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Menopause occurs when a woman stops ovulating and her monthly period (menstruation) ceases. Most women reach menopause between the ages of 45 and 55, with the average age around 50. However, about one per cent of women experience menopause before the age of 40 years. This is known as premature menopause or premature ovarian failure (POF).
In some cases, early menopause is brought on by surgery to remove the ovaries or by medical treatments such as radiation therapy and chemotherapy. In other cases, the woman’s ovaries spontaneously stop producing eggs and the underlying cause may not be found. For most women the loss of their fertility is devastating, particularly if menopause occurs before having children.
Most women will experience a long period of postmenopausal life. Hormone replacement therapy (HRT) – also known as hormone therapy (HT) – may be advised to counteract the health risks of early onset of osteoporosis and cardiovascular disease.
Symptoms
The symptoms of early menopause are the same as for menopause at any age and can include:
- Menstrual cycle changes, including changes to the usual bleeding pattern
- Hot flushes
- Sweats
- Urinary problems, such as incontinence or increased frequency of urination
- Dry vagina
- Mood changes
- Weight changes.
Induced menopause
Premature menopause can be specifically induced for medical reasons, such as cancer. For example, a woman with ovarian cancer may require surgery to remove the ovaries, with or without hysterectomy.
Early menopause can also be triggered by radiation therapy or chemotherapy. About one in two women treated for leukaemia or Hodgkin’s disease will experience premature menopause. In cases of premature menopause caused by cytotoxic treatments such as chemotherapy, the ovaries can sometimes start working again after a period of time. This depends on many factors including the woman’s age, the types of drugs used and the dosage.
A range of causes
Early menopause means the woman’s ovaries have spontaneously stopped working before she has reached the age of 40 years. Women can be affected in their teens or early 20s. Some possible causes include:
- Unknown causes – in the vast majority of cases, the cause can’t be found. This is known as idiopathic ovarian failure.
- Autoimmune conditions – about 10 to 30 per cent of affected women have an autoimmune disease such as hypothyroidism, Crohn’s disease, systemic lupus erythematosus or rheumatoid arthritis.
- Genetic conditions – such as familial ovarian failure (FOF) and galactosaemia. About five to 30 per cent of women have an affected female relative, which suggests a genetic link. Galactosaemia is when the body cannot convert the carbohydrate galactose into glucose. It is thought that the unconverted galactose could be toxic to the ovaries. Conditions characterised by enzyme problems, such as congenital adrenal hyperplasia, can also bring on premature menopause. Other genetic conditions, including Turner’s syndrome, can cause early menopause but this is usually evident before puberty. Fragile X syndrome may be another cause.
- Viral infections – the evidence is inconclusive but it is thought that a viral infection, such as mumps or cytomegalovirus, could trigger premature menopause in some women.
Diagnosis
Premature menopause is diagnosed using a number of tests including:
- Medical history, including family history.
- Investigations to rule out other causes of amenorrhoea (absence of periods). Other causes may include pregnancy, extreme weight loss, other hormone disturbances and some diseases of the reproductive system.
- Investigations into other conditions associated with premature menopause, such as autoimmune diseases.
- Genetic tests to check for the presence of genetic problems associated with premature menopause.
- Blood tests at various stages of the menstrual cycle to check hormone levels.
Treatment
There is no treatment available to make the ovaries start working again.
Women with early menopause have a long period of postmenopausal life, which means they are at increased risk of health problems such as osteoporosis and heart disease. It may be recommended that hormone replacement therapy (HRT) be taken until the woman reaches the typical age of menopause (around 50 years).
Psychological counselling and support groups may help the woman come to terms with her experience.
Sometimes the ovaries may spontaneously start working again, for reasons unknown. According to some studies, about one in 10 women who are diagnosed with spontaneous premature menopause get pregnant, for reasons that are not yet clear.
The emotional impact
Premature menopause can be emotionally devastating. Some of the common issues a woman may face include:
- Grief at the prospect of not having children
- Fear of growing old before her time
- Fears that her partner won’t find her sexually attractive anymore
- Self-esteem problems.
Psychological counselling and support groups may help the woman come to terms with her experience.
Where to get help
Things to remember
- Early menopause is menopause that occurs before the age of 40 years.
- Early menopause can be induced by some medical treatments such as surgery or chemotherapy.
- Women who experience early menopause may need hormone replacement therapy to reduce the risk of diseases such osteoporosis.
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