Premature Menopause

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When menopause occurs before 40 years, it is referred to as premature menopause. Menopause naturally occurs between the ages of 45 years to 55 years. Those occurring below 40 years are referred to as premature menopause while those occurring between 40 years and 45 years are referred to as early menopause.

This is irrespective of whether it occurs spontaneously or induced. While premature menopause affects about 1% of reproductive age women, early menopause affects about 5%. 

What are the risk factors for premature menopause?

  1. Surgery that removes both ovaries: ovaries are the source of reproductive hormones responsible for menstrual cycle. Once removed, hormone production ceases and menopause sets in. Women going for ovary removal due to certain health challenges should be aware of this.
  2. Surgery to remove the uterus: the uterus may be removed with the ovaries. This results in the scenario discussed in (i) above. However, when the uterus is removed alone and the ovaries are functional, only menstruation ceases while other functions of the ovaries are still sustained. If the blood supply of the ovaries is affected during the removal of the uterus, the ovaries may lose their functions too, resulting in menopausal symptoms.
  3. Chemotherapy for cancers: chemotherapy attacks the cells of the ovaries as well as other body cells. Depending on its effects on the ovaries, the ovaries may recover after the chemotherapy or not. This depends on the agents used and the duration of treatment.
  4. Pelvic irradiation: This follows radiotherapy to the pelvis for cancers localised in the pelvis. This radiation therapy may destroy the cells of the ovaries. 
  5. Smoking.
  6. Family history of premature ovarian failure: this is possibly genetic factor passed from parents to their offspring.
  7. Genetic conditions such as Turner’s syndrome: deficiency of genes that make eggs to germinate in the ovaries.
  8. Auto-immune diseases such as rheumatoid arthritis, inflammatory bowel disease: antibodies attacking normal body cells, including the ovaries.
  9. Medical condition such as HIV / AIDS, Mumps oophoritis (inflammation of the ovaries caused by Mumps): these destroy ovarian cells.

What are the symptoms of premature menopause?

These are the same as symptoms of natural menopause generally and they include:

  1. Hot flushes.
  2. Night sweats.
  3. Irregular menses later followed by missed periods.
  4. Vagina dryness, leading to discomfort during sex.
  5. Dry and wrinkled skin.
  6. Loss of urine control or frequent urination.
  7. Mood changes such as mood swing, anxiety, depression, irritability.
  8. Reduced sex drive.
  9. Weight gain.
  10. Difficulty in concentrating; forgetfulness.
  11. Sleeping difficulty.
  12. Gradual hair loss.

What is the treatment for premature menopause? 

Hormone replacement therapy is the management modality for premature menopause. It helps to replace the withdrawn hormones due to cessation of ovarian function. This may be necessary to reduce the complications of too early withdrawal of reproductive hormones.

Though a lot of safety concerns have been raised about hormone replacement therapy in women with natural menopause, these concerns do not necessarily apply to women with premature menopause as they do to women with natural menopause. In women with premature menopause, the benefits of treatment largely outweigh the risks.

What is the possibility of pregnancy in women with premature menopause?

In women with premature menopause with the ovaries still intact, occasional ovulation may occur, which may or may not be accompanied by menstruation. If sexual intercourse occurs during this period of ovulation, pregnancy is possible. Therefore, women with premature menopause who have no intention of getting pregnant may maintain their contraception till the average age of natural menopause.

For women who still desire to have children, they may benefit from assisted reproductive technology such as in vitro fertilization (IVF) with donor eggs, as ovulation to have natural conception may not be guaranteed. If you are in this category, discuss with a specialist to find out possible causes of the premature menopause and possibility of spontaneous ovulation or otherwise. 

What are preventive measures against premature menopause?

It may be difficult to prevent premature menopause since, in the majority of cases, it occurs due to genetic conditions. However, from the risk factors for this condition (some of which are amenable to change), a number of steps could be taken to prevent premature menopause. These include:

  1. Avoidance of smoking.
  2. Medical conditions such as HIV should be treated on time. This emphasizes the need for early diagnosis through testing.
  3. Before some chemotherapy drugs are given to women who may desire childbearing later, some eggs may be harvested and preserved by freezing for later use.
  4. For those who require irradiation to the pelvis as a result of cancer in the pelvis, the ovaries may be relocated somewhere up in the abdomen and shielded during the procedure so as to protect them from irradiation and preserve them. 
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