Early Menopause

Menopause is the stage where a natural decline occurs in the production of female reproductive hormones, called estrogens. At menopause, the ovaries of a female stop working and the normal menstrual cycle stops, due to which the female can’t get pregnant anymore. This is a natural, irreversible phenomenon which usually occurs at the age of 40s or 50s. But what happens if the ovaries stop working before the age of 40? It results in infertility. This condition is called Early Menopause or Premature Ovarian Failure.

Early menopause can occur due to many reasons:

  • Premature Ovarian Insufficiency (POI): It is the condition where the functioning of ovaries stops leading to early menopause. There are some possibilities of normal ovarian function after some time in few cases.
  • Induced Menopause: Occurs due to medical treatments such as chemotherapy and pelvic radiation treatments that damage the ovaries and reduce their functioning and estrogen production.
  • Surgical Treatments: Surgical treatments such as oophorectomy (removal of both the ovaries) and hysterectomy (removal of uterus) lead to early menopause. In case of oophorectomy, menopause may be seen right away and in hysterectomy, the hormones will be produced as the ovaries will be functioning normally but they no longer have menstruation.
  • Genetics: A female with a familial history is more likely to have an early menopause.
  • Chromosome Defects: Chromosomal defects such as Turner’s syndrome and fragile X syndrome may also lead to early menopause.
  • Autoimmune Diseases: Some autoimmune diseases such as thyroid disease, type 1 diabetes, Chron’s disease, celiac disease, chronic candidiasis and rheumatoid arthritis also cause early menopause.
  • Metabolic Disorders: Some metabolic disorders such as galactosaemia and aromatase deficiency can cause early menopause.
  • Epilepsy: Females with epilepsy are more likely to experience premature ovarian failure.
  • Infections: Infections such as mumps, tuberculosis, malaria, and chickenpox
  • Women with smoking habits and low body mass index (BMI) also have chances of early menopause.

Irregular or missed periods are the first and the early menopause symptoms. Sometimes, heavier or lighter periods than usual may also be experienced. Some of the symptoms of early menopause include:

  • Hot flashes
  • Vaginal dryness
  • Bladder irritability
  • Dryness of skin, mouth, and eyes
  • Mild depression
  • Mood swings
  • Decreased sex drive
  • Insomnia
  • Changes in cognition
  • Anxiety
  • Night sweats
  • Fatigue

Early menopause can cause challenges in fertility and desired pregnancy. Some other risks that are associated with early menopause are osteoporosis, depression, cardiovascular diseases, symptoms of Parkinson’s disease, dementia, colon cancer, ovarian cancer, cataract, and periodontal diseases.

Decreased estrogen levels in turn decreases bone density leading to osteoporosis. This can be prevented by taking calcium rich diet and vitamin D supplements. Cardiovascular diseases can be prevented by lifestyle changes, healthy diet, and regular exercises.

Diagnosis can include physical examination and some of the following tests

  • Pregnancy Test: helps to determine if pregnancy might be the cause of missed periods
  • Thyroid Test: It is recommended as it can also be a cause of early menopause.
  • Follicle-Stimulating Hormone (FSH) Test: FSH test is performed to ascertain the functional status of ovaries. FSH stimulates the production of estrogen. Reduced estrogen levels can make the FSH levels to be increased. Higher than 40 mIU/ml of FSH level is considered menopause.
  • Ovarian Hormones levels Test: Estradiol is an ovarian hormone. Less than 32 pg/ml of estradiol indicates menopause.
  • Prolactin Test: Prolactin is the hormone that is involved in the production of breast milk. Increased levels of prolactin can stop periods.
  • Transvaginal Ultrasound: This test is performed to assess the functioning of the ovaries. The number and size of the follicles or eggs in the ovaries are counted and the volume of the ovaries is measured. The thickness of the lining of the uterus or endometrium is measured. Any blockage that is stopping menstrual blood flow is assessed.

There is no treatment that can reverse or prevent early menopause. Some treatments options are recommended to relieve the symptoms of early menopause. The early menopause treatment options include:

Hormone Therapy (HT): Hot flashes and vaginal dryness can be controlled effectively by hormone therapy. Estrogen is induced in to the body in different forms such as pills, patches, transdermal sprays, gels or creams. Localized treatment is also available for intravaginal use. HT is recommend for short term use as it is associated with certain risks like heart attack, stroke, and breast cancer.

Antidepressant Medications: The selective serotonin reuptake inhibitors are proven effective in controlling hot flashes in 60% of women with early menopause.

Vaginal dryness can be treated by non-hormonal vaginal gels, creams, and lubricants.

Infertility can be overcome by assisted reproductive techniques.