Hello doctor,

I am 35 years old and have been in a serious relationship for six years now. I don’t have any children and neither does my boyfriend. But for about three months now I have been feeling strange. My period lasts only 2 days yet it normally goes for four.

I sweat a lot, even in the night when it is cold. I find myself restless most of the times and sometimes, I feel nauseated. At first, I thought  I was pregnant but then a friend told me I could be hitting menopause! Is she serious? I plan on having kids and I feel I’m still too young for menopause. Please tell me I still have the chance to be a mummy because I am now stressed about it.

Pamela, 35, Gikondo

Dear Pamela,

I am sorry about your predicament as I know it is very painful not to have a child when one desires to. You have not specified whether you and your boy friend have been investigated or not. Because the reason for not conceiving can lie with either of you. This could be at the level of reproductive organs or hormones and could be detected by tests which are available and affordable. 

Apart from reproductive hormones, imbalance of thyroid as well as pituitary hormones also leads to problems in conception.  

Regarding the other symptoms you mention, those could be due to the perimenopausal phase of your life. Actual menopause occurs much later in life after 45, 50 years or more. But after 35 years or so, hormonal changes gradually begin in the body. 

The level of feminising hormone estrogen gradually reduces while the virilising hormone may grow. But these changes do not occur overnight. During this period, women experience hot flashes, insomnia, vague body pains and at times severe depression.

These symptoms continue till actual cessation of menses and even till few months after that. There is also increased demand for iron and calcium in the body during this phase. This, if not fulfilled, usually causes softening of the bones and adds on to the pain of the joints and back. 

But a woman can still conceive during this period and even after menopause, because ovulation can occur for some months even after menopause. 

The nausea you feel could be due to indigestion or constipation as well. Apart from perimenopausal symptoms, all the problems you are facing can be due to anxiety as well. Mental tension itself can lead to many problems. It can also affect the fertility of a couple because the tubes in both men and women tend to go into spasm due to mental tension and anxiety. The reduced menstrual flow can also occur both due to hormonal changes as well as anxiety.

My suggestion is that first find out the days of ovulation by ultrasonography or basal body temperature and use those days for coitus.  If not investigated, both of you should undergo tests to find a cause for sterility. This would include tests for level of hormones for both, patency of fallopian tubes for you and sperm analysis of your boyfriend. 

The majority of reasons for infertility are treatable, though the results take time to appear. Try to be completely relaxed when together. You both can practice to relax by yoga and meditation. 

You are still young and can have a baby before menopause, just be relaxed and put in efforts in the right direction.

Dr. Rachna Pande is a Specialist in Internal Medicine at Ruhengeri Hospital