Q: I'm 39 years old and was diagnosed with premature menopause. What does this mean and what should I do?
A: Menopause is considered to be premature if it occurs before the age of 40. You're not alone, though — approximately one percent of women have premature ovarian failure; their ovaries run out of follicles before “their time” and consequently stop producing estrogen. Once there is no estrogen to stimulate the uterine lining, it doesn’t get built up, there is nothing to slough, and menstruation ceases. The diagnosis of “unable to work” ovaries is made through a blood test that shows low levels of estrogen, and high levels of follicle stimulating hormone (FSH) and lutenizing hormone (LH). The pituitary secretes the latter two hormones. Their levels become high when the brain and pituitary are “trying harder and harder” to get the ovaries to produce estrogen, alas, to no avail.
There are a number of reasons why premature menopause may occur:
Did your mom and/or older sisters become menopausal before the age of 40? If so, there could be a familial genetic disorder called fragile X, in which a certain portion of the X chromosome is abnormal. This can lead to various degrees of mental retardation, developmental delay, and behavioral changes especially in affected males who have only one X chromosome. (Remember women are XX and men are XY). The women in the family (you included) may simply have a pre-mutation; they can pass on this gene to their progeny, while they, themselves, develop socially, psychologically and intellectually in a normal fashion. But up to 20 percent of women with fragile X pre-mutations undergo premature menopause.
Lupus, diabetes, kidney failure, and rheumatoid arthritis can predispose a woman to the destruction of her ovarian follicles and affect her ability to produce estrogen. Your doctor should make sure you don't have these underlying diseases.
Cells that normally line the uterus can grow in other parts of the pelvis, including the ovaries. Endometriosis is usually accompanied by painful and abnormal menstrual cycles, so chances are you would probably have been diagnosed with this disorder before you entered premature menopause.
Body radiation and certain chemotherapies for cancer can cause “ovarian shut down”. And of course women who have had both their ovaries removed (bilateral oophorectomy) during their reproductive years will undergo immediate menopause.
There are also cases of mysterious premature menopause, where the ovaries simply stop working and we're not sure why.
How premature menopause can affect your body
The lack of estrogen that accompanies premature menopause will most likely lead to menopausal symptoms that include hot flashes, night sweats, vaginal dryness, loss of libido, joint discomfort, change in skin, and sleep disturbances. These tend to be more severe than symptoms experienced by women who reach menopause at a later age. It’s not uncommon for women who develop these symptoms at a younger age to be dismissed with the diagnosis that “you’re too young to be menopausal”. They are told to wait and see... for years!
Aside from these obvious symptoms, premature menopause can, unfortunately, affect your future health, increasing your risk of developing cardiovascular disease (heart attack and stroke), osteoporosis and even Alzheimer’s.
We now know that absence of estrogen before the age of 50 increases cholesterol plaque formation in blood vessel walls. This leads to subsequent “clogging” which then can cause clots to form or, if the plaque becomes unstable and breaks away, cause the blockage of small vessels in the heart or brain. Estrogen also slows down the activity of osteoclasts, cells that break down bones. So a lack of estrogen allows these “bone gobblers” to go to it and create micro cavities that thin the bones and make them fragile.
Estrogen has a positive effect on the neurons in the brain; depriving the brain cells of this hormone in your forties can lead to future (and earlier than usual) damage that occurs with the onset of Alzheimer’s.
The vagina is also very estrogen-dependent. Without estrogen, lubrication disappears; the vaginal walls become thin, lose their elasticity, and sex hurts. A total lack of estrogen can also affect your sex drive (although testosterone is also important for libido and can continue to be produced by the menopausal ovary for a number of years).
Having painted such a grim picture I must give equal time (or at least mention) to the fact that premature menopause may decrease your risk of breast and ovarian cancer.
The North American Menopausal Society and most other societies that deal with hormone replacement have issued recommendations that, if there are no major contraindications (previous blood clots, known clotting disorders, a very high familial incidence of breast cancer and/or you've had breast cancer), the use of hormone replacement therapy (HRT) is helpful for women who’ve undergone premature menopause. Since you're young, you'll need a fairly high level of estrogen to mimic the level found in women of your age group. If you have a uterus you should also use some form of progestational agent to protect the uterine lining from pre-cancerous changes that can occur when estrogen is “unopposed." You can use a cyclical progestational agent (so you'll get your period every month or every three months, depending on how your doctor prescribes it) or if you wish to have a period-less existence, you can take both hormones continuously. There are more than 20 ways to give HRT, so discuss the types (pills, patches, creams) thoroughly with your doctor.
You can continue to use HRT until the age of “usual” menopause (51). If you decide to continue using hormones after this time, you will do so for the same reasons that menopausal women in their 50’s decide to begin and/or continue hormone therapy.
Dr. Reichman’s Bottom Line: Premature menopause is harmful to your health and it shouldn't be ignored. Consider hormone replacement therapy and discuss the many types of available hormones with your doctor.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.
PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.