Early Menopause: Impacting Not Just Fertility
Medically reviewed by Carmen Fookes, BPharm. Last updated on April 14, 2021.
What Is Early Menopause?
Most women go through menopause around the age of 51. However, in some women, menopause occurs before they are even 40.
Sometimes the cause is obvious - chemotherapy, pelvic radiation, or surgery to remove the ovaries can induce menopause literally overnight. Chromosomal defects or autoimmune diseases can also play a role. Women whose grandmother, mother, or sister went through early menopause have an inherently higher risk. Premature menopause is also more likely in women who started menstruating at a young age and have never had kids.
Primary ovarian failure (POF) is the term used when a woman's ovaries stop functioning normally, resulting in some menopausal symptoms. The difference between POF and early menopause is that women with POF may still fall pregnant or have occasional periods for years.
Estimated to affect approximately 1:1000 women aged 15-29 and 1:100 women aged 30-39, early menopause can be particularly heartbreaking in women still planning their family. Because once menopause has set in, it's unlikely to be reversed.
Symptoms Of Early Menopause
Symptoms of early menopause are similar to those of regular menopause. Hot flashes (also called hot flushes), mood changes, irregular or changed periods, sleep disturbances, reduced sex drive, and vaginal dryness are common. For some women, these symptoms may be particularly severe.
Before a doctor can diagnose early menopause in a woman under 40, blood tests that determine levels of circulating hormones such as estrogen and follicle-stimulating hormone (FSH) are needed. For women still wanting to have children, it is a good idea to talk with your doctor about your options or ask to be referred to a fertility specialist.
Coping With The Unanticipated Early Loss of Fertility
A woman's most fertile years are in her twenties; however, many women delay having children until at least their thirties and sometimes their forties in favor of a college education, establishing a career or financial security, or worldwide travel. Across the entire U.S. population, the average age of a first pregnancy is now 26.3 years, up from 21.4 years in the 1970s. Asian and Pacific Island women are even more likely to leave having children till later in life (average age 29.5 years). Fertility in most women dramatically declines after the age of 35.
The problem is, it is hard to predict which women will go through menopause early. For some women, the symptoms are so subtle that it is not until they try for a baby, and are unsuccessful, that tests reveal they are postmenopausal. This news can be understandably devastating.
Women with a family history (mother, grandmother, sister) of early menopause should talk to a fertility specialist while they are in their twenties who may run some tests to see if there is any evidence of a decline in their fertility. Other women must weigh up their desire to have children versus the prospect of never getting pregnant. Fertility is not something to be taken for granted.
Why Does Early Menopause Impact On A Woman's Overall Health?
Estrogen has long been thought to have "protective effects", particularly with regards to the heart and blood vessels, based on the observation that women aged 20-50 are much less susceptible to Coronary Heart Disease (CHD) and other atherosclerotic diseases when compared to men. A Dutch review showed women were 50% more likely to develop heart disease if they were under the age of 45 when menopause began.
But experts are aware they don't know the full story. While pre-menopausal women are less likely to suffer from a heart attack or stroke, giving postmenopausal women estrogen does not negate that risk and may, in fact, enhance it. Which is why hormone replacement therapy is no longer advocated as a routine treatment for menopause. However, it may still be considered for women going through early menopause to reduce moderate-to-severe hot flushes and as a way to prevent bone loss if standard treatments are not tolerated. In Primary Ovarian Failure (POF), hormone replacement therapy may slightly increase the chances of conception.
Women who have gone through early menopause spend a greater proportion of their lives without the "protective" effect of estrogen. In addition to an increased risk of heart attack or stroke, they are also more likely to develop high blood pressure and high cholesterol at an earlier age. Studies have also shown women are 50% more likely to gain weight after menopause, which can also negatively affect their cardiovascular health.
Osteoporosis More Likely With Early Menopause
The relationship between estrogen and bone, or more correctly the formation of bone, is complex. One of the main actions of estrogen is to prevent the resorption of bone tissue, which is when osteoclasts (a type of bone cell) break down bone tissue and release minerals such as calcium into the blood.
Menopause brings about a decline in the production of estrogen which can have a significant effect on long-term bone health. A study that followed the same group of women for three decades found that those who went through menopause before the age of 47 were almost twice as likely to develop osteoporosis as those who went through menopause at or after the age of 47. In addition, an earlier age of menopause also correlated with a greater risk for fracture and an overall increased death rate.
Maintaining a good body weight and dietary calcium levels, exercising, not smoking, limiting alcohol intake and careful sun exposure can all help reduce the risk of osteoporosis. Medications such as bisphosphonates and hormones can help maintain bone density. Talk to your doctor about ways to maintain your bone density if you have gone through early menopause.
Could Early Menopause Trigger Depression?
It can a huge shock for a woman to learn she is in early menopause and not uncommon for women to develop depression in the months or even years following the diagnosis. Women who have already suffered from depression, particularly depression associated with childbirth or menstruation, are at higher risk.
Some experts believe that the gradual decline of estrogen makes women going through menopause more prone to depression. The fact that depression and menopause have several symptoms in common including trouble sleeping, tiredness and a lack of energy, anxiety, irritability, and difficulty concentrating, means that depression may go undiagnosed and untreated in women who put these symptoms down to a natural part of aging.
But depression is highly treatable and women do not have to suffer needlessly. Treatment may include medications or talk therapy coupled with exercise and a healthy diet.
Aging Accelerates After Menopause
Mankind has long been searching for a cure for aging. Unfortunately, studies have shown menopause contributes significantly to the aging process in women, and in fact, accelerates it.
Research indicates menopause boosts cellular aging by an average of 6 percent, which starts to add up over a lifetime. Biologically, a woman who went through menopause at age 42 would be a full year older by age 50 than a woman who started menopause at age 50.
To add to this, the same research indicates that insomnia, which often accompanies menopause, also speeds up our biological clock. Women reporting restless sleep, repeated night-time awakenings and difficulty falling asleep tended to be older biologically than women of similar chronological age with no symptoms.
Good Support Goes A Long Way
As devastating as early menopause may be, you are not alone and good support can be vital to help you cope with the diagnosis.
earlymenopause.com has been helping women going through early menopause to connect with each other and share their experiences and strategies for symptom relief.
Finding a good doctor who relates to you and understands what you are going through is vital. Don't be afraid to swap your doctor for somebody who specializes in menopause rather than staying with a doctor who is not giving you the support you need.
Most of all, keep exercising, eat healthily, maintain a good body weight and take time for yourself.
Finished: Early Menopause: Impacting Not Just Fertility
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- Premature Ovarian Failure: Premature Menopause. 2012. American Pregnancy Association. http://americanpregnancy.org/womens-health/premature-ovarian-failure/
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- Osteoporosis. Mayo Clinic. Reviewed June 2019. http://www.mayoclinic.org/diseases-conditions/osteoporosis/diagnosis-treatment/treatment/txc-20207886
- Estrogen - mechanisms of action on bone. Washington Education https://courses.washington.edu/bonephys/esteffects.html