As we know, women are born with a certain number of immature eggs in their ovaries. In an interaction between the ovaries and the hypothalamus-pituitary gland in the brain, a specific number of these eggs are released each month.
This results in ovulation and menstruation. However, sometimes a hormonal imbalance can occur in the ovaries causing disruption in this interaction, temporarily or long-term. Reasons for such hormonal imbalances can be due to either a reduction in the number of immature eggs or a dysfunction in the ovaries. This is called premature ovarian failure (POF) and when occurs is referred to as natural premature menopause. In such cases, a woman has not had menstruation for 12 months.
Reasons for this are often unknown, but about a third of the cases are linked to other illnesses.
The ovaries can also have been operated on or have been exposed to chemotherapy or radiation, all of which can cause early ovarian failure.
The symptoms of early menopause are the same as with regular menopause. This includes hot flashes and night sweats, mood swings, fatigue, reduced libido, vaginal dryness and bladder control problems. There is no typical menstruation pattern that occurs beforehand to indicate early ovarian failure and menopause. Initially one still has menstruation, but eventually it becomes more irregular or then nonexistent. Sometimes menstruation can suddenly return once or several times. Unlike ‘normal’ menopause which occurs around the age of 50, with premature menopause there can be remaining immature eggs in the ovaries which at times and unexpectedly can lead to ovulation. Therefore pregnancy can occur.
The diagnosis is often clinical and retrospective in that it is based on a woman’s health record and with hindsight looking back as to what has occurred. It isn’t possible to test beforehand who will progress from temporary ovarian failure to final early menopause.
The diagnosis is made after an examination at the doctor’s office including hormone tests, a gynecological check, ultrasound and a general health exam. In order to verify early menopause, two sets of hormone tests that measure the levels of the follicle stimulating hormone FSH must be taken with at least one month between. Following measurements of FSH levels will have risen just as in menopause.
There are also various methods of testing ovarian function in menopause, none of which are 100% accurate, and most that are intended to check a woman’s ability of getting pregnant. These methods include testing the hormones FSH and estrogen on the third day of menstruation and thereafter on the tenth day in the cycle following hormonal stimulation with the drug Clomiphene Citrate (Clomid). This is the so-called CC test.
In addition, further tests can be taken to measure Inhibin A and B which are also produced in the ovaries, as well as a vaginal ultrasound and measurements of the ovaries’ volume and number of egg follicles early in the cycle.
It is also important to check for other hormonal imbalances, in the adrenal, pituitary and thyroid glands, and to test for diabetes. Sometimes ovarian failure is due to other endocrine disorders.
Early menopause is also associated with certain autoimmune illnesses such as Lupus, rheumatoid arthritis, thyroiditis (Graves and Hashimoto), hypothyroidism, Sjögren’s syndrome, irritable bowel syndrome and vitiligo. Genetics and heredity can too play certain roles. Early menopause is also often seen together with chromosome disorders. But otherwise, many times the reasons remain a mystery.
Consequences and treatment
No basic treatment exists that can restore ovarian function. If another related illness is determined and then treated, the ovaries can eventually regain, more or less, normal function. Otherwise, there is no method of stopping ovarian failure and the mechanisms surrounding this are little known. Early menopause, however, can affect a woman’s fertility. It can be too late to conceive a child and the only alternative would then be an egg donor. The most important long-term health factors, excluding infertility, are increased risks of cardio-vascular disease and osteoporosis.
When a woman undergoes early menopause, her body is exposed to more years of reduced levels of estrogen and the aging process in bone tissue and blood vessels occurs at an earlier phase in life than otherwise. It is believed that the risk of heart attack, for example, increases by a factor of 2.8 for those with menopause before the age of 35.
Proper diet, exercise and a healthy lifestyle is therefore very important. Strength training, aerobic exercise, intake of enough calcium and vitamin D should be taken very seriously. Estrogen replacement therapy is also recommended, at least until ‘normal’ menopause age, due to these health factors. One can then choose a birth control pill which includes synthetic estrogen to safeguard against unwanted pregnancy or a replacement therapy to reduce menopausal symptoms.
Bone mass measurements should be taken to follow the development of bone density, loss and quality. Osteoporosis can be treated accordingly in which estrogen isn’t necessarily the first-hand treatment.
Early menopause can also often affect a woman’s mental well-being. It can be challenging to accept that it is no longer possible to become pregnant before expecting this and perhaps, in the worst case, before one has had a chance to have children. A woman’s sexual life can also change, both emotionally and even physically with vaginal dryness.