Premature Menopause: Causes, Symptoms, And Beyond

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".

"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.

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. 

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. 

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.

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. 

Premature Menopause: Symptoms And Beyond

Premature Menopause Symptoms

The symptoms of a premature menopause are identical to those of an average-timed menopause. Unless the menopause is the result of an oophorectomy, it will not commence suddenly — the menopause becomes official when a woman has not had menstrual periods for a full 12 months, and it is preceded by a transitional period called the perimenopause. 

The symptoms associated with the perimenopause are:

• Hot flashes — a hot sensation flashing across your upper body.

• Irregular periods, or less frequent menstruation.

• Other menstrual changes — your period may become lighter or heavier than before.

• Vaginal dryness. 

• Emotional symptoms including mood swings, irritability, depression and sleeplessness. 

• A decreased libido. 

• Dry skin.

These symptoms should signal you to have a chat with your doctor, even if you were already expecting a premature menopause. Many women find the symptoms of the perimenopause to be extremely challenging. There are numerous remedies that will help women manage the perimenopause more easily, however. They include Hormone Replacement Therapy (HRT) and herbal treatments. Your doctor will be able to advise you which of these methods are most suitable in your situation, if you wish to use any of them. 

We should note that irregular periods or a sudden change in the quantity or duration of menstrual flow can have other causes as well. The same holds true for a missed period — the easiest explanation is that you might be pregnant. 

Vaginal dryness, a decreased libido, mood swings, and even hot flashes can all have causes other than a premature menopause as well. Nobody should conclude that they are approaching the menopause based on any one symptom in isolation, and even the full range of symptoms can't immediately determine that you are dealing with a premature menopause. 

The diagnostic process will include a physical examination and blood tests to rule out other conditions or confirm a premature menopause. Your healthcare provider will want to measure your levels of the hormones estradiol and follicle-stimulating hormone (FSH) once other conditions like pregnancy and thyroid disease have been ruled out. 

Premature Menopause — What Now?

The ability to have children is a prime concern among women who are dealing with a premature menopause, regardless of the cause in their particular case. Egg freezing can offer many women the hope of having biological children even after they enter a premature menopause.

Those who are about to undergo chemotherapy, radiation treatment, or an oophorectomy will be aware of the challenges ahead. They can, in many cases, opt to have their eggs extracted and frozen prior to undergoing treatment. Women who are going through a more fluid, natural early menopause may still have ovarian reserves that can be harvested as well.

The egg-freezing procedure requires the use of fertility drugs routinely used in IVF. These stimulate as many eggs as possible to mature. Once that happens, the eggs are removed under sedation and cryopreserved in liquid nitrogen once their quality has been determined. Eggs can then be preserved for many years and used at a convenient time. In some cases, the woman will be able to carry a pregnancy to term herself, but surrogacy is another alternative. 

Women who have been diagnosed with a premature menopause also have some other medical issues to be aware of. A premature menopause caused a stop or steep decline in the production of the female hormone estrogen. This influences a woman's overall health negatively, and can place her at risk of medical conditions such as osteoporosis, periodontal disease, and certain cancers. Talk to your doctor to discuss ways in which you can protect your health.