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Untimely Pause

What happens when menopause occurs earlier than it should?

MENOPAUSE is an inevitable phase of life for every woman, characterised by the cessation of monthly menstruation. For some women, the onset of menopause, usually between the ages of 45 and 51 onwards, can be uncomfortable due to symptoms like hot flashes, mood swings, or vaginal dryness. For others, it can be a breeze. And then there are some who menopause before they even reach their 40th decade.

This is known as premature menopause and can be due to many factors. In this article, I will try to demystify the condition.

How are premature and regular menopause different?

Simply, premature menopause occurs earlier than it should. “Natural” menopause occurs because a woman’s ovaries stop producing oestrogen and progesterone hormones, leading to cessation of her monthly menstruation. Some women experience the onset much earlier due to natural or induced causes. Natural causes include genetic abnormalities. For instance, Turner syndrome and disorders that confer a Y chromosome predispose a woman to earlier menopause.

Some illnesses and medical conditions can also lead to premature menopause, such as autoimmune disorders that attack the body’s tissues, including the ovaries; metabolic disorders such as Addison’s disease and diabetes; or viral infections such as mumps. Sometimes, premature menopause is induced by certain surgical or medical procedures, including chemotherapy for cancer; radiation therapy; or surgical removal of the ovaries.

The symptoms of premature and regular menopause are identical. A woman will have irregular or missed periods, periods that are heavier or lighter than usual, hot flashes, vaginal dryness, bladder irritability and urinary incontinence, emotional mood swings, dry skin, eyes, and mouth, sleeplessness, and decreased sex drive.

How to tell it’s menopause

If you are under the age of 40 and begin experiencing menopausal symptoms, it may not cross your mind that it is related to menopause. You may think these symptoms are caused by stress or some other condition. However, your doctor or gynaecologist can perform some tests to confirm if it is premature menopause. First, he or she will perform a physical examination and conduct a blood test to rule out other conditions, such as pregnancy or thyroid disease.

Hormone tests are the most accurate way to determine if it is menopause. Your doctor will measure the levels of estradiol and follicle-stimulating hormones (FSH) in your blood. Estradiol is a form of oestrogen, which can be used as an indicator of whether your ovaries are producing sufficient oestrogen. FSH is needed to stimulate the ovaries to produce oestrogen, so increased FSH levels indicate the ovaries have decreased oestrogen production.

So it’s menopause … now what?

Just like regular menopause, premature menopause can lead to changes in a woman’s overall health. Oestrogen offers many protective benefits to women, so when oestrogen levels drop, it increases a woman’s risk for certain medical conditions such as osteoporosis, colon and ovarian cancer, periodontal (gum) disease and tooth loss, as well as cataracts.

Women who prematurely menopause spend up to a decade without the protective benefits of their own oestrogen. Therefore, it is important for them to manage their oestrogen, with the help of their doctor. Talk to your doctor about options for managing symptoms, such as hormone replacement therapy. Don’t be afraid to discuss options. It is important for you to know the risks and benefits so that you can make an informed decision.

Premature menopause also causes infertility. This may cause problems for younger women. A reproductive health specialist can advise you on your chances of conceiving through assisted reproductive techniques such as in vitro fertilisation. Getting menopause before your “time” may come as a rude surprise, but it is a health condition to be managed just like any other. Come to terms with it, get advice from your doctor, and continue to enjoy life!

BY DATUK DR NOR ASHIKIN MOKHTAR, Published in The Star Malaysia November 29, 2009

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