Causes of premature menopause in women

Menopause is the permanent cessation of periods. Premature menopause is when menopause occurs before age 40. It is also known as Premature Ovarian Failure . It affects 1% of women.

Causes of Premature Menopause
1. Family history of premature menopause on the maternal side of the women.
2. Genetic conditions like chromosomal abnormalities eg Turners syndrome, Fragile x syndrome.
3. Smoking and ingestion of tobacco is associated with premature menopause.
4. Chemotherapy or Radiation therapy used in cancer treatment can cause damage to ovaries leading to premature menopause.
5. Surgical removal of both the ovaries or the uterus.
6. Autoimmune diseases like Rheumatoid Arthritis, Crohns etc.
7. Early menarche can be associated with premature menopause.
8. HIV/AIDS
9. Viral infections like mumps can cause premature menopause
10. Metabolic disorders like Galactosemia and Immunological disorders like D George Syndrome
11. Many times there is no specific cause for premature menopause, it can be idiopathic in nature


Risks associated with premature menopause
1. Neurological diseases
2. Psychological dysfunction
3. Mood disorders
4. Infertility
5. Osteoporosis
6. Cardiovascular diseases

Short term consequences of Premature Menopause include: Vasomotor symptoms like
Hot flushes, Night sweats, Palpitations, Headaches, Weight Gain, Vaginal dryness, Dyspareunia, Urgency and Stress incontinence, Psychological Problems including Irritability, Forgetfulness , Poor concentration and insomnia.

Long term consequences of Premature Menopause include: Infertility, Osteoporosis and an increased risk of premature death, cardiovascular disease and stroke.


Diagnostic Criteria is based on:
Triad of Amenorrhoea i.e. no periods for 12 months , elevated Gonadotrophin levels i.e FSH &LH levels and sign and symptoms of Estrogen Deficiency.

Investigations for these women include:
FSH & LH levels, Estrogen levels, Chromosomal studies, Thyroid functions, Blood Sugar levels, X Ray of Pituitary gland, Blood calcium levels , Bone mineral density study.

Management of Premature Menopause is primarily to identify the cause and institute treatment based on the cause. It is now possible to induce Ovulation and go for Oocyte Donation in IVF Programmes for women with Premature Ovarian Failure. Some women may benefit with HRT( Hormone Replacement Therapy ) but HRT maybe contraindicated in some women especially those at risk for Ovarian & Breast Cancer. There are lifestyle changes with diet and exercise advised as also the psychological support to be sought through counselling, support groups and online forums.


Conclusion
Premature Menopause cannot be reversed but can be made more comfortable for the women going through it and certain preventive measures can be taken to counter the debilitating effects of premature menopause i.e. Osteoporosis, Angina, Infertility and the risk of Premature Death. Education is important to screen people at risk so as to take the preventive measures and promote women health in the community.

(Article Courtesy: Dr. Preeti Prabhakar Shetty, MBBS, MD - Obstetrics & Gynaecology, Senior Consultant Obstetrician,Gynecologist, Apollo Hospitals, Bannerghatta Road, Bangalore)