Menopause marks the end of a woman's reproductive years. It's said to have occurred when you've gone 12 months without a period. In the United States, the average age of natural menopause is 51, but some women, due to genetics, certain health conditions, or medical procedures, undergo it well before then. In addition to coping with the usual symptoms of menopause caused by declining hormone levels, they may also confront different physical and emotional concerns.

Low levels of estrogen can lead to changes in overall health and increase risk for conditions such as osteoporosis, something women who go through premature menopause will have to deal with for a greater portion of their lives. Other health concerns associated with the loss of estrogen include higher risk for colon problems, gum disease, tooth loss, and the development of cataracts.

Some women may welcome the end of fertility, which frees them from menstrual periods and concerns about birth control, and others may grieve for the children they never had. And in a society that places a premium on youth, menopause may be seen as an unwelcome and distressing sign of aging.

Menopause that occurs before age 40, whether natural or induced, is called "premature menopause."

Menopause can occur before the typical age for a variety of reasons:

Chromosome defects. Conditions such as Turner's syndrome, in which the second X chromosome is partly or entirely missing, can affect the ovaries and result in premature menopause.

Genetics. As a rule, women go through menopause at about the same age as their mothers and sisters.

Autoimmune diseases. Sometimes the body's immune mechanisms mistakenly attack a part of its own reproductive system, damaging the ovaries and causing them to stop making hormones. This can happen to women with conditions such as rheumatoid arthritis and thyroid disease as well as lupus.

Surgery to remove the ovaries. Removal of both ovaries brings on menopause immediately. Called a bilateral oophorectomy, the surgical procedure is usually done as a treatment for cancer, although it may also be performed to treat conditions such as uterine fibroids, endometriosis, or pelvic infections. If only the uterus is removed, the ovaries continue to make hormones, but the woman may go through menopause a year or two earlier than average.

Chemotherapy or pelvic radiation treatments for cancer. These can cause damage to the ovaries. Patients may stop getting periods, have trouble getting pregnant, or become completely infertile. This can happen right away or take months to occur. The type of chemotherapy given, how much was used, and how old the woman was when she was treated will all affect her chances of experiencing premature menopause. The younger she is during treatment, the less likely she is to go into menopause. A 2006 study of 2,819 female childhood cancer survivors found that when girls who survive cancer grow up, they are 13 times more likely to go through menopause before age 40 than other women. The risk is highest for women whose childhood treatment involved radiation to the ovaries and/or chemotherapy with a class of drugs called alkylating agents.

Smoking and other risk factors. Tobacco smokers experience menopause roughly two years earlier than nonsmokers. There is also some limited evidence to suggest that a woman may go through menopause earlier than average if any of these apply to her:

•Never gave birth

•Has a history of heart problems

•Took medication for depression

•Was exposed to toxic chemicals

•Had pelvic surgery

•Received epilepsy treatment

Women who go through premature menopause have symptoms similar to those who experience natural menopause at the average age:

•Irregular or missed menstrual periods

•Periods that are lighter or heavier than normal

•Hot flashes (a sudden sensation of heat that spreads through the upper body and face)

•Vaginal dryness

•Decline in bladder control

•Emotional changes such as mood swings, irritability, and mild depression

•Dry skin, mouth, or eyes

•Difficulty sleeping

•Decreased sex drive

You should see your doctor to determine whether you are undergoing premature menopause if you have some of the symptoms listed above, are under age 40, and fall into any of the following categories:

•You have had chemotherapy or radiation treatment.

•You or a relative has an autoimmune disorder such as lupus, hypothyroidism, or Graves' disease.

•Your sister or mother experienced premature menopause.

•You have been trying to get pregnant for more than a year.

Start with a visit to your gynecologist. She will ask if you've had symptoms typical of menopause, but sometimes this may not be enough information for a diagnosis.

Your doctor may order a blood test for follicle-stimulating hormone (FSH). When the ovaries stop making estrogen, FSH levels will rise. Your doctor may also test for levels of estradiol (a type of estrogen), which fall when the ovaries fail, and luteinizing hormone (LH), which will be above normal if you've gone through menopause.

If a planned treatment or surgery has the potential to induce menopause, your feelings about having children should be addressed before your ovaries are removed or damaged by treatment.

If you want to have a child, options may include harvesting your eggs, fertilizing them by using in vitro procedures, and freezing the resulting embryos for future use. Your age, overall health, type of treatment, and ability to pay for the fertility method will determine whether or not you're a candidate for the available reproductive technologies.

When you have surgery or other treatments that could bring on menopause, it may be several months before menopause occurs, so if you are sexually active and don't wish to become pregnant, you should continue to use reliable birth control.

-- Susan Murphy is an award-winning journalist and former staff writer for The Phoenix Gazette and The Press-Enterprise in Riverside, California. She has worked as a medical/clinical content editor for companies providing patient education and has won two National Health Information awards.

References

First published November 20, 2008
Copyright © 2008 Consumer Health Interactive

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