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Premature or Early Menopause Can Come as a Shock
By Nancy Kennedy

Mary Peterson, M.D.Menopause most often takes place between the ages of 45 and 55. But for a small number of women, it starts well before that. This condition, known as early or premature menopause, is relatively rare, occurring in just one percent of women, but the diagnosis is usually unexpected and it can be emotionally traumatic if you happen to be one of those women.

"When menopause begins spontaneously before the age of 40, it is considered premature or early," says Mary Peterson, M.D., a gynecologist at the Midlife Health Center of Magee-Womens Hospital of UPMC. "Premature ovarian insufficiency is diagnosed by the absence of three or four menstrual periods in a row, along with an elevation in follicle-stimulating hormone, or FSH, which is measured by a simple blood test. The function can be unpredictable and it can be very difficult to become pregnant with this. In some women there is a rapid change to where the ovaries are no longer producing any eggs and permanent menopause.

Premature menopause can be a consequence of chromosomal abnormalities or autoimmune disorders. Turner's Syndrome, a genetic condition in which an X chromosome or part of an X chromosome is absent, is associated with early menopause because the ovaries fail to develop normally, affecting the young woman's sexual development and fertility. Autoimmune disorders, such as thyroid disease or rheumatoid arthritis, can also lead to early menopause. Premature menopause can run in families.

Premature menopause can be induced, due to treatment for other problems. Chemotherapy or radiation for cancer, for example, can knock out the ovaries temporarily or permanently, Peterson says, and ovarian surgery for cancer or endometriosis can also result in premature menopause.

Despite all of these associated factors, most women with premature ovarian insufficiency have no identifiable underlying cause. Peterson, a certified menopause practitioner, says that when premature menopause occurs, gynecologists always search for a cause but don't often find one. "It's frustrating, we simply don't know why it happens." But there may be an autoimmune condition that has not even been diagnosed yet, so the onset of early menopause can alert physicians to other conditions. Premature menopause is not associated with gynecological cancers, but every woman still needs to have Pap smears and gynecologic exams, no matter when she experiences menopause.

Lisa H. knew that her biological clock was ticking in her mid-thirties, but she still believed that she had time for a family. She found consolation in reminding herself that her mother had had a healthy pregnancy at the age of 41. Lisa was healthy and saw her gynecologist for regular check-ups, so she had no reason to worry. But when her periods changed, she knew something was wrong. "My periods had always been normal. All of a sudden the flow was extremely heavy and my periods became less frequent. I was worried about endometriosis; when my gynecologist told me it was early menopause, I was heartbroken. I had always envisioned becoming pregnant and now it was never going to happen; my husband and I both felt a deep sense of loss. We eventually adopted and we're a happy family."

There are health risks associated with premature menopause. Some are minor, treatable discomforts, such as dry skin and vaginal dryness, while others are far more serious. "Women who have experienced premature menopause are at higher risk for developing cardiovascular disease and osteoporosis," says Peterson. There is likely an association with memory too. "The risk is so significant that most women with premature ovarian failure should go on hormone therapy for protection against developing those diseases. The goal is usually to keep them on hormone therapy until around the age of 50."

But a woman can feel cheated when menopause comes early says Peterson. "If you are in your late 30's and you have had your family, it's not so bad, although the end of fertility is always a milestone. If you have not had a family, and you had hopes for that, it's very hard to learn that it's no longer going to be an option for you. The younger you are when it happens, the tougher it can be emotionally. Younger women are not prepared – they usually think menopause is a long way off."

The signs of premature menopause are the same as for midlife menopause: hot flashes, vaginal dryness, sleep disturbances, diminished sexual drive and irregular or absent periods. If these symptoms are present under the age of 40, it is a good idea to talk with your gynecologist about them.

The Midlife Center at Magee-Womens Hospital offers specialized care for women in perimenopause and menopause. The Center's physicians have expertise in the management of menopausal symptoms such as hot flashes, night sweats, sleep disturbances, vaginal dryness, diminished sexual desire and irregular or absent periods The Center provides well-woman gynecologic care for midlife women who have menopausal symptoms and are healthy, as well as for women who have more complex medical needs.

The MLHC has established relationships with specialists in bladder function, cancer, digestion, heart disease and endocrinology conditions such as thyroid, osteoporosis and diabetes.

For more information or to make an appointment, call (412) 641-8889 or visit www.magee.edu.

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