Premature menopause – here is all that you need to know!

Dr Duru Shah Director, Gynaecworld Center for Assisted Reproduction & Women’s health, talks to us about premature menopause

Debjani Arora | Published: July 6, 2018 7:59 pm

Premature menopause is a condition in which a woman stops menstruating completely before the age of 40 years. Sometimes this can happen as early as 30 leading to various problems related to health and reproduction in the affected women. Here Dr Duru Shah Director, Gynaecworld Center for Assisted Reproduction & Women’s health, Mumbai talks to us about premature menopause.

The ovaries have two functions, the first to produce eggs for fertility and the second, to produce reproductive hormones. The ovaries make three types of steroid hormones – testosterone, estrogen and progesterone. The ovaries are most active when a woman is around 20 to 30 years of age.

Global statistics suggest that approximately 1-4% of women stop ovulating and menstruating before the age of 40 years and those women who reach menopause prior to the age of 40 are considered to have premature menopause.

The causes of premature menopause may vary from person to person, the commonest causes being:

Ovarian Surgery, anti-cancer drugs or radiation therapy for cancer
Genetic disorders like turners syndrome, Swyers syndrome
Infections like mumps, tuberculosis etc
Environmental toxins like tobacco etc
In 5-30% of cases, there may be a family history

However, in many cases, the cause remains unknown. Women who attain premature menopause at a relatively young age, face various problems, like:

Their ability to conceive naturally is hampered leading to infertility.
Due to lack of reproductive hormones, there are many long-term health issues.
Psychologically a woman gets disturbed because she is no longer menstruating as her contemporaries are, and it makes her feel older. Added to that she has various symptoms related to estrogen deficiency.

Women with premature menopause are at increased risk of osteoporotic bone fractures, atherosclerotic heart disease, cancer of the colon, Alzheimers and Parkinsons disease. All these conditions are related to a low estrogen state. The risk is similar to that seen after natural menopause.

Symptoms

Due to the hormonal changes following premature menopause, a woman may get hot flushes, have mood swings, get irritable develop insomnia or may also go into severe depression.

Diagnosis

Clinical presentations:

The first symptom is the absence of periods.
Due to her low levels of estrogen, she may have mood changes in form of irritability, emotional lability, depression etc. She may also have hot flashes, decreased sex drive, fatigue, night sweats, vaginal dryness or palpitations. I have seen such women being treated by various specialists such as psychiatrists, cardiologists, neurologists etc. when all they need is a little estrogen therapy.

Investigations:

Measurement of hormones is the key to the diagnosis.
Rise in serum follicle stimulating hormone (FSH) levels. A value >40u/l is suggestive of menopause.
Low levels of estrogen (<20pg/ml)
Low Serum Anti-Mullerian Hormone(AMH) levels suggestive of the poor ovarian reserve.
Serum prolactin and thyroid levels need to be done to rule out the common causes of amenorrhoea
Chromosomal analysis to rule out a genetic disorder.

The hormone profile needs to be repeated on three occasions at least one month apart, because in certain instances the ovaries may return to normal after a phase of low activity.

Ultrasound

On ultrasound, the ovaries appear smaller than normal, the ovarian volume being less than 3 ml. Hardly any follicles are seen in the ovaries and the endometrium is thin, less than 5 mm in thickness.

Management

This depends on how the patient presents to her doctor. If she has a problem of infertility, then she is investigated further accordingly and counselled. If she has menopausal symptoms then the symptoms are attended to with the appropriate therapy. And if she has no problems, she is still advised for further management in order that she does not have a poor quality of life in her later years due to the ageing process starting prematurely.

Image source: Shutterstock

Published: July 6, 2018 7:59 pm

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