Most women reach menopause between the ages of 45 and 55, with the average age being around 51. However, about one percent of women experience menopause before the age of 40 years. This is known as premature menopause. Menopause between 41 and 45 years of age is called early menopause.
It is a rare case of a girl Amanda who started experiencing symptoms of premature ovarian insufficiency known as early menopause when she was 11 years old.She turned out to be the youngest person in the UK to have experienced it.Only one in a thousand women go through the menopause in their teens She was advised to take hormone replacement therapy (HRT) after being diagnosed with the menopause at such a young age.
According to Amanda at age of 11, she felt as if her body was spiraling out of her control.‘I went from a size 8 to a size 18 in a matter of months — from 8 st to 15 st,’ she says. ‘My body weight nearly doubled and my periods, which had started when I was ten, stopped. I also felt very emotional.’Amanda assumed that what was happening to her was quite normal as a part of puberty.It took her two years for her to consult a doctor about being overweight.
‘I couldn’t take it in at the time,’ says Amanda, now 24 and a dance teacher living in Nuneaton, Warwickshire.
‘I think, initially, Mum was more upset than me — about the fact that I’d never had my own baby. She realized that would influence the rest of my life.‘My friends were enjoying normal teenage life, but I felt middle-aged.’
The story of Amanda is not the only story and there are increasing numbers of young women, some still in their teens who are experiencing early menopause.The challenges of these girls not only the mood swings and hot flushes, but also an increased risk of osteoporosis, stroke and cardiovascular disease.
There are several known medical causes of premature ovarian insufficiency which range from the side-effects of cancer treatment to chromosomal, Genetic or auto-immune disorders but in most cases, the underlying cause is not known.It is surprising as well as a cause of worry that higher than expected numbers of women are becoming infertile before 40, for no known medical reason.
In addition to it, women from a lower socio-economic background are three times more likely to experience menopause before the age of 40 than those from a higher socio-economic background.In about 70 percent of cases of premature ovarian failure, there is a clear cause, such as radiotherapy treatment while in others there are also genetic links.
Some possible causes include:
- unknown causes – in the vast majority of cases (60%), the cause can’t be found. This is known as idiopathic premature menopause
- autoimmune conditions – about 10 to 30 percent of affected women have an autoimmune disease such as hypothyroidism, Crohn’s disease, systemic lupus erythematosus or rheumatoid arthritis
- genetic conditions – about 5 to 30 percent of women with early or premature menopause have an affected female relative, which suggests a genetic link. Genetic conditions which can lead to early or premature menopause include:
- – this is when the body cannot convert the carbohydrate galactose into glucose. It is thought that the unconverted galactose could be toxic to the ovaries
- conditions characterised by enzyme problems, such as congenital adrenal hyperplasia
- Turner’s syndrome – this chromosomal abnormality can cause early menopause, but this is usually evident before puberty
- Fragile X premutation
- viral infections – the evidence is inconclusive, but it is thought that a viral infection, such as mumps or cytomegalovirus, could trigger premature menopause in some women.
Diagnosis of premature or early menopause
Premature and early menopause is diagnosed using a number of tests including:
- medical history, family history, and medical examination
- investigations to rule out other causes of amenorrhoea (absence of periods), such as pregnancy, extreme weight loss, other hormone disturbances and some diseases of the reproductive system
- investigations into other conditions associated with premature or early menopause, such as autoimmune diseases
- genetic tests to check for the presence of genetic conditions associated with premature or early menopause
- blood tests to check hormone levels.
Treatment for early or premature menopause
There is no treatment available to make the ovaries start working again. In rare cases, the ovaries may spontaneously start working again, for reasons unknown and in about one in 10 women who are diagnosed with premature ovarian insufficiency (POI) get pregnant, for reasons that are not yet clear.
Women with early menopause have a long period of postmenopausal life, which means they are at increased risk of health problems such as early onset of osteoporosis and heart disease. For this reason, it is recommended that they take some form of hormone therapy until they reach the typical age of menopause (around 51 years old). This may be the combined oestrogen and progestogen oral contraceptive pill, or menopausal hormone therapy (MHT). Either option treats menopausal symptoms and reduces the risk of early onset of osteoporosis and heart disease. The implication of infertility is that the only way to get pregnant will be to use an egg donor.
New research shows the age at which a woman will go through the menopause is, in the vast majority of cases, genetically determined. But scientists have been quick to add that even women whose relatives had a late menopause should not postpone motherhood – nature can still catch you out.In order to help women further, scientists are working on a new test that can reveal whether you have the ‘early menopause’ gene.
Dr. Kamal Kant Kohli
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