Premature menopause

It is easy to confuse this with the ‘premenopause’but they are in fact, two separate stages in the menopause process.

The pre-menopause is the name given to the early stages of the menopause –hence the use of the suffix ‘pre’.

Whereas premature menopause is a term used to describe a type of menopause which occurs before the age of 40.

The average age for the menopause is 51: but if you experience the symptoms of the menopause before your 40^th birthday then you are said to be going through a premature menopause.

Some women go through an early menopause in their 20’s and 30’s!

Is this normal? It is unusual but by no means uncommon. In fact, there are more cases of premature menopause occurs than you realise which is due to the reasons mentioned below.

If you are under 40 and suspect that you have started the menopause then see your GP. He or she will examine you and carry out a series of tests to determine this.

Causes of an early menopause

This can occur for a variety of reasons which include:

• Surgery, e.g. hysterectomy
• Autoimmune disease
• Genetics
• Infections, e.g. mumps
• Chemotherapy/radiation therapy
• Medical conditions

All of these can cause the ovaries to shut down earlier than normal which is known as ‘premature ovarian failure’. It can also trigger an early menopause as well.

Hysterectomy

One of the most common causes is that of a hysterectomy. If you have undergone surgery to remove your uterus, ovaries and Fallopian tubes or removal of the ovaries only then either of these will trigger an early menopause.

Removing the ovaries causes an immediate drop in oestrogen and progesterone levels. These female hormones play en important part if ovulation and the menstrual cycle but low levels of these can precipitate the menopause.

This can also happen if you have undergone surgery which has resulted in damage to the ovaries. The ovaries can dry up or start to fail, for example removal of an ovarian cyst or damaged blood vessels.

This affects the blood supply to the ovaries which prevents them from functioning as normal. This impairment can lead to total ovarian failure and the menopause.

Premature menopause also occurs in women who have undergone tubal ligation. Tubal ligation is the medical term for ‘having your tubes tied’and refers to the procedure in which a woman’s Fallopian tubes are tied off to prevent pregnancy.

Autoimmune disease

This is another common cause of a premature menopause.

There are diseases such as lupus, diabetes, thyroid disorder and rheumatoid arthritis which cause the immune system to turn upon itself. The immune system views your body as an invader and releases antibodies to deal with the threat.

The problem with this is that you may have antibodies present in your ovarian tissue or within the lining of the uterus known as the ‘endometrium’. These antibodies then attack your reproductive system and damage your ovaries.

If this occurs then it can lead to premature ovarian failure plus an early menopause.

Genetics

If you have a history of autoimmune diseases in your family or the female members have undergone an early menopause then you are likely to do the same.

This is not automatic but there is a high chance of you doing so.

Infections

Certain diseases such as mumps can cause menopause although for a short period of time only. But some infections such as malaria can lead to a full blown menopause.

But these tend to be rare.

Chemotherapy and/or radiation therapy

These are forms of treatment for cancer but they do have side effects. High doses of chemicals or radiation can damage the ovaries which then trigger a menopause.

There are some cases in which a woman receives low doses or short term treatment which stops the ovaries from functioning as normal. This then causes a temporary menopause.

But the ovaries return to normal, several months after the treatment has ended.

This also means a resumption of the menstrual cycle although she remains infertile.

Medical conditions

There are several conditions which can cause menopausal symptoms although this does not necessarily mean that you are going through the menopause.

These include:

• Cushing’s syndrome: a condition in which the adrenal glands become overactive which leads to a cessation of menstrual periods and a range of other symptoms. This can trigger an early menopause.
• Thyroid disorders such as under/over active thyroid: these cause symptoms which are similar to those experienced due to falling hormone levels. These symptoms include night sweats, weight gain and cessation of menstrual periods (known as ‘amenorrhea’) which are the same as those experienced during the menopause.
• Endocrine disorders, e.g. pituitary gland: diseases of the pituitary gland such as pituitary tumours can cause a cessation of periods which is usually associated with the menopause. However they may not experience any other menopausal symptoms. A woman with this disorder may find that she has low to normal FSH and LH levels but raised prolactin levels. This needs further investigation as it may indicate the presence of a tumour.
• Polycystic ovarian syndrome (PCOS): a disease in which tiny cysts form around the ovaries causing a range of symptoms which are very similar to those of the menopause. Examples include weight gain, irregular or skipped menstrual periods and mood swings.

Other causes of menopausal symptoms include skipped periods due to dramatic weight loss; excessive exercise and low body fat levels; contraceptive pills and certain types of medication.

Symptoms of premature menopause

These are much the same as those experienced by women undergoing a normal menopause and include:

• Night sweats
• Hot flushes
• Irregular periods
• Vaginal dryness
• Moodiness
• Insomnia

In many ways a premature menopause can be worse for younger women than those who experience the menopause in their late 40’s and 50’s.

Impact of premature menopause on your life

You expect to go through the menopause when you reach middle age and so view this as a natural part of growing older. So imagine the shock of discovering that you are experiencing this whilst still a young woman.

Your 20’s and 30’s are often considered the best years of your life and a time when you are having fun and enjoying yourself before thinking of settling down.

You may be thinking of starting a family at some point and to find that you are unlikely to do so whilst in your 20’s or 30’s is unexpected and unwelcome.

To be told that your reproductive capabilities are coming to an end much sooner than you expected and feeling as if you are the only one is devastating and can lead to depression.

What makes it worse is that you are completely unprepared for this. You expect this when you are older and so can come to terms with it but not when you are still a young woman.

These are the psychological effects of a premature menopause but there are physical aspects to take into account.

The main problem is to do with the protective effects of oestrogen: oestrogen protects the woman against a range of diseases which include osteoporosis and cancer.

Oestrogen levels fall during the menopause which means a loss of its protective effects and this causes an increased risk of these diseases.

This is expected in the latter years of life but a premature menopause means that you will experience this loss of protection for a larger part of your life than a woman who goes through a normal menopause.

It also means that not only are you exposed to the same risks; these are likely to be greater than for someone who experiences a normal menopause.

Specialist treatment is required in these cases to ensure careful management of the risks and to maintain reproductive capability.

Premature menopause or premature ovarian failure?

These two terms are often interchanged with each other and whilst there are some similarities between the two there are some differences as well.

Strictly speaking premature ovarian failure is similar to the menopause but is not the menopause. Confusion arises due to the fact that they both share the same symptoms, for example hot flushes and night sweats.

But, there are a few key differences between the two.

Premature ovarian failure versus premature menopause

What is important to remember is that premature ovarian failure (POF) does NOT mean a permanent loss of ovarian function.

A woman with POF still has menstrual periods although these tend to be irregular. The first signs of this are a shorter menstrual cycle which means more periods than usual but this does not apply to every woman.

There are women who have normal menstrual periods but display symptoms which we associate with low oestrogen levels and the menopause.

Premature ovarian failure (POF)

This is a condition in which some of the follicles within the ovaries do not function as normal which is a result of any of the reasons mentioned above. These include chemotherapy, surgery and autoimmune diseases.

Reduced follicle supply is often seen as an indicator of menopause but there are some women with this condition who have functioning follicles which enables them to ovulate although this can be sporadic.

In some cases they can even become pregnant.

If you have POF then you will have high levels of follicle stimulating hormone (FSH) and low oestrogen levels which are not normal for this condition.

But these are entirely normal for a menopausal woman.

Basically, if you have POF then you have the same hormone levels as a menopausal woman.

This is where it becomes confusing. You can be diagnosed with premature menopause when in fact, you have premature ovarian failure.

What makes this difficult is that fact that POF develops over time as a series of stages. It starts at an early stage known as ‘premature ovarian insufficiency’before progressing through stages 2 and 3 before it reaches stage 4 which is ovarian failure.

This is characterised by a cessation of menstrual periods and hormone levels which are similar to those seen in the post-menopausal stage.

This is one of the reasons why these two conditions are confused with each other.

It is difficult to determine the exact cause of premature ovarian failure as there may be several causes.

Your GP will perform a series of tests to check your FSH levels which will confirm or reject a diagnosis of POF. He or she will be able to tell you if you have POF or are going through an early menopause.