Conception

Early menopause: symptoms, causes, treatment and fertility

Women who receive a diagnosis of early menopause undergo a severe shock due both to the confusion surrounding the causes and possible consequences of this condition on their health, and to the questioning of their plans for family life.

This article aims to provide more clarity in a little known and often stigmatized situation.

Discovery can occur in two ways: gradually after many failed attempts to conceive by a couple quickly and unexpectedly after a period of menstrual cycle disturbances (oligo/amenorrhoea or polymerrhoea) or after surgery or oncological treatments such as radio and chemotherapy.

Let’s start with the basics. At puberty every woman has about 300,000 oocytes and of these only 400-500 are released during ovulation throughout the reproductive age.

Menopause is characterized by the permanent cessation of the menstrual cycle and occurs due to the depletion of functioning primordial follicles. The average age of menopause is 50 years, if it occurs before the age of 40 we speak of early menopause.

Premature menopause affects one in 10,000 women by age 20, one in 1,000 by age 30, and one in 100 by age 40.

Le cause dela early menopause

 Reduction of primordial follicles from birth

This condition is due to genetic causes such as Turner syndrome, fragile X syndrome and ovarian dysgenesis.

Accelerated loss of primordial follicles

An accelerated loss can be caused by:

  • from an autoimmune ovaritis, a disease that can also be associated with other autoimmune diseases such as Hashimoto’s thyroiditis, type 1 diabetes mellitus and Addison’s disease (insufficiency of the adrenal glands);
  • from damage caused by an infection such as viral mumps and HIV;
  • from oncological therapies such as chemotherapy based on alkylating agents or radiotherapy;
  • from surgical causes for operations on the ovaries or other operations that have compromised the normal blood supply to the ovary.
Diagnostic criteria
  • Age under 40;
  • Menstrual cycle alterations in the last 4-6 months (oligo-amorrhea);
  • Two determinations at least one month apart of the elevated FSH hormone, in the laboratory range indicative of menopause (>30 U/L).

FSH (follicle stimulating hormone) is produced by the pituitary gland and together with LH controls the course of the female cycle.

 Symptoms of early menopause

Symptoms of estrogen deficiency: hot flashes, mood disturbances, sleep disturbances, pain during sexual intercourse.

Consequences and complications

  • Infertility (see below);
  • reduction of bone mineral density with greater risk of osteoporosis and therefore of bone fractures following trivial traumas;
  • increased risk of cardiovascular diseases and in particular of myocardial infarction.

treatment for early menopause

Hormone replacement therapy should be done at least up to 50 years of age, when the physiological menopause would occur. It is not recommended only in selected cases such as for example in women suffering from severe blood clotting disorders and women operated on for a tumor sensitive to estrogen (breast cancer).

The aim of HRT is to mimic normal ovarian function by administering estrogen (50-100μg/day). The preferred therapy is transdermal (patch) or transvaginal which, compared to oral administration, leads to a lower risk of thromboembolic event. Progesterone is also cyclically associated with estrogen, thus reducing the risk of endometrial cancer.

This therapy also reduces the cardiovascular risk and that of osteoporosis.

To further reduce the risk of bone fractures these women should be encouraged to practice regular aerobic physical exercise (walking, running, swimming, cycling, aerobics…) and to follow a diet rich in calcium which is present in milk and its derivatives. In case of lactose intolerance, a calcium food supplement is recommended (1200 mg calcium/day). Vitamin D supplementation if deficient may also be beneficial.

Fertility and early menopause

5-10% of women with early menopause who undergo hormone replacement therapy can become pregnant naturally. For this reason, a pregnancy test should be performed if the menstrual cycle is delayed. Ovulation is intermittent and unpredictable.

At the time of diagnosis of early menopause, a therapeutic plan must be established based on the wishes and needs of the patient.

Contraception should be advised if pregnancy is not desired. For example, instead of the plaster, the pill could be prescribed which acts both as hormone replacement therapy and as a contraceptive.

For women wishing to have offspring, however, a consultation at a center specialized in fertility problems would be useful. For women who are about to undergo chemotherapy and radiotherapy there is the possibility of cryopreservation of oocytes.

In conclusion, premature menopause is a condition that must be framed on a case-by-case basis and treated. There are many other conditions that can present similarly, such as micropolycystic ovary syndrome , thyroid gland disease, prolactin hormone excess, hypothalamic dysfunction, and strenuous exercise associated with a very restrictive diet. Therefore, the collaboration between gynecologist, endocrinologist and fertility specialist is necessary. 

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

Leave a Reply

Your email address will not be published. Required fields are marked *