DEAR DR. DONOHUE: What is the age of menopause? I am only 40, and I think I am entering it. This is too young, isn’t it? My mother says that many of her friends had their menopause at my age. I believe it’s unusual. None of my friends is having symptoms of it.

I am not pregnant. I have had three children, and I know the signs of pregnancy. I also took a pregnancy test. – D.K.

The average age for menopause is 51, and it has remained at that age for a long time, even in your mother’s day. Its definition is one full year of no periods, along with typical menopausal symptoms, like hot flashes.

Menopause before 40 is considered premature, and a search for causes should be made. Even at 40, an effort ought to be made to look for some of the many causes of early menopause.

Cigarette smoking lowers the age for menopause. A number of inherited conditions are responsible for it. Infections of the ovary are a possibility. Pituitary gland disturbances can be responsible. The pituitary gland is a small gland at the base of the brain that directs the production of many hormones, including the production of female hormones essential to having periods and ovulation. An underactive thyroid gland is another cause for early menopause.

Even things that appear to be quite normal can bring on the cessation of periods. Weight loss is an example.

You should report this to your doctor. Another important consideration enters the picture. If you are menopausal at this age, you are going to have years and years of no estrogen. That makes osteoporosis loom large. So this is an issue you should not neglect.

The pamphlet on menopause goes into this topic more thoroughly. Readers can obtain a copy by writing: Dr. Donohue, No. 1103, P.O. Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: You wrote an item entitled “Connective Tissue Diseases Explained.” You listed five conditions. I was shocked not to see Ehlers-Danlos syndrome included. I have it, and it has forced me to leave the teaching profession, caused my husband to take many weeks off work to care for me and has me presently fighting to walk. – E.S.

That item was about the acquired connective tissue diseases. I didn’t mention any of the inherited connective tissue diseases, of which Ehlers-Danlos syndrome is one.

Connective tissues include skin, cartilage, blood vessels, bones and tendons. E-D is an inherited condition. Because of it, the skin is very elastic and can stretch far beyond the limits of normal skin. It’s also easily damaged. Joints are so loose that people can assume extreme positions with their arms and legs. Joints can be dislocated. Blood vessels are fragile and break easily.

There are many varieties of this illness, and you appear to have one of the serious ones. I am more than happy to pass on the Web site you provided for the Ehlers-Danlos Foundation:

DEAR DR. DONOHUE: My fiance has a skin condition called Darier’s disease. Can you give me information on it? – L.H.

Darier’s is inherited. It begins with brown, flat skin dots that often itch. The dots merge into crusted patches found on the neck, face, shoulders, arms, legs, chest and middle back. It’s lifelong. It worsens in the summer, but sunscreens can prevent flare-ups.

There are a number of lotions, creams and oral medicines for it. Cortisone skin medicines are often prescribed. Acne medicines also are used. For large, resistant lesions, dermabrasion, laser vaporization and excision with skin grafts are options.

DEAR DR. DONOHUE: I have COPD (60 years of smoking). I have been advised to stay away from people in supermarkets, theaters, concerts and churches, especially churches where there is lots of touching – shaking hands and hugging. What is your opinion of this? – A.S.

ANSWER: Chronic obstructive pulmonary disease consists of emphysema or chronic bronchitis or both. If your doctor has given you this advice, I’m in no position to challenge it.

However, most people with COPD don’t have to go to such extremes to avoid coming down with respiratory infections. They can protect themselves, if need be, by not partaking in handshaking or hugging, but they still can frequent public gatherings. Frequent hand-washing gets rid of most germs. A yearly flu shot protects you from that infection. The pneumonia shot prevents the most serious kind of bacterial pneumonia. Those precautions allow most COPD patients to have an active life.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from

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