Early menopause explained, from the diagnosis
to the physical and psychological effects
Almost one in 10 women will go through early menopause before the age of 40, robbing them of the choice of starting or completing a family, and playing havoc with their bodies. Before the age of 40, this is called premature menopause. For women aged 40 to 45, it is early menopause.
For one in 100 women, their ovaries will spontaneously fail but the figure climbs to eight in 100 once surgery and chemically induced menopause (due to chemotherapy or radiotherapy) are taken into account.
For up to 80 per cent of women whose ovaries spontaneously stop working, the cause is unknown, says Melbourne endocrinologist Dr Amanda Vincent, a council member of the Australasian Menopause Society.
In a minority of cases, it can be caused by a genetic disorder such as Turner's syndrome, an autoimmune disorders, inborn metabolic problems such as galactosaemia and rarely, as a result of viral infection.
"If you're a smoker or have a family history of early menopause, you're at greater risk. Having a hysterectomy or pelvic surgery can also be risk factors," Dr Vincent says.
For one in 100 women, their ovaries will spontaneously fail but the figure climbs to eight in 100 once surgery and chemically induced menopause (due to chemotherapy or radiotherapy) are taken into account.
For up to 80 per cent of women whose ovaries spontaneously stop working, the cause is unknown, says Melbourne endocrinologist Dr Amanda Vincent, a council member of the Australasian Menopause Society.
In a minority of cases, it can be caused by a genetic disorder such as Turner's syndrome, an autoimmune disorders, inborn metabolic problems such as galactosaemia and rarely, as a result of viral infection.
"If you're a smoker or have a family history of early menopause, you're at greater risk. Having a hysterectomy or pelvic surgery can also be risk factors," Dr Vincent says.
The symptoms
The most common symptoms are hot flushes and vaginal dryness, says Dr Ted Weaver, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Other symptoms include itching under the skin, reduced libido, urinary frequency, tiredness, depression and sleep disturbances.
"The loss of libido can have a devastating effect, not only on the woman but on her partner," sexual health expert and author Dr Rosie King says.
Other symptoms include itching under the skin, reduced libido, urinary frequency, tiredness, depression and sleep disturbances.
"The loss of libido can have a devastating effect, not only on the woman but on her partner," sexual health expert and author Dr Rosie King says.
Diagnosis
Dr Vincent says diagnosis of premature menopause can take from six months to several years because women have such variable symptoms. "Often, doctors don't think about premature menopause as a possibility when a woman comes to them in her 20s or 30s and her period has stopped."
Other reasons a woman's period may have stopped need to be excluded, such as pregnancy, thyroid problems or prolactin issues.
"A lot of women have very few symptoms, so diagnosis might be missed," Dr Weaver says.
Other reasons a woman's period may have stopped need to be excluded, such as pregnancy, thyroid problems or prolactin issues.
"A lot of women have very few symptoms, so diagnosis might be missed," Dr Weaver says.
The effects
Early menopause affects young women physically and psychologically. One of the most devastating moments is when a young woman is told she won't be able to have children.
"Early menopause, particularly for women who haven't started their family, can be a catastrophe," Dr King says.
Dr Mandy Deeks, a psychologist with the Jean Hailes Foundation for Women's Health, says for these women, the issue is more that a choice has been taken away from them.
"There are impacts on sexual function and body image, and a woman who's had surgically induced early menopause is more likely to be anxious or depressed," Dr Deeks says.
"You're not going through menopause when your friends are and suddenly you're a young woman in an old body."
Dr King agrees it's a sign of ageing: "They're not prepared for it. It can be a tremendous shock and it affects your self-image."
"Early menopause, particularly for women who haven't started their family, can be a catastrophe," Dr King says.
Dr Mandy Deeks, a psychologist with the Jean Hailes Foundation for Women's Health, says for these women, the issue is more that a choice has been taken away from them.
"There are impacts on sexual function and body image, and a woman who's had surgically induced early menopause is more likely to be anxious or depressed," Dr Deeks says.
"You're not going through menopause when your friends are and suddenly you're a young woman in an old body."
Dr King agrees it's a sign of ageing: "They're not prepared for it. It can be a tremendous shock and it affects your self-image."
Fertility
Women who undergo early or premature menopause can no longer have children. An egg donor is the only option and unless you have a willing sister or friend, they are hard to come by in Australia, where it is illegal to pay a donor.
Some women go overseas to buy an egg, says Professor Michael Chapman, IVF expert and head of Women's and Children's Health at the University of NSW.
"South Africa, Spain and Greece are reputable," he says. "It's $12,000 to $15,000 per cycle, with a better than 50/50 chance of pregnancy." The US is another option but it is more expensive.
One approach is putting a woman on the contraceptive pill for six weeks to suppress her pituitary hormones and when she comes off the pill, she can sometimes get what is called rebound ovulation.
"It's very ineffective, probably only a two to three per cent chance at best," Professor Chapman says. "But against nothing, it's an approach."
Women needing surgery or chemotherapy to treat cancer can undergo an assisted reproductive cycle, where their ovaries are hormonally stimulated and eggs collected. The eggs can then be fertilised with her partner's sperm and the embryos frozen. Women with no permanent partner can freeze eggs, but the technology is new and success rates unclear.
Ovarian preservation is where a woman is given a hormone called GnRH agonist to cause a chemical temporary menopause during chemotherapy, with the idea that once chemotherapy is complete and the hormone stopped, the menstrual cycle should return.
Some women go overseas to buy an egg, says Professor Michael Chapman, IVF expert and head of Women's and Children's Health at the University of NSW.
"South Africa, Spain and Greece are reputable," he says. "It's $12,000 to $15,000 per cycle, with a better than 50/50 chance of pregnancy." The US is another option but it is more expensive.
One approach is putting a woman on the contraceptive pill for six weeks to suppress her pituitary hormones and when she comes off the pill, she can sometimes get what is called rebound ovulation.
"It's very ineffective, probably only a two to three per cent chance at best," Professor Chapman says. "But against nothing, it's an approach."
Women needing surgery or chemotherapy to treat cancer can undergo an assisted reproductive cycle, where their ovaries are hormonally stimulated and eggs collected. The eggs can then be fertilised with her partner's sperm and the embryos frozen. Women with no permanent partner can freeze eggs, but the technology is new and success rates unclear.
Ovarian preservation is where a woman is given a hormone called GnRH agonist to cause a chemical temporary menopause during chemotherapy, with the idea that once chemotherapy is complete and the hormone stopped, the menstrual cycle should return.
Other implications
Women who go through premature or early menopause are at greater risk of osteoperosis, which can lead to bone fractures. There is also a higher risk of cardiovascular disease, because they don't have the protective benefits oestrogen provides the heart.
Other treatments
The 2002 Women's Health Initiative (WHI) study reported increased risk of heart disease and breast cancer with combined hormone-replacement therapy (HRT) use.
But Dr Vincent says the average age of women in the WHI study was 63 and the benefits and risks of HRT are quite different for younger women.
"The general consensus of the menopause and endocrine societies around the world is that a woman with premature menopause, unless she has a contra-indication to oestrogen, such as breast cancer, should take HRT until the age of 50."
But Dr Vincent says the average age of women in the WHI study was 63 and the benefits and risks of HRT are quite different for younger women.
"The general consensus of the menopause and endocrine societies around the world is that a woman with premature menopause, unless she has a contra-indication to oestrogen, such as breast cancer, should take HRT until the age of 50."
Source: http://www.bodyandsoul.com.au/
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