|What Is It?
The average age for the onset of natural menopause in women in the western world is 51, although it can commonly occur anywhere between 45 and 55. If menopause occurs before the age of 40, this is considered premature. Premature menopause can be induced either surgically or medically, or it can occur as a result of premature ovarian failure (POF). When the ovaries fail or are removed the woman immediately enters menopause (no ovaries, no estrogen). She experiences typical menopause symptoms such as hot flashes and night sweats but often symptoms are more severe than in women who experience menopause naturally. Additionally she may have emotional concerns knowing her fertile years have ended far sooner than she had expected.
What Are The Causes?
This is where menopause is induced overnight by the surgical removal of both ovaries. It can be carried out via an oophorectomy which is the removal of both ovaries. Or it can be performed as a hysterectomy where the uterus (womb) and both ovaries are removed (or blood supply to the ovaries is cut off). Both procedures are irreversible and in 90 percent of cases they are carried out electively. The fact that a hysterectomy induces premature menopause is one of the main reasons why women may first seek alternatives or second opinions (see, hysterectomy side effects). The most common reasons hysterectomies are performed are to treat chronic cases of uterine fibroids and endometriosis. Other possible reasons are a prolapsed uterus or cervical cancer. It may also be recommend as a prophylactic (preventative) measure where genetic testing has revealed the woman carries BRCA gene mutations (increasing her chances of both breast and ovarian cancer). See Genetic Testing For Breast Cancer.
Certain medications and treatment can also induce menopause. Cancer treatments, specifically chemotherapy and radiation therapy can cause damage to the ovaries so that they no longer work efficiently. This is not a definite outcome, some women are not affected while others may enter menopause but find it is a temporary condition. However, statistically, 50 percent of women under the age of 35 who undergo chemotherapy with the combination of CMF drugs (Cytoxan, methotrexate, fluorouracil) do enter menopause. This rises to 80 percent in women aged 35 to 44 and nearly 100 percent of women over 45. The risk is slightly lower for women under 40 who receive Adriamycin chemotherapy, although the outcome for women over 40 is the same as CMF. Women taking tamoxifen for breast cancer may find they experience menopause symptoms like hot flashes. Although it is not menopause, it may feel like it. If you were taking estrogen replacement therapy for treating perimenopause but then had to stop because you were diagnosed with breast cancer, you can experience a sudden menopause. This is a hybrid between natural and medical induced causing a 'cold turkey' scenario where symptoms arrive suddenly and severely.
Premature Ovarian Failure
This is where the ovaries start failing to produce estrogen. POF can occur at any age, even in your 20s, and it can be devastating because it means the end of your fertility. In many instances the cause is never discovered, but it has been linked to a variety of conditions including:
• Pituitary tumors
• Genetic Disorders
• Polycystic Ovary Syndrome (PCOS)
• Severe Anorexia
• Nutritional Deficiencies
• Immune System Disorder such as hypothyroidism, Graves’s disease or lupus
Although POF is rarely reversible, occasionally there are instances where an early diagnosis and treatment can still save the ovaries. If you suspect you are experiencing menopause symptoms, even in your 20s and 30s, discuss it with a physician. Be prepared for them to reject the notion, so you may need to insist on having the relevant blood tests to check things out.
What Symptoms Can I Expect?
The most common symptoms to expect after both medical and surgical induced menopause are:
• Missed periods
• Hot flashes
• Night sweats
• Vaginal dryness (vaginal atrophy)
• You may also experience low libido
• Menopause depression
• Hair loss during menopause
• Urinary tract infections
• Sleeping difficulties
• Dry skin (see menopause skin problems)
As mentioned previously, the symptoms may be worse than those experienced by women who naturally transition into the change of life. You may find it useful to read our article on the effects of menopause on the body.
How Is It Diagnosed?
Unfortunately there is no diagnostic test which can accurately diagnose if a woman has entered menopause. Your doctor is likely to take a list of symptoms and perform a medical examination to rule out other possible causes such as pregnancy or thyroid disorders. The blood test can also check for estradiol (estrogen), follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels. Low levels of estradiol (below level 36) can signal menopause but it is not a definitive diagnosis as hormones can fluctuate for many reasons. See Menopause testing.
What Are The Health Consequences?
Premature menopausal women will experience the same health risks associated with low levels of estrogen as women become menopausal naturally. This includes increased risks of developing osteoporosis, ovarian cancer, gum disease, tooth loss and cataracts. However the risks may be even greater because women who become menopausal naturally spend a greater portion of their lives living with the protective benefits of estrogen. Premature menopause also increases the risk of heart attacks and strokes in women by 50 percent. However, the news is not all bad. It does reduce the woman's breast cancer risks factors.
How Is It Treated?
Symptoms such as hot flashes and vaginal atrophy are treated in the same way as women who enter menopause naturally (see menopause treatment). However, given the fact that premature menopause can increase the risks of osteoporosis and heart disease in women, they may be given the following healthcare maintenance advice:
1. Maintain your ideal body weight. That is a BMI of less than 25.
Exercise aerobically 3 or 4 times a week.
2. Avoid smoking.
3. Consume alcohol moderately, that is one drink per day.
4. Adopt a healthy diet as part of your lifestyle, with lots of fresh fruit and vegetables and limit your intake of animal fat.
Heart Health: Monitor your blood pressure regularly (it should be less than 120/80).
6. If you discover high blood pressure, have it treated immediately.
7. Track your blood lipid levels regularly (LDL cholesterol should be less than 100 and HDL should be between 50-60).
8. Monitor your blood sugar levels periodically to test for type 2 diabetes.
9. Keep your waist circumference under 32 inches. See also: Coronary heart disease prevention.
Ask your doctor for a bone density test (see osteoporosis diagnosis) to monitor your bone health.
If you experience bone loss treat it aggressively by taking calcium and vitamin D supplements. See: treatment for osteoporosis.
Can It Be Reversed?
Unfortunately not. Once the process of menopause has started, for whatever reason, it is unlikely to be reversible.
Questions To Ask Your Doctor Before Surgical Menopause
• Will I need to take HRT?
• Are there natural alternatives to HRT?
• Should I have a bone density test carried out before surgery?
• If so, how often thereafter should it be repeated?
• Is my blood pressure normal?
• How about my blood sugar levels?
• What are my cholesterol levels before surgery and how often should they be checked after?
• Are there complimentary therapies you can recommend that I should be taking?
• Can you recommend a program for quitting smoking?