When menopause comes early

Menopause occurs when menstrual periods stop due to natural ovarian ageing. The average age of natural menopause is 51 years. Whenmenopause comes early before the age of 40, this is termed as premature menopause or premature ovarian failure (POF).

There is decreased activity in the ovaries, with little or no production of the female hormone oestrogen. Menstrual periods, therefore, stop prematurely. But the ovaries may still produce some oestrogens, and menstrual periods may return. Some women can even become pregnant after the diagnosis.

Missed periods

Natural causes of premature menopause include: Chromosomal defects (some parts of the female X chromosome may be missing), auto-immune diseases or simply genetic predisposition to earlymenopause as seen in some families.

Medical treatments like chemotherapy and radiotherapy can also damage the ovaries and cause pre-mature failure. Surgical removal of the ovaries leads to menopause right away, while hysterectomy (removal of the uterus) may predispose one to menopause setting earlier than expected.

Missed periods are usually the first sign of early menopause. Later symptoms may be similar to those of natural menopause and include; irregular bleeding, mood swings and hot flashes (a sudden feeling of warmth that spreads to the upper body).

In addition, there is vaginal dryness (making sex uncomfortable), worsening of bladder control, sleeplessness and decreased sex drive. Most women with POF cannot get pregnant naturally. Fertility treatments may help a few, while others may require donor eggs to have children. There is no current treatment that will restore normal ovarian function.

Any woman under 40 years experiencing such symptoms should be assessed to determine whether they are undergoing premature menopause. A medical examination and tests will be required to make a diagnosis, which has to be confirmed by a full female hormone profile. Some imaging studies may also be performed.

Hormone replacement

Women in premature menopause experience lowered oestrogen levels. Low levels of oestrogen can lead to changes in a woman’s overall health and may increase her risk for certain medical conditions, such as osteoporosis and cardio-vascular disease.

Compared with women who go through natural menopause, women undergoing pre-maturemenopause spend a greater portion of their lives without the protective benefits of their own oestrogen. This puts them at an even greater risk for menopause-related health problems.

The symptoms and health risks of premature menopause, as well as the emotional issues that may result from it, can be managed with the methods similar to those used for natural menopause. Oestrogen hormone replacement is advised till the expected age of natural menopause.

Additional beneficial lifestyle measures include: Stopping smoking, physical exercise and supplementary calcium and vitamin D. Psychological support is also important for women diagnosed with premature menopause, as it is usually irreversible and has life-long consequences.