Is Premature Menopause on the Rise Today?
The number of women who experience early menopause related to premature ovarian failure is rising, according to recent studies. It breaks my heart when a new patient comes in to see me devastated by her diagnosis of premature ovarian failure (POF) or Premature Menopause. This unfortunate condition often hits young women at the heart of their self-esteem, and that many of them think they will never feel normal again, let alone getting pregnant. Aside from hormone replacement therapy (HRT), conventional medicines do not have a lot of answers when it comes to POF. It is not possible to reassure them of regaining the normal function of ovaries but a complete understanding of the problem and its management does make the life easier for the affected woman.
Some important facts about Premature Menopause:
- Premature menopause is a complete cessation of menses for more than a year in a woman before the age of 40 years.
- Normal menopause occurs between 45 to 51years of age, with a mean age of 51 years.
- Menopause is said to be Early if occurs between 40 to 45 years age whereas below 40 years is labelled as Premature.
- On average, the ovaries produce eggs till 51 years of age, the average age of normal menopause.
- POF is the dysfunction of ovaries leading to loss of eggs and subsequently causing infrequent menstruation or complete cessation of menses before the age of 40 years.
- The overall incidence of POF is 1%. Some surveys have reported the incidence of premature menopause as high as 8%.
Causes of Premature Menopause:
POF leads to abnormally low estrogen levels and increased gonadotrophin hormones i.e. FSH. The cause of POF is usually idiopathic although it has been attributed to various other conditions.
- Autoimmune conditions like thyroiditis, adrenal insufficiency, rheumatoid arthritis are commonly associated with POF leading to premature menopause.
- Cancers in young women and treatment with chemotherapy and radiation give a longer lifespan but are strongly linked to POF where ovaries have a complete failure of the function.
- Women who have had their tubes tied, or who have had hysterectomies, tend to go through menopause several years earlier than average, likely due to decreased blood flow to the ovaries.
- Family history and ovarian or other pelvic surgery earlier in life are also implicated as risk factors for POF.
- Above all, several studies have strongly associated POF with rapidly changing dynamics of an Indian family, the increased stress upon women to be financially independent with reducing family support system leading to tremendous physical, emotional and mental strain on women. These pressures are coupled with lack of proper nutrition and sedentary lifestyles.
Effects of Premature Menopause:
- The premature menopausal woman is faced with a devastating concern of infertility if she has had no issue till such situation has arisen.
- POF is usually permanent but ovarian activity can resume in 5-10% of cases leading to return of menses and sometimes fertility
- However, with complete menopause use of donor eggs, IVF and adoption are the only means left for becoming parents in cases of Premature Menopause.
- The other clinical features of concern are the premature start of hot flushes, night sweats, mood swings, irritability, vaginal dryness and lowered sex drive.
- Apart from these clinical features women facing premature menopause are at greater risk of bone weakness or osteoporosis due to longer span of life left with very low estrogens.
- Having lost the protective effect of estrogens for the heart at an early age, these women are more prone to a heart disease.
- Premature menopause often leads to some form of depression as a result of fluctuating hormones in the body coupled with extremely anxious state of mind following the premature cessation of menses.
Medical management of women suffering from premature menopause aims at regaining the vibrant perspective of life with specific therapies, lifestyle modifications including regular exercise schedule. Dietary changes have an important role in lowering of transfats and refined carbohydrates. Fresh fruits and vegetables are preferred over processed foods. Exercise, yoga and meditation provide welcome relief in this stressful condition leading to a more positive and happy life.