What is the difference between early and premature menopause?
The definition of menopause implies the absence of menstrual periods for 12 months. For the most part, it is a gradual process with women experiencing different symptoms during this transitional stage, referred to as perimenopause. Normally, menopause occurs in women at the average age of 51. Women can however experience menopause at any age. If the final menstrual period occurs before a woman is 45, it is called early menopause. Sometimes menopause can occur in women before the age of 40, in which case the menopause is premature.
Causes of premature and early menopause
Both premature and early menopause can be caused by specific surgical or medical conditions, including radiation, chemotherapy, or oophorectomy (surgical removal of ovaries). Cancer chemotherapy and radiation therapy can lead to menopause in ovulating women, with symptoms appearing during or after the treatment. Oophorectomy leads to immediate menopause, skipping the transitional period, perimenopause. Both of these causes lead to so-called “induced menopause”.
However, menopause can also occur due to natural causes, such as primary ovarian insufficiency (POI), which happens when periods stop spontaneously. This condition cannot be considered menopause, as with POI there is a small chance of ovaries resuming their function, which does not happen in women after menopause. The causes of POI are not clear, although they may be related to autoimmune diseases (e.g. thyroid disease, Crohn’s or celiac disease), genetic abnormalities (e.g. Turner’s syndrome or fragile X syndrome), infections (e.g. mumps), metabolic disorders (e.g. galactosaemia) or for 60% of women with POI, the cause is not known.
Risk factors of early and premature menopause
Besides the above mentioned causes of early and premature menopause, there are several factors that can also put women at risk, among which are family history, smoking and epilepsy. Even though it is not a rule, generally women experience menopause around the same age as their mothers when they went through menopause. If a woman has a family history of premature or early menopause (the age her mother, grandmother, or sister experienced it), the woman is also at risk of early onset. Another factor associated with early menopause is smoking. A study in has found that smoking can bring the menopause closer by as much as a whole year in smoking women. A study found women with epilepsy are also at risk of developing premature ovarian failure leading to early/premature menopause.
Signs & symptoms of early and premature menopause
Women with early or premature menopause often experience the same symptoms as women at the age of normal menopause. However, women with induced menopause have reported more severe symptoms. Some of the symptoms include hot flushes, night sweats, and sleep problems, with varying frequency and intensity. Moreover, women may experience mood fluctuations and depression during the menopausal transition. Other symptoms include vaginal dryness, vulnerability to urinary infections, changes in sexual function and bone density loss.
How can it be diagnosed?
The best way to diagnose menopause, regardless of the type, is to monitor the lack of woman’s menstrual periods for 12 months at the age when menopause is expected to happen. Currently, there is no blood test that can diagnose menopause, except for the tests that will help eliminate other possible causes of stopped periods other than menopause.
If you suspect you might have primary ovarian insufficiency, discuss all the existing symptoms with your doctor. Your doctor is likely to do an assessment including family health history and possibly perform some tests, including pregnancy test, test for hormone prolactin which can cause periods to stop, transvaginal ultrasound, and check for blockages preventing menstrual flow.
Treatment options for of early and premature menopause
Even though menopause may not always need to be treated, there are therapies aimed at relieving severe menopausal symptoms that interfere with your everyday life. Menopause hormone therapy (MHT) offers treatment by combination of hormones oestrogen and progesterone and is the most effective way to treat many symptoms of menopause including vaginal dryness and hot flushes. Also the younger the age at diagnosis the greater the long term health risks especially osteoporosis. Your healthcare practitioner may therefore recommend taking MHT until the expected age (around 50), unless you have a strong family history of breast cancer. Another treatment for menopausal symptoms is oral contraceptives, which are used to treat irregular menstrual bleeding in perimenopausal women. Your doctor can also discuss local hormonal treatments, such as oestrogen creams, tablets, or rings.
What are the complications for early menopause?
Compared to women of average aged menopause (51), women with early or premature menopause have higher risk of cardiovascular diseases and osteoporosis. The treatments for osteoporosis are aimed at increasing bone strength and density and slowing down bone loss, so prevention is crucial. Lifestyle changes, such as stopping smoking, limiting alcohol and exercising regularly, can help with prevention of both cardiovascular disease and osteoporosis, and taking vitamin D and calcium supplements added to those lifestyle changes are used as prevention measures for osteoporosis.
women with early or premature menopause have higher risk of cardiovascular diseases and osteoporosis.
What is the long term prognosis for women with premature menopause?
Women with premature menopause are placed at increased risk of mortality because of the increased risk of developing cardiovascular disease and osteoporosis. Women with premature menopause should consult their doctor and make necessary diet and lifestyle changes for prevention of osteoporosis and cardiovascular disease. Psychological counselling should also be recommended in regards to maintaining good mental health and sexual function. Maintaining mental well-being is equally important as introducing necessary dietary and lifestyle changes.
♥ Premature and early menopause can be triggered by medical or natural causes
♥ Smoking women, as well as women with epilepsy or family history of menopause are at increased risk of developing early onset
♥ Women with early or premature menopause have higher risk of osteoporosis and cardiovascular disease
♥ Dietary and lifestyle changes play a crucial role in prevention of early mortality in women with premature menopause
So ladies, let’s now talk…
What has been your greatest concern since being diagnosed with early menopause and how are you dealing with it?
With love and gratitude
Perimenopause. Mayo Clinic.