4 Things to Know About Early and Premature Menopause
1. The causes of early and premature menopause are not always known.
Early or premature menopause can occur for unknown reasons, or it can be the result of medical treatments or procedures, including chemotherapy or pelvic radiation for cancer, surgical removal of the ovaries, and removal of the uterus (hysterectomy).
Women with a family history of early or premature menopause are more likely to go through the transition early. “We don’t know why this happens, but if mom has gone through menopause at a very early age, we encourage her to talk to her daughters about it because that can figure into their family planning in terms of when they might lose fertility,” says Mary Jane Minkin, MD, a Yale Medicine gynecologist.
Other factors that increase the chance of early or premature menopause include having an autoimmune condition or certain other diseases (such as thyroid disease, rheumatoid arthritis, or HIV/AIDS) and specific genetic conditions (such as Turner Syndrome). Additional associations have been reported, but there is nothing definitive.
2. Going through menopause is harder on younger women.
In addition to the many uncomfortable symptoms that can accompany menopause, ranging from vaginal dryness and pain during sex to memory problems to incontinence, it’s even harder for women who are younger, Dr. Minkin notes. “We know the consequences of menopause are more significant the earlier you go through it,” she says.
There is bone loss, for instance, at a young age, which might put women at a higher lifetime risk of fracture, says Dr. Taylor. “That is tough because these are often active women who want to be engaged in sports,” he says. “And they are also likely sexually active and need to prevent vaginal atrophy, which is another symptom.”
Early or premature menopause might be especially difficult for women who experience it suddenly as a result of surgery or a medical treatment.
That sudden drop in hormone levels can feel dramatic, Dr. Taylor explains, because most women first go through perimenopause, which is the time leading up to menopause when the ovaries slow down, periods become irregular, and hormone levels fluctuate.
“It’s not that one day the ovaries shut off and you're in menopause. Often, it's a slow, gradual transition, and it can last several years,” Dr. Taylor says. “But if a woman enters menopause suddenly from having her ovaries removed surgically, for example, it can feel like they are falling off a cliff, and they can suffer significantly.”
3. Estrogen is important in preventing the health effects related to early and premature menopause.
Estrogen is a natural hormone mostly produced in the ovaries that is important for building and maintaining bone. In young women, it can also prevent vascular damage. However, after menopause, the ovaries do not produce much estrogen, Dr. Taylor says.
Notably, women who experience premature or early menopause have a higher risk of heart disease and osteoporosis because they will spend more years of their lives without the benefits of estrogen.
“If you have healthy blood vessels, estrogen tends to keep them healthy by allowing them to be relaxed and open, and by helping the body maintain a healthy balance of good and bad cholesterol. However, if you have damaged blood vessels, such as from aging or diseases like obesity, having supplemental estrogen around may be a risk. If you have atherosclerotic plaques, for instance, it may make them more likely to rupture,” Dr. Taylor explains. “If they do, estrogen causes an increase in clotting, so it's more likely to clot off that blood vessel and cause a heart attack or stroke. If you're 80 and have damaged blood vessels with some atherosclerosis, taking estrogen can be risky for the heart. But if you're 30, you really need it to preserve cardiovascular benefits.”
Because of this, women who are going to use MHT should do so within six to 10 years of their last menstrual period, Dr. Minkin says.
“The timing is very important. If you don’t give estrogen early but wait 12 years after menopause, which was the average incidence when estrogen was given in the WHI study, we know it’s too late, and it won't protect against heart disease,” Dr. Minkin says. “That’s why I do my best to educate patients who go through menopause early on the benefits of estrogen—it can protect your heart, your brain, your bones, and your vagina.”
