It May Not Be Menopause

Q: I started menopause at age 35 and have not had any periods since. In the past year and a half, I’ve noticed my face has discoloration spots and my hair is much drier. Also, my body hair and the hair on my head don’t grow as fast as they used to. I am not taking any medications, nor have I seen a physician. What type of vitamin deficiency could I have, if any?

A: Without the benefit of seeing the spots on your face, it is difficult to give an opinion with certainty. However, my first impression is they may be related to a skin condition known as melasma. These tan, brown or bluish-black spots are more common in women and often are linked to a history of sun exposure. Also, hormonal imbalances involving the relationship among estrogen, progesterone and melanocyte-stimulating hormone, as well as thyroid disease, may be contributing to this symptom.

Looking at the big picture and integrating the other body changes you described, as well as your early onset of menopause, I think there is more to this story than a vitamin deficiency. While it is true you may be deficient in a few vitamins (some of the B vitamins, for example) and minerals, I am more focused on the fact that you experienced premature menopause. Premature menopause is defined as having stopped menstruating before the age of 40.

There are many reasons for premature menopause. These include known causes such as:

• Surgery. Types include a bilateral oophorectomy (removal of both ovaries), total hysterectomy (removal of the uterus, both fallopian tubes and ovaries), and complications from other procedures that may compromise the blood supply to the ovaries.
• Radiation or chemotherapy. These treatments have the potential to damage the ovaries.
• Medications such as tamoxifen (used for prevention or treatment of certain breast cancers), phenothiazines (a type of psychiatric medication) and others.

When premature menopause is from “natural” or unknown reasons and you have had confirming blood tests and no periods for at least four to six months, it is referred to as premature ovarian failure (POF). This is a disconcerting term that basically means the ovaries have shut down years before their time (the average age of completed menopause is 51). The causes for this occurrence include but are not limited to:

• Family history of early menopause.
• Genetic defects that interfere with the production of eggs. These cause a woman to have a decreased supply of eggs in her ovaries, leading to earlier menopause.
• Autoimmune disorders, where the body’s own immune system may destroy a woman’s ovaries, thus interfering with their normal function.

It is also possible your symptoms are attributable not to premature ovarian failure but to another condition that triggers the bodily changes you have described. These can include:

• Thyroid disease, especially hypothyroidism. (Given your symptoms, I suspect this may be a contributing factor.)
• Disorders of the pituitary and adrenal glands, or Cushing’s disease.
• Extreme weight gain or weight loss.

It is vital that you see a physician specializing in hormonal dysfunction and women’s health (a family physician, gynecologist or endocrinologist). Blood tests will be performed to check your thyroid and your levels of luteinizing hormone, estrogen, progesterone, testosterone, prolactin and follicle-stimulating hormone, as well as a complete blood count. Other tests, including an ultrasound of your ovaries and a CT scan of your brain, also may be recommended.

When the results are in, a proper diagnosis and treatment plan will be designed to maximize your health and sense of well-being.

More from Dr. Rob on MSN Health & Fitness:

• Is It Perimenopause?
• Let's Talk About STDs
• The Basics on Bruises

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)