Premature Menopause

Age is the most common factor that influences menopause.

• When menopause occurs before the age of 40, it is referred to as premature menopause.
• One medical cause of premature menopause is premature ovarian failure.
• Other causes of premature menopause include damage to the ovaries by chemotherapy and/or radiation treatments or surgical removal of the ovaries.
• The symptoms of premature menopause include mood swings, vaginal dryness, cognitive changes, hot flashes, a decrease in sex drive, and sleep disturbances. Symptoms are the same as those of menopause, which occurs later in life.
• Diagnostic tests can show an elevated level of follicle-stimulating hormone (FSH) and a low level of estradiol.
• There is no treatment that can reverse or prevent premature menopause.
• Hormone therapy and other treatments are available to help relieve the symptoms of premature menopause.
• Complications of premature menopause include infertility and an increased risk of osteoporosis.

Menopause is not a disease but rather the point in a woman's life at which she is no longer fertile and menstrual periods have ceased.

Menopause is the time in a woman's life when menstrual periods cease. It is defined medically as the absence of menstrual periods for 12 consecutive months. The average age for natural menopause is 51. Sometimes, menopause occurs earlier, due to diseases, genetic factors, or surgery. There is also a wide variation among women regarding the timing of normal menopause.

As mentioned previously, menopause before the age of 40 is considered to be premature, or early, menopause. One medical cause of premature menopause is known as premature ovarian failure. Technically, premature ovarian failure is not the same as premature menopause. In premature ovarian failure, the ovaries stop functioning normally before the age of 40. Women with premature ovarian failure may still occasionally have menstrual periods, but they typically experience infertility. Premature ovarian failure is usually accompanied primary ovarian insufficiency. Premature ovarian failure is usually accompanied by the symptoms of premature menopause.

Premature menopause can also be caused by treatments for cancers or other conditions that involve chemotherapy and/or radiation therapy to the pelvis. These treatments can damage the ovaries and result in ovarian failure.

Surgery to remove the ovaries, either for benign or malignant conditions, results in premature menopause if both ovaries are removed. Surgery to remove the uterus results in menopause only in the sense that menstrual bleeding does not occur. In that case, the ovaries will continue to produce hormones.

Other infrequent causes that may lead to premature menopause include drugs, chronic diseases, pituitary and hypothalamic tumors, psychiatric disorders, and other relatively rare or undefined conditions.

Premature ovarian failure affects about one out of every 1000 women from ages 15 to 29 and about one out of every 100 women aged 30-39. It can be related to genetic (inherited) factors, illnesses like autoimmune diseases, thyroid disease, viral infection, hormonal disorders, and eating disorders. The risk of premature ovarian failure risk increases in women who have relatives with the condition.

Women at risk for surgical or treatment-induced menopause are those who are undergoing treatment for cancer or other conditions that require surgical removal of the female organs.

Menstrual irregularity (irregular periods) is a common symptom that women may experience during perimenopause.

The symptoms of premature menopause are those of typical menopause. They can include:

• Mood swings
• Vaginal dryness
• Changes in cognition and memory
• Hot flashes
• Diminished desire for sex
• Sleep disturbances
• Weight gain
• Night sweats
• Vaginal pain during intercourse

Irregular periods usually precede menopause and can begin years before periods actually cease.

No special tests are needed to determine the absence of menstrual periods, but sometimes women begin having symptoms of menopause and irregular periods. At that point, they may be tested to determine their ovarian function. For example, tests may be done to rule out pregnancy or other causes of missed menstruation, such as certain thyroid diseases. The level of follicle-stimulating hormone (FSH) is often measured in the blood to determine whether a woman is nearing menopause and to ascertain the functional status of her ovaries. FSH stimulates the ovaries to produce estrogen, so levels of this hormone rise when estrogen levels drop. FSH levels that are higher than 40 mIU/ml are considered diagnostic of the menopause. Levels of ovarian hormones, such as estradiol, may be also measured, as low levels (levels less than 32 pg/ml) are suggestive of menopause.

There is no treatment that can reverse or prevent premature menopause. However, women who have reached menopause do have treatment options that can help control unpleasant symptoms.

Types of treatments for symptom relief include the following:

• Hormone therapy: Hormone therapy (HT, or estrogen therapy, ET) is available in different forms including pills, patches, transdermal sprays, or gels or creams. Localized hormone treatments are also available for intravaginal use. HT/ET is the most effective way to control symptoms like hot flashes and vaginal dryness. Because HT/ET has been associated with certain health risks (heart attack, stroke, and breast cancer), experts recommend using the lowest effective dose of hormone therapy for the shortest period of time necessary for symptom control.
• Oral contraceptive pills are a form of HT that is sometimes used to help relieve menopausal symptoms.
• Antidepressant medications: Selective serotonin reuptake inhibitors (SSRIs) and related medications have been shown to be effective in controlling the symptoms of hot flashes in up to 60% of women.
• Non-hormonal vaginal gels, creams, and lubricants can help prevent the symptoms of vaginal dryness.
• Assisted reproductive technologies: In select cases, pregnancy may be achieved using donor eggs in women with premature menopause.

Women with premature menopause are faced with the challenges of infertility if they desire pregnancy. This can be accompanied by feelings of emotional distress and depression.

There is also an increased risk of osteoporosis in women with low estrogen levels. Women with premature menopause have a longer time period of their life of decreased estrogen production and this, in turn, increases their risk for low bone density. This risk may be offset by taking calcium and vitamin D supplements, consuming plenty of dietary calcium, and obtaining weigh-bearing exercise.

The prognosis for women with premature menopause is related to the circumstances and cause of the condition. If premature menopause occurs due to surgery or cancer treatments, the prognosis is related to the underlying reasons for these treatments. Women with premature ovarian failure for undefined causes may be at increased risk for osteoporosis, as mentioned above. These women may also be susceptible to cardiovascular disease in later in life, although this risk has not been fully studied.