Premature menopause is a condition in which a woman stops menstruating completely before the age of 40. Sometimes this can occur as early as 30 years leading to various problems related to health and reproduction in the affected women. The ovaries have two functions, the first being 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 during the ages of 20-30 years.
The causes of premature menopause may vary from person to person, the commonest causes being.
Women who attain premature menopause at a relatively young age, face various problems.
Infertility Due to the absence of good quality eggs, infertility becomes a major consequence of premature menopause. A very small percentage of women may spontaneously become pregnant, but there are no medical investigations to predict which of these women would conceive.
Health-related issues: 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.
On ultrasound, the ovaries are 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.
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.
Women who experience symptoms are managed with supplements and hormone replacement. A wide range of HRT preparations is available for estrogen replacement including oral, transdermal, subcutaneous and vaginal routes of administration. The choice of estrogen is made on an individual basis. These women will need hormone replacement at least till they reach an age of natural menopause (in order to avoid premature ageing).
Hormone replacement therapy is absolutely necessary for these young women, contrary to women who have reached natural menopause in whom it is optional. The benefits and risks of HRT are discussed in another chapter in this same issue. One must remember, that in cases of premature menopause the benefits of hormone therapy definitely outweigh the risks.
Intake of calcium and vitamin D, avoidance of smoking and alcohol abuse also help to prevent osteoporosis. Affected women are counselled to carry out weight-bearing exercises and to have a balanced nutrition.
Once a woman is found to be menopausal, whatever may be the cause or at whatever age, we advise her to undergo all the necessary investigation done in a postmenopausal woman.
Note: This is a guest article written by Dr. Duru Shah. She is the Director of Gynaecworld, and a panel consultant at many popular hospitals in Mumbai. This article has been written to ensure awareness, based on the experience of treating patients related to reproductive issues.