant is likely to have trouble.

What Are the Symptoms of Premature Menopause?
Symptoms of premature menopause are often the same as those experienced by women undergoing natural menopause and may include:


Irregular or missed periods
Periods that are heavier or lighter than usual
Hot flashes (a sudden feeling of warmth that spreads over the upper body)
These symptoms are a sign that the ovaries are producing less estrogen.

Along with the above symptoms, some women may experience:

Vaginal dryness (the vagina may also become thinner and less flexible)
Bladder irritability and worsening of loss of bladder control (incontinence)
Emotional changes (irritability, mood swings, mild depression)
Dry skin, eyes, or mouth
Sleeplessness
Decreased sex drive
In addition to the symptoms listed above, if you are under the age of 40 and experience any of the following conditions, you should see your doctor to determine whether you are undergoing premature menopause:

You have undergone chemotherapy or radiation
You or a family member has an autoimmune disorder such as hypothyroidism, Graves' disease, or lupus
You have unsuccessfully tried to become pregnant for more than a year
Your mother or sister experienced premature menopause
How Is Premature Menopause Diagnosed?
To diagnose premature menopause, your doctor will most likely perform a physical exam and draw blood to rule out other conditions, such as pregnancy and thyroid disease. He or she may also order a test to measure your estradiol levels. Low levels of estradiol, a form of estrogen, can indicate that your ovaries are starting to fail. When estradiol levels are below 30, it may signal that you are in menopause.

However, 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 40 mIU/mL, it usually indicates that you are in menopause.

Are There Other Health Issues That Affect Women in Premature Menopause?
Like all menopausal women, women in premature menopause experience lowered estrogen levels as the ovaries stop most of their production of this hormone. Low levels of estrogen can lead to changes in a woman's overall health and may increase her risk for certain medical conditions, such as osteoporosis. Other health risks associated with the loss of estrogen include increased risk for colon and ovarian cancer, periodontal (gum) disease, tooth loss, and cataract formation.

However, compared with women who go through natural menopause, women undergoing premature menopause spend a greater portion of their lives without the protective benefits of their own estrogen. This puts them at an even greater risk for the above mentioned menopause-related health problems.


How Is Premature Menopause Treated?
The symptoms and health risks of premature menopause, as well as the emotional issues that may result from it, can be managed with the methods similar to those used for natural menopause. Women dealing with infertility that is brought on by premature menopause may want to discuss their options with their doctor or with a reproductive specialist.

Can Premature Menopause Be Reversed?
Not usually. Once menopause has set in, it is unlikely to be reversed.

WebMD Medical Reference

Can a Woman Become Pregnant During Her Period?

It's a common misconception that if a woman has sex during her period she cannot become pregnant. While a woman is unlikely to get pregnant during her period, it is absolutely possible.

Defining a Period

"A period is defined as the blood loss that happens at the end of an ovulatory cycle, as the result of an egg not being fertilized by a sperm," explains Michele Hakakha, M.D., a board-certified obstetrician and gynecologist based in Los Angeles and co-author of Expecting 411: Clear Answers and Smart Advice for Your Pregnancy.

"Every month, a woman releases an egg on approximately day 14 of her cycle," Dr. Hakakha says. "Prior to the release of the egg, the hormones in a woman's body increase to prepare (and thicken) the lining of the uterus in case the egg is fertilized and a pregnancy occurs. If there is no fertilization, the lining of the uterus is sloughed off about 14 days later. This is called your period."

Most women have periods that last from two days to eight days and take place every 26 to 34 days. Ovulation (when an egg is released from one of your ovaries) typically occurs midway through the cycle and is the most fertile time in your menstrual cycle -- meaning, when you are most likely to conceive.

"The egg that is released during the process of ovulation survives for only 24 hours," explains Dr. Hakakha. "If it is not fertilized by a sperm during this time, it does not survive and comes out with all of the menstrual blood about 14 days later."

Most women have normal 28- to 32-day cycles, and if someone with this cycle has an average two- to eight-day period, she will not get pregnant during her period.

Special Circumstances

However, not every woman follows a 28- to 32-day cycle. "In less common scenarios, a woman with a shorter menstrual cycle (24 days, for example), could have seven days of bleeding, have intercourse on her final day of bleeding, and ovulate three days later," Dr. Hakakha says. "Since sperm live for three to five days, she could definitely get pregnant."

In addition, some women experience breakthrough spotting or bleeding between periods. This can occur during ovulation and be mistaken for a period, making it difficult to establish the exact place in the menstrual cycle.

If you had unprotected sex during your period and are concerned that you may be pregnant, look out for symptoms like mild lower abdominal cramping, spotting (implantation spotting, a fairly common cause of bleeding once the egg has been fertilized), breast tenderness and moodiness. These symptoms can occur as early as two weeks after ovulation.

Other, more common, pregnancy symptoms to watch out for will manifest closer to six or seven weeks' gestation, and include nausea, vomiting and severe fatigue.

Copyright 2011 Meredith Corporation.

Breast and Nipple Discharge: What It Could Mean

In this article
What is normal and what is abnormal nipple discharge?
What might cause normal nipple discharge?
What causes abnormal nipple discharge and can it be noncancerous?
What is the connection between nipple discharge and breast cancer?

For women who aren't breastfeeding, the sight of nipple discharge can be alarming. But if you notice discharge from your nipple, there's no reason to panic. While nipple discharge can be serious, in most cases, it's either normal or due to a minor condition.

Still, if you are not nursing, you should contact your health care provider any time you notice breast discharge. Based upon your symptoms and the results of diagnostic tests, your doctor will decide on the best course of treatment.

What is normal and what is abnormal nipple discharge?
Bloody nipple discharge is never normal. Other signs of abnormality include nipple discharge from only one breast and discharge that occurs spontaneously without anything touching, stimulating, or irritating your breast.

Color isn't usually helpful in deciding if the discharge is normal or abnormal. Both abnormal and normal nipple discharge can be clear, yellow, white, or green in color.

Normal nipple discharge more commonly occurs in both nipples and is often released when the nipples are compressed or squeezed. Some women who are concerned about breast secretions may actually cause it to worsen. They do this by repeatedly squeezing their nipples to check for nipple discharge. In these instances, leaving the nipples alone for a while may help the condition to improve.

Based on your medical evaluation, your doctor will determine whether your nipple discharge is normal (physiologic) or abnormal (pathologic). Even if your doctor determines your breast discharge is abnormal, keep in mind that most pathological conditions that cause nipple discharge are not serious and are easily treated.

What might cause normal nipple discharge?
Some causes of normal nipple discharge include:

Pregnancy. In the early stages of pregnancy, some women notice clear breast discharge coming from their nipples. In the later stages of pregnancy, this discharge may take on a watery, milky appearance.

Stopping breastfeeding. Even after you have stopped nursing your baby, you may notice that a milk-like breast discharge persists for a while.

Stimulation. Nipples may secrete fluid when they are stimulated or squeezed. Normal nipple discharge may also occur when your nipples are repeatedly chafed by your bra or during vigorous physical exercise, such as jogging.

What causes abnormal nipple discharge and can it be noncancerous?
A number of noncancerous conditions can cause nipple discharge.

If your initial medical evaluation indicates the discharge is abnormal, your doctor may ask for more tests. The tests will help determine the underlying condition that's causing the problem and may include one or more of the following:

Laboratory analysis of the discharge
Blood tests
Mammogram and/or ultrasound of one or both breasts
A brain scan
Surgical excision and analysis of one or more ducts in your nipple

Possible causes of abnormal discharge include:

Fibrocystic breast changes. Fibrocystic refers to the presence or development of fibrous tissue and cysts. Fibrocystic changes in your breasts may cause lumps or thickenings in your breast tissue. They do not indicate, though, the presence of cancer. In addition to causing pain and itching, fibrocystic breast changes can, at times, cause secretion of clear, white, yellow, or green nipple discharge.

Galactorrhea. It might sound scary. But galactorrhea simply describes a condition in which a woman's breast secretes milk or a milky nipple discharge even though she is not breastfeeding. Galactorrhea is not a disease and has many possible causes. These include:
Pituitary gland tumors
Certain medications, including some hormones and psychotropic drugs
Some herbs, such as anise and fennel
Hypothyroidism
Illegal drugs, including marijuana

Infection. Nipple discharge that contains pus may indicate an infection in your breast. This is also known as mastitis. Mastitis is usually seen in women who are breastfeeding. But it can develop in women who are not lactating. If you have an infection or abscess in your breast, you may also notice that your breast is sore, red, or warm to the touch.

Mammary duct ectasia. This is the second most common cause of abnormal nipple discharge. It is typically seen in women who are approaching menopause. This condition results in inflammation and possible blockage of ducts located underneath the nipple. When this occurs, an infection may develop that results in thick, greenish nipple discharge.

Intraductal papilloma. These are noncancerous growths in the ducts of the breast. They are the most common reason women experience abnormal nipple discharge. When they become inflamed, intraductal papillomas may result in nipple discharge that contains blood or is sticky in texture.

What is the connection between nipple discharge and breast cancer?
Most nipple discharge is either normal or caused by a benign medical condition. There are instances, though, when discharge from the breast may be a symptom of some forms of breast cancer. This likelihood is greater if your nipple discharge is accompanied by a lump or mass within the breast or if you have had an abnormal mammogram.

One form of breast cancer that may cause breast discharge is intraductal carcinoma. This cancer develops within the ducts of the breast located beneath the nipple.

Another rare form of breast cancer that may result in nipple discharge is Paget's disease. This condition develops in the ducts of the breast and then moves to the nipple. It may cause the nipple and the surrounding areola to bleed or ooze. Paget's disease usually occurs with another form of breast cancer.


Source: WebMD
Reviewed by Traci C. Johnson, MD, FACOG on September 22, 2014

What Is Implantation Bleeding?

If you see light bleeding -- small pink or brown spots -- in your underwear and you think you might be pregnant, it could be implantation bleeding. That happens 6 to 12 days after conception, and you may mistake it for your regular period.

It’s actually an early sign of pregnancy. It’s not dangerous, and you don’t need treatment.

Heavy bleeding (more than a typical period) is cause for concern, though. Contact your doctor if you have this alone or combined with fever, chills, or cramps that get worse.

Cause

After a sperm fertilizes your egg, they become an embryo. It then travels to the uterus, where it implants itself into the lining.

Sometimes, as the embryo attaches, it causes a little bleeding. This doesn't cause any problems for the baby that will develop.

Symptoms

The blood may be lighter in color and flow than what you see during your period. Mild cramping is common.

This bleeding tends to happen sooner than you'd notice morning sickness.

Treatment

It will stop on its own. If you're worried that you've bled a lot, call your doctor. He may want to know how much you saw in your underwear and what color it was.

Other Causes of Bleeding

Pregnant women can bleed for reasons other than implantation. If it’s heavy plus with or without pain or cramping at any time, call your doctor.

If you’re pregnant and you see blood, it may be caused by:

Sex. Sometimes this happens early on, although it can happen at any time during pregnancy. Hormone changes in your body may be to blame. It should stop on its own.

Ectopic pregnancy. This is when an embryo implants outside of the uterus. You may have bleeding with pain and cramps. It’s dangerous, and you need to see a doctor right away.

Miscarriage. About 15% of known pregnancies end during the first few months. Most women bleed and cramp afterward. Call your doctor right away if you know you're pregnant and you have these symptoms.

Source: WebMd