Premature Menopause

Definition

The average age at which American women go through menopause is 51 years. If menopause (hormonal changes at the end of the female reproductive years) occurs before age 40, it is said to be premature menopause. Possible causes include autoimmune problems and common cancer treatments.

Description

About half of all women will go through menopause before age 51 and the rest will go through it after. Most women will finish menopause between the ages of 42 and 58. A small number of women will find that their periods stop prematurely, before age 40.

Causes and symptoms

There are many possible causes of premature menopause. Women who have premature menopause often have autoimmune disorders like thyroid disease or diabetes mellitus. In these diseases, the body produces antibodies to one or more of its own organs. These antibodies interfere with the normal function of the organ. Just as antibodies might attack the thyroid or the pancreas (causing thyroid disease or diabetes), antibodies may attack the ovaries and stop the production of female hormones.

Cancer treatments like chemotherapy or radiation can cause premature menopause. The risk depends on the type and length of treatment and the age of the woman when she first begins radiation or chemotherapy.

If the ovaries are surgically removed (during a hysterectomy, for example) menopause will occur within a few days, no matter how old the woman is.

The symptoms of premature menopause are similar to those of menopause at any time. Menstrual periods stop and women may notice hot flashes, vaginal dryness, mood swings, and sleep problems. Sometimes the first symptom of premature menopause is infertility. A woman may find that she cannot become pregnant because she is not ovulating (producing eggs) anymore.

When menopause occurs after the ovaries are surgically removed, the symptoms begin within several days after surgery and tend to be more severe. This happens because the drop in the level of estrogen is dramatic, unlike the gradual drop that usually occurs.

Diagnosis

Premature menopause can be confirmed by blood tests to measure the levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH). The levels of these hormones will be higher if menopause has occurred.

Because premature menopause is often associated with other hormonal problems, women who have premature menopause should be screened for diabetes, thyroid disease, and similar diseases.

Treatment

There is no treatment to reverse premature menopause. Hormone replacement therapy (HRT) can prevent the common symptoms of menopause and lower the long-term risk of osteoporosis. Women who have premature menopause should take HRT. Estrogen relieves the unpleasant symptoms of menopause, including the hot flashes and the vaginal dryness. Estrogen is especially important for women who go through premature menopause. The long-term health risks of menopause (osteoporosis and increased risk of heart disease) are even more likely to occur after premature menopause. However, women who have certain medical conditions (like liver disease, uterine cancer, or breast cancer) may not be candidates for estrogen.

If a woman still has her uterus after premature menopause, she will also need to take progesterone along with the estrogen. If her uterus has been removed, estrogen alone will be enough.

Women who wish to become pregnant after premature menopause now have the option of fertility treatments using donor eggs. This is similar to in vitro fertilization, but the eggs come from a donor instead of the woman who is trying to become pregnant.

Prevention

Premature menopause cannot be prevented.

Resources

BOOKS

Hall, Janet E. "Amenorrhea." In Primary Care of Women, edited by Karen J. Carlson and Stephanie A. Eisenstat. St. Louis: Mosby-Year Book, Inc., 1995.

KEY TERMS

Autoimmune diseases— Diseases in which the body creates antibodies that attack one of its own organs.

Follicle stimulating hormone (FSH)— A female hormone that regulates ovulation and menstruation.

Hormone replacement therapy (HRT)— Replacement of estrogen and progesterone lost by women who have gone through menopause. Hormone replacement therapy has been shown to lower the risk of osteoporosis and heart disease in elderly women.

Luteinizing hormone (LH)— A female hormone that regulates ovulation and menstruation.

Menopause— The end of a woman's reproductive years. The hormonal changes that accompany menopause include the hot flashes, vaginal dryness, mood swings, sleep problems, and the end of menstrual periods. Commonly known as "the change" or "the change of life."