Navigating the choppy waters of menopause is hard enough in the middle of one’s life, never mind the little-known prospect of menopause before 40. Premature menopause affects many young women and because of the lack of awareness surrounding it, can be a lonely and confusing position to be in. With understanding, we are better placed to accept a diagnosis or comfort a friend in need, and recognize that we are as young as we feel and that life is far from over.
What is Premature Menopause?
The average age of menopause in the US is 51, and so we largely understand it as a later chapter in one’s life. 1 in 100 women however, will experience Premature Menopause, or Premature Ovarian Failure, which occurs when the ovaries cease to work properly before the age of 40. While it becomes more and more common as your get closer to 40, there have been cases found in girls as young as 14.
What is happening?
Our menstrual cycles are all about hormone interaction. Normally, Follicle Stimulating Hormone (FSH) is released from the brain, sending signals to the ovaries to increase levels of estrogen and prepare a mature egg for release. Menopause occurs when our ovaries are no longer able to produce estrogen and so there is a breakdown in these vital communications. Low levels of estrogen mean an end to menstruation and the onset of menopausal symptoms.
How is it diagnosed?
First and foremost, no released eggs means no more periods. Menopause at any age is primarily determined by the absence of a period for 12 consecutive months, however doctors recommend being wary when you have not menstruated in 4 months or more. If this is the case, one must first rule out the effects of birth-control, then pregnancy. When FSH is unable to stimulate estrogen, the level of FSH continues to climb in an attempt to kick start the ovaries into releasing an egg.
The most common test for premature menopause is therefore a blood test to assess levels of FSH and estrogen in the body. This test needs to be carried out several times at monthly intervals and if estrogen is repeatedly low and FSH very high, it is usually enough for a firm diagnosis.
What are the causes?
About 90% of women experience Spontaneous Premature Menopause where no underlying cause can be found, while the remaining 10% will have a more clear root to their diagnosis. Autoimmune diseases, surgery, chemotherapy and radiotherapy for example, can all cause temporary or even permanent damage to the ovaries, and your doctor will communicate these risks to you as you undergo treatment. For many women the psychological blow of an early menopause diagnosis is lessened for many women when they understand it as genetic or a consequence of these other treatments.
What are the symptoms?
The symptoms of premature menopause are the same as those for menopause; hot flashes, vaginal dryness, mood changes, night sweats and so on. However, premature menopause is distinct from its mature counterpart in that for young women, it’s abruptness brings unique challenges. Affecting everything from our hair to our heart, brain, breasts and bones, estrogen’s importance as a protective hormone within the body cannot be overstated.
Lower levels of estrogen mean our body is more vulnerable to various ailments that we would normally face later in life.
For young women under 40, contemplating just these physical changes can be difficult, but beyond that the emotional and psychological toll is likely the biggest challenge. In these situations it’s always good to talk to someone, whether that is a therapist, a support group or even just a friend – at the end of the day, your mental well-being is as important as your physical health.
What are the treatment options?
Optimizing one’s lifestyle is key to dealing with menopause and doctors will advocate a healthy diet, regular exercise and abstaining from smoking and drinking alcohol in order to alleviate symptoms.
Hormone Therapy (HT) where estrogen and progesterone are supplemented is a common treatment with many benefits, especially in preventing serious issues such as osteoporosis, but is not without health risks. Some studies however, show that young women diagnosed with premature menopause are more likely to be recommended HT as the benefits outweigh the risks of long-term hormone deficiency. Consulting your doctor and working out a suitable HT regime is key in these circumstances.
What about fertility?
Menopause is considered the curtain call on a woman’s fertile years and for many, this is a tough consequence to face with diagnosis. However, whilst becoming pregnant is extremely difficult, studies have found that ovarian function can be transient, and that in rare cases spontaneous remission may occur.
According to research, pregnancies are more likely when the woman is undergoing some form of HT, as hormones make the uterus more suitable for implantation and thus more capable of sustaining the duration of a pregnancy. In cases where pregnancy is not possible, there are other options to starting a family and talking to your health care provider is necessary to examine all avenues available.
Despite how the impacts of premature menopause may make you feel, even just on contemplation, it is truly not the end of the world. Treatment is available to assuage almost all symptoms, and there are options regarding fertility. In fact, many women diagnosed with premature menopause claim the most isolating and confusing thing is that there is so little awareness around it. So let’s get in the know and get talking, so that we are properly informed and ready to face menopause whenever it may come.