The signs and symptoms of early menopause and primary ovarian insufficiency
Every woman is different. She will experience menopause in her own unique way. A minority of women will sail through this phase in life with hardly a care, but others will suffer quite severe menopausal symptoms and very early in life.
So when does menopause usually start?
Menopause is strictly defined as the day after you have not had a period for 365 days. You are officially in menopause on the 365th period-free day.
The period before that 365th day is called perimenopause and it is often referred to as “being in menopause” or “starting menopause”. This stage starts around age 45. For some women, it is a few years earlier, for others, a few years later. Bad news: It can last for 4 to 7 years or even more.
What is premature menopause or early menopause? What is primary ovarian insufficiency (POI)?
- Early Menopause: It is estimated that 5% of women will experience early menopause, which is defined as occurring between the ages of 41 and 45.
- Premature Menopause: Around 1% of women experience menopause before age 40 (0.1% before age 30!) This is called premature menopause. It is also called primary ovarian insufficiency (abbreviated as POI). It was previously was called “Premature ovarian failure”, but this term has gone out of use as it is possible for women with POI to get pregnant.
What are the causes of premature menopause/primary ovarian insufficiency (POI)?
According to the Cleveland Clinic, premature menopause can have several different factors. Some of these are:
- Family history of early menopause.
- Surgical removal of the ovaries.
- Hysterectomy: Surgical removal of the uterus.
- Chemotherapy or radiation.
- Some types of infections such as Mumps.
- Chromosomal genetic abnormalities, including Turner Syndrome (genetic disorder involving an abnormality in one of a female’s two X chromosomes) or Fragile X syndrome.
- Autoimmune diseases (e.g. IBS and rheumatoid arthritis).
- HIV and Aids.
What are the symptoms?
The symptoms of early and premature menopause include many of the usual symptoms, the difference is that these symptoms start earlier than common.
- Hot flashes.
- Night sweats.
- Cold flashes.
- Urinary urgency (needing to urinate more frequently).
- Urinary tract infections (UTI’s) with higher frequency.
- Mood swings, mild depression, anxiety and irritability.
- Weight gain.
- Memory issues: Memory lapses and difficulty in concentration).
- Vaginal dryness .
- Discomfort during sex.
- Changes in sex drive.
- Hair loss/thinning.
- Dryness of skin, eyes or mouth.
- Breast tenderness.
- Racing heart.
- Joint and muscle pains and aches.
Can I still get pregnant if I am in early or premature menopuase?
The answer to this question is: Yes. However, it can be more difficult to get pregnant.
The problem is that doctors often find it difficult to diagnose early, premature, or POI in younger women unless the ovaries have been surgically removed because this is not what physicians expect at an earlier stage in a woman’s life.
Once you are diagnosed with early, premature menopause, or POI, it is important that you speak with your physician about the fertility issues related to your diagnosis.
If you want to get pregnant, you can discuss the probability of getting pregnant without treatment versus various fertility treatment options (such as IVF) with your doctor, who will be better able to advise you.
If you do not want to get pregnant, be aware that this can still be a possibility and discuss appropriate contraception methods with your physician.
What are the risks of premature menopause and primary ovarian insufficiency?
You should take a diagnosis of premature menopause seriously. Health risks increase with these conditions. Some of these risks are:
- Heart disease.
- Osteoporosis (weak bones that are more likely to fracture)
- An earlier death.
- Increased Dementia risk.
- Problems with sex and libido.
- Mood swings, depression, anxiety
How is premature menopause or primary ovarian insufficiency diagnosed?
Some women are unaware that they have premature menopause and only discover there is a problem when their periods don’t start after pregnancy or after stopping birth control pills in order to get pregnant. Many women have irregular periods for years before seeking medical advice.
If your periods are irregular before the age of 40, you should speak with your doctor. They will need to do a blood test to look at your hormone levels. In particular, your gynecologist will probably order an FSH (Follicle Stimulating Hormone) blood test. FSH is higher in women who are in menopause and who are no longer releasing eggs.
If diagnosed, your physician will also likely run other tests such as a blood test for thyroid and prolactin levels (both of which can cause POI), genetic testing and osteoporosis assessment.
What is the treatment?
In some women, if there is a health problem (such as thyroid disease) that is underlying POI, treating that problem may help treat POI.
For other women, they are likely to need hormonal treatment which should be discussed with their gynecologists. In these cases, such treatment can help prevent osteoporosis and other health risks.
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