Early menopause is when it occurs before the age of 40. What is behind this phenomenon? What are the causes, symptoms, and treatments? One makes the point with a gynecologist and endocrinologist.
Table of contents
- Primary ovarian insufficiency: how to detect it and at what age?
- What are the symptoms of early menopause?
- How is early menopause diagnosed?
- Medical, genetic or immunological causes
- Hormone therapy to prevent osteoporosis and reduce symptoms
- What are the symptoms of early menopause?
- Can early menopause be prevented?
- What about endocrine disruptors?
Premature menopause, or premature ovarian failure, affects approximately 1% to 2% of women in France. This cessation of ovarian function can be of medical, genetic, or immunological origin.
Primary ovarian insufficiency: how to detect it and at what age?
Because early menopause does not include the exact mechanisms or the same age as the so-called ‘normal’ menopause, gynecologists generally prefer to speak of premature ovarian failure or primitive ovarian failure (POI). This difference in language also makes it possible to avoid the term menopause, which is rather traumatic for young women. But in reality, the term of premature menopause is entirely legitimate since it is well about a stop of the functioning of the ovary of ovarian origin. In essence, we define early menopause as a cessation of ovarian function and a fortiori, cessation of menstruation before the age of 40.
What are the symptoms of early menopause?
There are two main types of symptoms of early menopause. On the one hand, there is the cessation of fertility when the woman cannot conceive after several months or even years of trying. On the other hand, there are symptoms linked to the cessation of hormonal functioning. The latter are similar to those of classic menopause:
- the end of menstruation and ovulation
- hot flashes
- mood swings
- decreased libido
- Vaginal dryness, etc.
But not all women with early menopause have these characteristic symptoms. Fertility drops significantly ten years before menopause; many women do not worry about having difficulty getting pregnant after their thirties. Yet, some later realize it’s because they went through menopause early.
How is early menopause diagnosed?
The cessation of menstruation, most often associated with night-time hot flashes, prompts women to consult a doctor. The doctor then confirms the diagnosis of early menopause with a blood test. Hormonally, early menopause is characterized by low levels of estrogen from the ovaries and high levels of FSH hormones from the brain. This brain command tries to stimulate the ovaries to produce more hormones but to no avail.
Medical, genetic or immunological causes
Surgical or medical treatments can be the cause of early menopause. This is the case in particular with removing the ovaries (oophorectomy, and sometimes even hysterectomy), which suppresses hormonal activity, and cancer treatments (chemotherapy and radiotherapy), which can alter the ovarian function and the stock of oocytes.
In addition to medical causes, the gynecologist also distinguishes three types of causes that can explain early menopause: genetic abnormalities (in particular Turner’s syndrome, characterized by the absence or abnormality of one of the two X chromosomes, which affects one woman out of 2,500), autoimmune diseases that lead to the destruction of the ovary (such as insulin-dependent diabetes, for example, Basedow’s disease or hypothyroidism) and hereditary factors.
Other examples: Addison’s disease, lupus, and certain viral infections such as mumps or cytomegalovirus can also explain early menopause. In most cases, the cause of premature menopause is not discovered.
Hormone therapy to prevent osteoporosis and reduce symptoms
There are cases of contraindications to the administration of hormone replacement therapy, such as breast or uterine cancer. Apart from these particular cases, before the age of 50, there is no real reason to hesitate. The benefits outweigh the risks involved in the treatment. To compensate for the lack of sex hormones and reduce osteoporosis, hot flashes, and other symptoms associated with menopause, hormonal treatment is the most common.
A contraceptive pill or hormone replacement therapy (HRT) for menopause can be prescribed to maintain a sufficient estrogen level.
The consequences for a woman’s fertility
“If the cessation of hormonal function is easy to treat, the cessation of fertility is more complicated to manage,” concedes the gynecologist. There is, in fact, no treatment to date capable of restoring the functioning of the ovaries if they have definitively ceased their activity.
Generally, doctors suggest that patients in early menopause call upon an oocyte donation to try to get pregnant since their uterus remains functional and capable of receiving an embryo. However, due to the lack of egg donors in France, some women go to foreign countries where the procedure is more straightforward.
Can early menopause be prevented?
Even if there is no treatment or method to prevent the onset of premature menopause, it is possible to anticipate the consequences, particularly on fertility.
French women can indeed choose to freeze their oocytes to be able to use them when they wish to become pregnant. But this will not be guaranteed.
What about endocrine disruptors?
Endocrine disruptors (e.g., parabens and bisphenol A) have been accused of disrupting our hormonal system for some years. When we are overexposed to them, these substances are likely to disrupt our reproductive system and lead to early puberty or early menopause.
In January 2015, a scientific study in Plos One managed to establish a correlation. Conducted over 10 years on 1,442 61-year-old American women, it found that women with high blood and urine levels of these chemicals went through menopause two to four years earlier than those with lower levels of the disruptors.
Menopause occurs when your ovaries stop producing eggs, resulting in low estrogen levels. Estrogen is the hormone that controls the reproductive cycle.
Early menopause generally doesn’t require treatment. However, there are treatment options available to help manage the symptoms of menopause or conditions related to it. The most common treatment is hormone replacement therapy.