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Menopause - premature and early

menopause

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Menopauseoccurswhenawomanstopsovulatingandhermonthlyperiod(menstruation)ceases.
Mostwomenreachmenopausebetweentheagesof45and55,withtheaverageagearound51.
However,aboutonepercentofwomenexperiencemenopausebeforetheageof40years.Thisis
knownasprematuremenopauseorprematureovarianinsufficiency(POI).Menopausebetween41
and45yearsofageiscalledearlymenopause.
Insomecases,earlymenopauseisbroughtonbysurgerytoremovetheovariesorbymedical
treatmentssuchasradiationtherapyandchemotherapy.Inothercases,thewomansovaries
spontaneouslystopproducingeggsandtheunderlyingcausemaynotbefound.Formostwomen,
thelossoftheirfertilityisdevastating,particularlyifmenopauseoccursbeforetheyhavehad
children.
Mostwomenwillexperiencealongperiodofpostmenopausallife.Hormonetherapy(HT)also
knownashormonereplacementtherapy(HRT)maybeadvisedtocounteractthehealthrisksof
earlyorprematuremenopausesuchasearlyonsetofosteoporosisandcardiovasculardisease.

Symptoms of premature and early menopause

Thesymptomsofearlymenopausearethesameasformenopauseatthetypicalageandcan
include:

menstrualcyclechanges,includingchangestotheusualbleedingpattern,particularly
irregularbleeding
hotflushes
sweats
urinaryproblems,suchasincontinenceorincreasedfrequencyofurination
dryvagina
moodchanges
weightchanges
achesandpains.

Causes of early or premature menopause

Prematuremenopausemeansthewomansovarieshavespontaneouslystoppedworkingbefore
shehasreachedtheageof40years.Womencanbeaffectedintheirteensorearly20s:Aboutone
in1,000womenmayreachmenopausebeforetheageof30.
Somepossiblecausesinclude:

Unknowncauses inthevastmajorityofcases,thecausecantbefound.Thisisknownas
idiopathicprematuremenopause.
Autoimmuneconditionsabout10to30percentofaffectedwomenhaveanautoimmune
diseasesuchashypothyroidism,Crohnsdisease,systemiclupuserythematosusor
rheumatoidarthritis.
Geneticconditionssuchasfamilialovarianfailure(FOF)andrarelygalactosaemia.About
fiveto30percentofwomenhaveanaffectedfemalerelative,whichsuggestsagenetic
link,suchas:
Galactosaemiaiswhenthebodycannotconvertthecarbohydrategalactoseintoglucose.It
isthoughtthattheunconvertedgalactosecouldbetoxictotheovaries.
Conditionscharacterisedbyenzymeproblems,suchascongenitaladrenalhyperplasia,can
alsobringonprematuremenopause.

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Othergeneticconditions,suchasTurnerssyndrome,whereachromosomalabnormality
cancauseearlymenopause,butthisisusuallyevidentbeforepuberty.FragileXsyndrome
maybeanothercause.
Viralinfectionstheevidenceisinconclusive,butitisthoughtthataviralinfection,such
asmumpsorcytomegalovirus,couldtriggerprematuremenopauseinsomewomen.

Induced menopause
Menopausecanbespecificallyinducedformedicalreasons,suchascancersurgery.Forexample,a
womanwithovariancancerwillrequiresurgerytoremovetheovaries.
Earlymenopausecanalsobetriggeredbyradiationtherapyorchemotherapy.Aboutoneintwo
womentreatedforleukaemiaorHodgkinsdiseasewillexperiencemenopauseearly.
Incasesofprematuremenopausecausedbycytotoxictreatmentssuchaschemotherapy,the
ovariescansometimesstartworkingagainafteraperiodoftime.Thisdependsonmanyfactors,
includingthewomansage,thetypesofdrugsusedandthedosage.Chemotherapyforbreast
cancerinpremenopausalwomenmayalsoleadtoearlymenopause.

Diagnosis of premature or early menopause

Prematureandearlymenopauseisdiagnosedusinganumberoftestsincluding:

medicalhistory,familyhistoryandmedicalexamination
investigationstoruleoutothercausesofamenorrhoea(absenceofperiods),suchas
pregnancy,extremeweightloss,otherhormonedisturbancesandsomediseasesofthe
reproductivesystem
investigationsintootherconditionsassociatedwithprematureorearlymenopause,suchas
autoimmunediseases
geneticteststocheckforthepresenceofgeneticproblemsassociatedwithprematureor
earlymenopause
bloodtestsatvariousstagesofthemenstrualcycletocheckhormonelevels.

Treatment for early or premature menopause

Thereisnotreatmentavailabletomaketheovariesstartworkingagain.
Womenwithearlymenopausehavealongperiodofpostmenopausallife,whichmeanstheyareat
increasedriskofhealthproblemssuchasearlyonsetofosteoporosisandheartdisease.
Itmayberecommendedthathormonetherapy(HT)betakenuntilthewomanreachesthetypical
ageofmenopause(around51yearsold)totreathermenopausalsymptomsandtoreducetherisk
ofearlyonsetofosteoporosisandheartdisease.
Rarely,theovariesmayspontaneouslystartworkingagain,forreasonsunknown.Accordingto
somestudies,aboutonein10womenwhoarediagnosedwithspontaneousprematuremenopause
getpregnant,forreasonsthatarenotyetclear.

Emotional impact of early or premature menopause

Prematuremenopausecanbeemotionallydevastating.Someofthecommonissuesawomanmay
faceinclude:

griefattheprospectofnothavingchildren
fearofgrowingoldbeforehertime
fearsthatherpartnerwontfindhersexuallyattractiveanymore
self-esteemproblems.

Psychologicalcounsellingandsupportgroupsmayhelpthewomancometotermswithher
experience.

Where to get help

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Yourdoctor
Gynaecologist
JeanHailesforWomen'sHealthTel.1800JEANHAILES(532642)

Things to remember

Prematuremenopauseismenopausethatoccursbeforetheageof40years.
Earlymenopausecanbeinducedbysomemedicaltreatmentssuchassurgeryor
chemotherapy.
Womenwhoexperienceearlyorprematuremenopausemayneedhormonetherapyto
reducetheriskofdiseasessuchasosteoporosis.

This page has been produced in consultation with, and approved by:

JeanHailesforWomen'sHealth
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