Premature Menopause

PREMATURE 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 therapy, or surgical removal of the ovaries
  • The symptoms of premature menopause include mood swings, vaginal dryness, cognitive changes, hot flushes, decrease in sex drive, sleep disturbances. Symptoms are the same as those of menopause that occurs later in life.
  • Diagnostic tests can show an elevated level of follicle stimulating hormone (FSH) and low levels of oestrogen
  • 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

What is Premature Menopause?

Menopause is a 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 a natural menopause is 51.  There is a wide variation amongst women regarding the timing of normal menopause.

What Causes Early Menopause?

As previously mentioned, menopause before the age of 40 is considered to be premature or early menopause.  One medical cause for premature menopause is known as premature ovarian failure.  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 results in premature menopause if both ovaries are removed.  Surgery to remove the uterus and preserving the ovaries 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 disease, pituitary and hypothalamic tumours, psychiatric disorders, other relatively rare or undefined conditions.

Risk factors for Early Menopause

Premature ovarian failure affects one out of every thousand women from age 15 to 29 and about one out of every hundred women aged between 30 and 39.  It can be related to genetic (inherited factors) such as fragile X syndrome and illnesses such as autoimmune diseases.  It may also be unexplained.  The risk of premature ovarian failure increases in women who have relatives with the condition.

Signs and Symptoms of Early Menopause

Symptoms of premature menopause are those of typical menopause.  They can include:

  • Mood swings
  • Vaginal dryness
  • Changes in cognition and memory
  • Hot flushes
  • Weight gain
  • Night sweats
  • Vaginal pain during intercourse due to the thinning of vaginal skin and dryness
  • Reduced libido

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

How is Early Menopause Diagnosed?

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.  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 oestrogen so levels of this hormone rise when oestrogen levels drop.

Treatment to Relieve Sign and Symptoms

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 treatment for symptoms include:

  • Hormone therapy is available in different forms including pills, patches, transdermal sprays, gels or creams. Localised hormone treatments are also available for intravaginal use.  Hormone therapy is the most effective way to control symptoms, such as hot flushes and vaginal dryness
  • Antidepressant medications – the selective serotonin reuptake inhibitors (SSRIs) and related medications have been shown to be effective in controlling the symptoms of hot flushes in up to 60% of women
  • Oestrogen creams and pessaries as well as non-hormonal vaginal gels, creams and lubricants can help prevent the symptoms of vaginal dryness
  • Assisted reproductive technologies; in selected cases pregnancy may be achieved using donor eggs in women with premature menopause

What are the complications of 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 oestrogen levels.  Women with premature menopause have a longer time period of their life of decreased oestrogen production and this in turn increases their risk for low bone density.  This risk may be offset by taking calcium and vitamin D supplements, in consuming plenty of dietary calcium and obtaining weight bearing exercises.

What is the outlook for a woman in early menopause?

The prognosis for women with premature menopause is related to the circumstances and causes 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 an increased risk of osteoporosis as mentioned above.  These women may also be susceptible to cardiovascular disease in later life although this risk has not been fully studied.

Dr Len Kliman is one of Melbourne’s most experienced obstetricians and gynaecologists.

With over three decades of experience, Dr Kliman has delivered over 20,000 babies and treated tens of thousands of gynaecological patients.

In 2017, Dr Kliman was awarded an Order of Australia (OAM) for his services to obstetrics and gynaecology.