Menopause refers to cessation of periods for a year or for 6 months in a woman with previously regular menstrual cycles. The normal age of menopause varies from 40-55years, depending on genetic and environmental factors.
Cessation of period prior to the age of 40 is described as early menopause or premature ovarian insufficiency. Early menopause or Premature ovarian insufficiency is seen in1 to 3.7percent of women.
Dr Geeth Monnappa, Senior Consultant obstetrician and gynaecologist at Bengaluru’s Fortis La Femme Hospital shares the reasons for a few women experiencing early or premature menopause?
Genetic: The age of menopause is largely dependent on an individuals genetic make-up.Most often, women attain menopause around the age when their mother or older siblings did so. In 30 percent of women, when no cause is found for premature menopause, a detailed history reveals a similar age of menopause in the mother or an older sibling. However, X linked chromosomal abnormalities like Turners syndrome and Fragile X syndrome can cause defective development of the ovaries and their function, leading to early menopause.
Environmental causes: Smoking( active or passive) is a known cause of early menopause. Smokers attain menopause a few years before non smokers due to the harmful effects of polycyclic aromatic hydrocarbons found in cigarettes. Toxins emitted during plastic production can also contribute to early cessation of ovarian function.
Autoimmune factors: Juvenile diabetes, adrenal insufficiency, Hashimoto’s thyroiditis, rheumatoid arthritis and many more autoimmune conditions are associated with accelerated destruction of the ovarian follicles resulting in early menopause.
Infections: HIV, malaria, tuberculosis, chickenpox, mumps, viral infections etc can lead to an early menopause.
Galactosemia: Accumulation of galactose due to an enzyme deficiency can lead to toxic levels of galactose in the ovaries and cause premature menopause.
Iatrogenic/Induced Surgery: Women needing removal of both ovaries due to disease, experience early menopause. Chemotherapy and radiation: Drugs and radiation given to cure cancer can cause temporary or permanent cessation in the ovarian function.
Poor Nutrition: Women in under developed nations often enter menopause early when compared to their counterparts in developed nations.
What are the problems associated with early/ premature menopause?
Psychological issues: Depression, anxiety, feeling of low self esteem
Sexual disturbances: Reduced sexual desire, vaginal dryness, pain during intercourse, recurrent urine infections, stress incontinence often result in hesitation and avoidance of intercourse causing marital disharmony.
Cardiovascular accidents: Women have a higher risk of heart attack and other cardiovascular events if they have an early menopause.
Osteoporosis or weak bones: Early menopause compounded by Vit D deficiency and lack of exercise lead to brittle bones and easy fractures later in life.
Dementia/ Loss of memory
The treatment of premature menopause is focused on the symptoms and problems caused by it and often requires multiple specialities coming together for a comprehensive treatment.
Hormone replacement therapy, non hormonal therapies for vaginal dryness, oocyte cryopreservation prior to cancer treatment, surrogacy, Vitamin D supplementation and counselling are the various options available for women with premature menopause.
While we cannot foresee the age of menopause in a woman or change her genetic makeup, cessation of smoking, a healthy diet and regular exercise can reduce the risks of osteoporosis and cardiovascular events associated with early menopause.