Endless POFibilities -- September 1999

Early Menopause is Her Cause
She Seeks to Raise Awareness of Condition
By Susan Steinmueller
Staff Writer
as published in The Observer & Eccentric / Thursday, April 8, 1999

Beth Hockman, 30, has always been fit and athletic.

At Seaholm High School in Birmingham, she was a competitive gymnast. Today, as an Outward Bound instructor based in North Carolina, she leads groups in such challenging activities as white water rafting.

But ironically, it was her physical lifestyle that caused her to live for years with a misdiagnosed, potentially debilitating condition she now knows as "premature ovarian failure", or in effect, early menopause.

"One doctor said because I was in the woods and hiking and so forth, my body was responding as such. She said once you act more feminine, you'll be fine," she recalls.

Today, Hockman is on hormone replacement therapy to correct symptoms of the condition, which include bone loss and damage to the heart caused by lack of the hormones estrogen and progesterone. And, she is dedicated to helping educate others about it. That's why she agreed to an interview while on a recent visit home.

"My big goal with this article is just education, so people do not have to go through what I did," said the ebullient Hockman, speaking at the Birmingham home of her parents, Geoffrey and Mixie Hockman. She also has two brothers, Jason and Geoff.

While it is a relatively unknown condition, it is not a rare one, she added.

"According to studies, one in 1000 women get it before age 29, and one in 100 in their thirties."

Traveling lifestyle

Hockman first noticed the condition as a 20-year old student at Michigan State University. Doctors, however, said it was due to "exercise induced amenorrhea," in which an active woman ceases to have menstrual periods.

When she was a junior, she took an Outward Bound course in Washington and California, "a defining moment in my life." She went on to get a graduate degree at Mankato State, and eventually became an Outward Bound instructor.

A lifestyle of traveling -including three months in New Zealand- did not help.

"The problem with my lifestyle, was not having an address or roots. I didn't have a doctor I felt comfortable with. I think that helped in my denial."

While she did see other doctors, she was again misdiagnosed.

In graduate school, blood work showed a possible clue of early menopause -she had elevated levels of follicle stimulating hormone, she said. The FSH hormone is produced by the pituitary gland, an stimulates the follicles in the ovary. But it was not looked into further.

Compounding her difficulties were "my other frustration -our health insurance system."

For instance, at Outward Bound, her new insurance policy said she could start getting treatment for her "exercise induced amenorrhea" after two years. But after two years, the insurance group refused to pay for treatment. Hockman finally found a way to get the tests covered.

But she did find good doctors along the way, she said. One is a homeopathic doctor she started seeing right after graduate school. The doctor prescribed homeopathic remedies, after which her monthly cycle started again.

And, she praises her doctor now, reproductive endocrinologist Dr. David Brinton, M.D., a West Bloomfield resident practicing at the Center for Fertility and Reproductive Endocrinology in Royal Oak. She advises those who suspect POF to "go straight to a reproductive endocrinologist."

Emotional toll

Her years of searching and suspecting, however, did not make it any easier when the final diagnosis came from Brinton some three years ago. One of the biggest losses of the condition in that there is just a slight chance of natural pregnancy, which studies place at 8 percent.

"That was when I got my final diagnosis of infertility. I just lost it in his office," she said. "It was hard."
Making it harder, "At that point, for the first time in my life, I was also seeing someone."

But, she said, that Dr. Brinton "was great".

"He said, there are many ways to be a mother. He said, you're fortunate, because your uterus is still healthy." So, there is a chance, for instance, that she could carry a donor egg.

As for the slight chance that she could become pregnant naturally, she said, "I have a realistic hope. You can reach for the stars, but keep your feet on the ground."

Her boyfriend, Greg Gillett, 29, also an Outward Bound instructor and a South African citizen, was also very comforting and supportive.

"He said, the most important thing a person passes on is spirit. And that's not genetic, that's something you give. It's okay to have sad moments. I think you have to let yourself grieve for the children you will never be able to have and then move on."

Hockman said adoption is also a definite possibility when she decides to start a family.

Tests needed

When reached for comment, Brinton said that the condition in one that is sometimes overlooked.
"It should be diagnosed more than what it is, but it takes the appropriate tests to do it," he said. "There are blood levels that will tell you what is going on. Many women in a younger age group are not ovulating for other reasons, it takes the right tests to tell."

In Beth's case, it is hard to tell whether she was not ovulating for reasons other than POF when she was previously tested, he said.

Brinton said there are various causes for the condition.

"A woman is born with all the eggs she will ever have," he said. Some women use them up faster, some are born with fewer eggs, which are among the causes.

"There are some cases where there has been a spontaneous resumption of ovulation," he said of the condition and getting pregnant, but "they are fairly unusual."

Beth would be a "great candidate" for carrying a donor egg, he said.

"The important thing to know is, it happens to nice people too, but there are options."

Once the condition is diagnosed, it's also important to get treatment for health risks resulting from it, he added.

For instance, the loss of estrogen must be addressed, he said. Estrogen is produced as an egg is brought to maturity and is important in several ways such as cholesterol and heart and bone health, he said.

Treatment

Hockman is now taking synthetic estrogen and progesterone.

"Estrogen is what protects our heart and our bones," she said. "The only thing (synthtic) estrogen puts you at risk for is breast cancer. But the stuff I have read is, it's a small risk" compared to not taking it.
She continues her active lifestyle, noting that paid off in that she has suffered little damage physically despite going for years with little estrogen.

"The only place where I had low bone density was in my spine," she said. "Lifestyle is so important."
And she continues to research and study the condition. Last year, she spent a week at the National Institute of Health in Bethesda, Md., where doctors are studying the condition. "You get the best treatment there," she said.

She is also a member of a support group started in 1995 in the Washington, D.C. area for those with the condition. And, her plans include an eight-day Outward Bound for P.O.F. diagnosed women in October.

"Life is going to throw us these disabilities, but they can also contain opportunities," she said.

Beth Hockman's e-mail address is Hockwoman@hotmail.com.

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