The perpetual snooze on fertility

Episodes of hot flushes, mood swings and some tests later, 29-year-old Dubai resident Nimra was told she was experiencing premature menopause. Eight years later, she tells Sa’adia Reza that was just the start of her health woes

One of the reasons for young girls with very low egg reserves is the plastic we use to store or heat our food. It has harmful chemicals

Nimra* still remembers the day eight years ago when she was sitting in the doctor’s waiting room. Nervous and stressed out because of the changes she had been experiencing in her body, she was not sure what to expect after meeting her gynaecologist. The then 29-yearold single woman was enjoying her job as a media professional when she realised that all was not right with her health.

‘It began when I started experiencing hot flushes a year earlier,’ says the Dubai resident. Nimra also found that she was gaining weight although she had been careful about her diet.

‘While my unreasonable mood swings baffled my family, severe backaches left me wondering what was happening to my system,’ she says. However when her menstrual cycle started becoming increasingly irregular, she – on the insistence of her mother and sister – decided to consult the doctor.

‘After listening to my symptoms, the ObsGyn prescribed a series of tests including LH (Luteinizing Hormone) and FSH (Follicle Stimulating Hormone) tests, along with an ultrasound. But what actually got me worried was the look on the doctor’s face which spelled that something was seriously not right with me,’ remembers Nimra.

Her instincts proved right; tests revealed that Nimra’s LH and FSH levels were so high that she had entered perimenopausal stage. At 29, Nimra was experiencing premature menopause.

Premature menopause – also known as premature ovarian failure – is an infertility issue that affects around 1:10,000 women by age 20 and 1:1,000 women below 30; the irreversible process is often discovered too late for any medical intervention. Traditionally, any woman whose menstrual cycle completely stops before the age of 35 is considered a premature menopausal case.

The symptoms for any menopause, whether it’s premature or not remain the same. The first sign usually is an irregular menstrual cycle which finally ceases; if there’s no menstruation in the last six months, it means that the woman has entered menopause. Other symptoms also start kicking in and these are usually related to the lack of estrogen hormone. Women suffer from severe hot flushes, a disturbed sleep pattern, anxiety, irritability and mood swings, decreased libido, more frequent urinary infection and a burning sensation while passing urine.

The Obs-Gyn, immediately put Nimra on a hormonal therapy of estrogen and progesterone to induce artificial periods and to offset or slow down any health issues such as osteoporosis, a common outcome of menopause, which occurs due to severe lack of estrogen in the body.

is to ‘The safeguard primary the target reproductive of these medications and menstrual function of women suffering from this rare disorder,’ says Dr Amala

Nazareth, Specialist Obsgyn, Prime

Healthcare Group, Dubai. ‘But it is vital for the treating physician to understand that such allopathic preparations do tend to have some side effects, such as cardiovascular issues and a strain on the liver. Hence mandatory checkups every six months are essential in such cases,’ she cautions.

‘By then, I was beginning to figure out what was happening to me, but acceptance did not come as easily and my body’s shock absorbers refused to function. In retrospect, I could see the onset of menopause creeping on me for almost a year, at least sporadically, but to be honest I did not recognise it,’ recalls Nimra.

According to fertility specialists, it is difficult – almost impossible – to identify the causes of premature menopause. However, incidental evidence points towards family history of premature ovarian failure and diseases such as Fragile X syndrome (an X-linked genetic disorder caused by mutation) and Turner’s syndrome (a genetic defect where affected women have only one X chromosome, causing infertility). Other such causes include surgical removal of the ovaries or undergoing radiotherapy or chemotherapy which severely affects the quality and quantity of eggs to the point of depletion. Having said that, there’s no conclusive evidence which explains any definite cause.

‘But there’s a strong relationship between egg depletion and smoking and even the use of sheesha,” stresses Dr Pankaj Srivastav, fertility expert and founder of fertility clinic, Conceive, ‘A girl who smokes will reach menopause 4-5 years before she was destined to and if her husband is a smoker, then the age of menopause will be advanced by two years – such is the impact of secondhand smoking on fertility. There’s also the environmental factor. We see so many young girls coming to us with very low egg reserves and no obvious reason for it. But recent research points fingers at the toxins that are seeping into our water table and food chain. The plastic we use to store or heat our food, for example, releases harmful chemicals that are directly toxic for eggs.’

N ot willing to accept the diagnosis, and hoping the doctor had been wrong, Nimra sought a second opinion, consulting a few other specialists. ‘I was hoping to hear a different answer. But it was not to be.’ while Within the prescribed a year Nimra hormone was two replacement sizes larger therapy (HRT) took her on an emotional roller coaster ride every month. ‘There were days when I was normal, there were days when I was thoroughly depressed, and then there were days when I would turn into a wailing banshee. I felt as if an essential part of my life had been forcefully amputated, like I had a hit a cul-de-sac of motherhood’.

In most premature menopausal cases, as the estrogen level declines rapidly, a number of health issues begin to rear their heads. And while problems are similar across all ages, for younger women the effect is far more devastating since they have to live with these chronic issues much longer. There’s also evidence that premature menopause can lead to premature ageing. Nimra’s case was no different and within a few years, her bone health started giving all the signs of ageing with arthritis making steady inroads. In fact, a full body examination just a few years down revealed vulnerable areas in her backbone, knees and feet.

While the HRT helped Nimra’s condition from worsening further, she was

worried about the long-term effects of the medication. Despite tons of benefits, the HRT has proved to be a double-edged sword. Over the years, a debate has ensued over the potential risks of the prolonged use of such therapies and some of the risks include strokes, formation of blood clots and breast cancer. Yet the fact remains that young women running out of estrogen and progesterone need the therapy to replenish the crucial depletion in their bodies. T he question is, how long does one take it? Dr Srivastav suggests a probable timeline of 10 years. He is also quick to point out that there is insufficient evidence whether doctors should continue to give HRT for longer than 10 years. ‘So the basic principle that we work on is to give the therapy to someone who requires it for her symptoms, use the lowest dose possible and try and taper it off as soon as we can.’

‘The consensus of opinion is that the clock starts ticking on the side effects after the age of 50 which is the average age of the natural menopause as these hormones are naturally occurring in a woman’s body until then. Therefore, when counselling women they need to be made aware of the benefits and risks of HRT to be able to make informed choices that can affect their quality of life,’ advises Dr Bohaira Elgeyoushi, Reproductive Medicine & IVF Consultant at HealthPlus Fertility Center, Dubai.

For Nimra, these eight years have been fraught with twists and turns, disappointments and self-doubts. Yet, despite all these adversities her confidence brims with positivity, and the experience has left her a much stronger person.

‘In these few years I’ve learnt that life has a terrible timing irrespective of what we may have planned for it. And when things go wrong to a point that they can’t be fixed, we need to find inner strength to overcome those hurdles. I can honestly say that it was my firm faith in God and the immense love and support of my loved ones that pulled me through this ordeal. It does not happen overnight, but it’s a gradual process with each day bringing more courage. Most importantly, over the years I’ve restored my self-confidence, fully aware that this was neither my fault nor something to be ashamed of,” smiles Nimra.

The potential risks of the prolonged use of therapies like HRT include strokes, formation of blood clots and breast cancer