11/06/2013 05:27 EST | Updated 01/23/2014 06:58 EST

My 34-Year-Old Patient Was Post-Menopausal

I've been a practicing physician for more than 10 years now, and have unfortunately treated many patients whose stories were just heartbreaking. One patient, however, stands out so indelibly in my mind; her story, so very sad, and so very preventable.

I met Marian, a 33-year-old nurse and wife, one year after the birth of her first child. She had some medical difficulties during her pregnancy, including high blood sugar, which was brought under control with healthy diet and exercise. Personally, things weren't much better, either. Her husband had lost his job shortly after Marian found out she was pregnant. However, when their healthy baby boy was born via C-section nine months later, everything seemed to be going on a better path for the family.

However several days after giving birth, Marian became very depressed and anxious. She simply couldn't stop crying and found it very difficult to care for her child. Marian's doctor diagnosed her with postpartum depression -- a fairly common condition that affects around 13 per cent of pregnant women and new mothers. Though it took several months of treatment, Marian successfully pulled through and was acting like her "old self" again in no time.

When Marian decided she wanted to try for a second child, she came to me, her internist, for a regular physical exam and to seek advice on living a healthier lifestyle.

When I saw Marian, I was shocked. One year after giving birth, she was 35 pounds heavier than her pre-pregnancy weight. She also felt very stressed, and was unable to sleep soundly at night, despite successfully completing treatment for postpartum depression. She had lost any sexual desire, had not menstruated since giving birth, and suffered from skin itchiness, crankiness, breast tenderness and bloating.

Both Marian and her husband felt that she had become a different person after becoming a mom.

Puzzled, I reviewed some of Marian's medical records. The results astounded me. Her blood test from nine months prior showed low estrogen levels, and her progesterone levels were extremely low. A more recent test showed that Marian had little to no estrogen at all and even lower progesterone levels than before. I couldn't imagine why her OB/GYN hadn't addressed these results with Marian. Perhaps it's because the news was so devastating.

Marian, at age 34, was clearly post-menopausal. Any chance of giving birth to another child was definitively out of the picture.

Post-menopausal. At age 34. Unfortunately, cases like Marian's are not uncommon. She had been mismanaged by an uninformed OB/GYN who should have recognized the signs of early menopause.

This is a warning to all women in their late 30s and early 40s -- during this age group, many women see a dramatic drop in their fertility. If you notice symptoms similar to Marian's, get yourself to a doctor immediately.

As for Marian, her menopause was caused by premature ovarian failure. It became extremely important to control her symptoms (insomnia, hot flashes, night sweats, anxiety, low libido). I put her on a regiment of bioidentical hormones, which are structurally-identical to the hormones made by the body. Thus the body recognizes them, has receptors for them throughout and is adept at breaking them down. Marian applied an estrogen cream to her inner arms and took a progesterone pill by mouth every evening. I also supplemented her with DHEA, a prehormone to enhance her muscle to fat ratio. DHEA also helps to raise a woman's production of testosterone and can raise one's sex drive.

After a month, Marian was reporting improvement, but she still wasn't completely herself. Blood work showed low testosterone, although the DHEA had raised it by 30 per cent. I then supplemented her with a low-dose bioidentical testosterone cream.

On follow-up three months later, Marian felt much better. Nothing could excuse the misdiagnosis of premenopause in this young woman, but I was at least able to return her libido, help her lose weight and make her feel more like herself.

The onset of early menopause can be triggered by a number of other factors -- women can even go into menopause spontaneously. If caught early enough, however, early-onset menopause is completely treatable with the help of a good physician and bioidentical hormones.

If you're curious about how menopause could potentially affect you, a great resource is Suzanne Somers' new book I'm Too Young For This!, which talks about bioidentical hormone replacement therapy.


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