Premature menopause

No one really knows why the menopause occurs spontaneously at an earlier age for some women than others. There are certain factors which some believe may influence the timing, although there is little scientific evidence to prove this. For example, some think that if a woman's mother experiences menopause at an early age, she may experience menopause early too, and that if periods begin at an early age, they may stop late.

In addition to the women who have a premature menopause spontaneously, there are others who become menopausal as a result of their ovaries being affected by treatments such as radiotherapy or chemotherapy for cancer or leukaemia. With more widespread use of these treatments and better survival rates, it is likely that more women will experience menopause prematurely in the future. Chemo- and radiotherapy can also affect those treated during childhood, and it is possible that the effects on the ovaries may not be mentioned.

A third group of women who may experience premature menopause is those whose ovaries are removed surgically. This procedure is called an oophorectomy and either one of both ovaries can be removed usually because of disease. Abrupt premature menopause will only occur when both ovaries have been removed.

Women who are having a hysterectomy sometimes also have their ovaries removed at the same time, to prevent ovarian cancer which can be very difficult to detect at a later date. Women who have had a hysterectomy, but have retained their ovaries, may begin to experience the change of life a few years earlier than they would have done had they not had the operation.

What are the symptoms of a premature menopause?

Menopausal symptoms affect between 50 - 75% of women. They are caused by the drop in oestrogen levels that occurs as the ovaries stop producing eggs and are therefore similar at whatever age the menopause occurs. The symptoms, together with the changing menstrual cycle, usually provide enough information for the doctor to diagnose menopause.

However, these symptoms can occur for reasons other than menopause. Therefore, when a menopause occurs prematurely, or when a woman has had a hysterectomy (which masks any changes in the menstrual cycle) two or even three blood tests may be necessary to confirm that the menopause has taken place.

Taking the contraceptive pill can mask the date of the menopause, as it creates a withdrawal bleed or "mock period" each month during the seven day break from treatment. The fact that a premature menopause has occurred may only be revealed when a woman stops taking the pill and her periods fail to return. Taking the pill does not cause premature menopause.

Symptom/disease

Short term problems

• Hot flushes
• Night sweats
• Insomnia
• Mood changes
• Anxiety
• Irritability
• Poor memory
• Poor concentration
• Loss of self esteem
• Begins before, at the time of, or just after the last period
• Lasts usually for 2-5 years , sometimes much longer

Intermediate problems

• Vaginal dryness
• Painful intercourse
• Loss of libido
• Genito urinary infections
• Skin thinning
• Joint aches and pains
• Incontinence
• Begins usually anytime after the last period, but may start before
• Lasts indefinitely, and worsens with time

Long term problems

• Heart disease

• Osteoporosis
• Begins anytime after the last period
• Lasts indefinitely, and worsens with time

Of course, the severity and the duration of symptoms will vary from woman to woman, and some women may experience none of the short term or intermediate symptoms at all. However, if a woman's ovaries are surgically removed, the sharp drop in oestrogen levels that this causes may bring on the shorter term symptoms more suddenly and sometimes more severely than if the ovaries had stopped working more gradually.

How can the symptoms be relieved?

If a woman's symptoms are caused by the menopause, then a doctor may prescribe Hormone Replacement Therapy or HRT. As well as alleviating the short and medium term symptoms of the menopause, it can protect against the long term consequences of oestrogen deficiency such as heart disease and thinning of the bones (osteoporosis).

Women who experience menopause early are at an increased risk of the long term menopausal problems - as they will spend a longer time without the hormone oestrogen in the body, and should seek expert advice on whether they should consider HRT. Like all medicines, HRT is not for everyone. A woman's decision to take it should only be made after a consultation with her doctor.

The Amarant Trust has a variety of different leaflets about HRT which may help a woman understand more about the therapy.

The emotional aspects of a premature menopause

Although most of your questions about the change may now be answered, it is very understandable that in a society that pays so much attention to youth and sex, you may still have some concerns about the emotional issues involved with a premature menopause.

For some women, a premature menopause can be very distressing, and can be a considerable anxiety or even grief. Some see it as threatening their sexuality and self- identity, and may feel angry, cheated or old before their time. Often they feel isolated from other women, even former close friends in their age group, and feel negative about themselves and life in general.

We are grateful to the Amarant Trust for their help in compiling this section.