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Early Menopause

When your body starts to change before 40

Early menopause is defined as menopause that happens before age 40. A diagnosis of early menopause is made with a follicle stimulating hormone (FSH) test, which is a measure of ovarian function. Higher FSH indicates lower ovarian function, suggesting menopause.

Early menopause has a number of causes and progresses in different ways. It might be helpful to think of it as having three different "types":

  • Premature menopause is early menopause without any external cause. There is complete stoppage of menstruation and release of eggs, and pregnancy is impossible.
  • Premature ovarian failure is similar to premature menopause, but the ovaries have not completely stopped functioning. The ovaries may occasionally release an egg and pregnancy is possible, but rare. The average age of onset is 27. Some people lump these two together and use the terms interchangeably. Causes can be genetic or due to autoimmune disease. Usually the cause is never known.
  • Treatment induced menopause is caused by surgery or medications. Removal of the ovaries for any reason results in immediate menopause. Cancer treatments (chemotherapy, and / or radiation) can cause ovarian toxicity (death of the ovaries) and early menopause. More women are surviving a cancer diagnosis, but it is leading to a whole new set of challenges.

Some chemotherapy drugs, like tamoxifen, a common treatment for breast cancer, can cause menopausal symptoms that are reversed when treatment stops. This is not considered early menopause unless ovarian toxicity occurs.

Symptoms of Early Menopause

The symptoms of early menopause are the same as for "normal" menopause: hot flashes, night sweats, sleep problems, mood swings and vaginal dryness. The risks are also similar, the most common being bone loss and heart disease. However, the early loss of protective estrogen increases these risks even more.

Managing Early Menopause

Early menopause cannot be prevented or cured, though it can be managed quite successfully. Regardless of the cause, treatment is usually the same: hormone replacement therapy (HRT) until the normal age for menopause.

While prolonged HRT might seem worrisome given the known risks, these risks do not seem to play out the same way in early menopause. In addition to HRT, women should exercise and take a calcium supplement to combat bone loss.

The psychological impact may be the worst part of early menopause. Menopause signals the end of fertility, so a woman who has put off having children may feel guilt, remorse or even become depressed over missed opportunity.

Many people find it inconceivable that someone "so young" could be experiencing menopause. Unfortunately, this includes many doctors who may not take concerns seriously, dismissing them with "you're too young for menopause." Any woman who believes she may be in early menopause should find a doctor who will listen and take the necessary steps to make an accurate diagnosis. Most importantly, she should recognize that she is still the same person and enlist the help of family and close friends to navigate this life-changing event.

By Melissa J. Luther

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