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Premature menopause is menopause before the age of 40. Are you familiar with its causes, symptoms, and management options?

The menopause is, to most women in their twenties and thirties, an alien milestone they don't expect to reach until much later in life. If you're still busy having babies or using contraception to prevent pregnancy, you may even think of the menopause as something that makes one an "older woman".

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"Menopause" literally means the end of menstruation. It marks the end of a woman's reproductive life. The average American woman reaches the menopause at age 51, and though that timing varies, you don't generally expect to enter the menopause before age 40. When that does happen it is considered early and called a "premature menopause". Genetics, diseases and medical procedures can all lead to a premature menopause.

Would you recognize the symptoms of a premature menopause? Do you know what causes it? How would you cope?

What Causes A Premature Menopause?

Certain diseases — or their treatments — can lead to an early menopause while a woman is in her twenties or thirties. Affected women will usually be aware of this possibility, and will be prepared. But an early menopause can also come seemingly out of nowhere. Genetics may explain a spontaneous premature menopause in some cases, but the exact cause is not always clear. 

Chemotherapy or pelvic radiation therapy are cancer treatments that can cause damage to the ovaries while they kill cancer cells. This damage can cause an irreversible halt to menstruation — in other words, early menopause. The odds that chemotherapy or pelvic radiation will cause an early menopause depend on the exact treatment and the type of cancer. While younger women have a lower risk of going through the menopause following cancer treatment, all who would like to attempt to become biological mothers after their treatment should speak to their doctors about freezing their eggs for later fertility treatment. 

Surgery that removes the ovaries or uterus can also — quite obviously — affect a woman's reproductive life. 

Oophorectomy is the procedure that removes one ovary or both ovaries. Medical conditions that necessitate this procedure include a tubo-ovarian abscess, ovarian cancer, benign tumors or cysts, a twisted ovary, and endometriosis. Endometriosis is a condition in which the tissue that usually lines the ovaries also grows in other organs, including the ovaries. It can lead to damage and chronic pain. In some cases, an oophorectomy can be performed as a preventative measure, for women who have a particularly high risk for ovarian cancer. 

The removal of one ovary will not lead to a premature menopause, bot a bilateral oophorectomy will immediately cause a cessation of periods and other reproductive activity.

A hysterectomy, the removal of the uterus, is major surgery that is only used as a last resort. Uterine cancer, extremely heavy and painful periods caused by conditions such as Pelvic Inflammatory Disease or endometriosis, uterine prolapse and severe complications after childbirth can all make a hysterectomy necessary. 

If a woman's ovaries are not also removed when she has a hysterectomy, her hormone levels will remain normal and she will not enter the menopause. But she cannot have periods or get pregnant any more, because her uterus is gone. In some cases, a hysterectomy interferes with blood supply to the ovaries, and the woman will still have symptoms that mimic the menopause — most notably hot flashes. Women who had a hysterectomy may still enter the menopause a few years earlier than expected.

What if you didn't have any surgery but still notice perimenopausal symptoms much earlier than expected?

A family history of premature menopause increases the likelihood that it will happen to you, too. This is especially true if your mother entered the menopause early on. Certain autoimmune disorders can attack the ovaries and send a woman into premature menopause. Rheumatoid arthritis and thyroid disorders are examples.  Chromosomal disorders are yet another explanation for the premature menopause. Turner's Syndrome, lupus and Grave's Disease are examples of a chromosomal disorder that causes an early menopause. 

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