Early Menopause - Causes and Treatment

The two ovaries in women are organs that belong at the same time to the reproductive system and the endocrine system. By the part of the reproductive system, they are responsible for the maturation and release of the ovule to be fertilized, while for the endocrinological part, they are responsible for the production of the female sex hormones. The joint performance of both functions is responsible for the menstrual cycle during the reproductive years.

Early menopause
Early menopause
 

The ovaries age along with women and over time their functioning begins to deteriorate, causing menstrual irregularities, deficiency in the production of sex hormones, reduction of ovulation frequency, decreased fertility and, finally, complete cessation and irreversible period of menstruation, known as menopause, which usually occurs after 50 years of age.

When the ovaries go bankrupt before the time, especially before the age of 40, we give the name of precocious menopause or primary ovarian failure.

What is early menopause

Most women enter "natural" menopause between the ages of 45 and 55. The average is 51 years old. When menopause occurs before the age of 40, we say the woman had an early menopause because her ovaries went bankrupt earlier than usual.

Unlike men who produce sperm throughout life, women are already born with a number of ovarian follicles, which are the precursors of the ovule. On average, the woman begins life with 300 to 400 thousand ovarian follicles. Although only releasing one ovule per menstrual cycle, the maturation process of this ovule involves the development of several follicles at the same time. At the end of the process, only one of the various follicles becomes mature, giving birth to the ovule. The rest involute and is despised by the organism.

During the 30 or 40 years of fertile period, the woman consumes all her follicles, entering the menopause at the moment when she no longer has a reserve of ovarian follicles. When the ovaries stop working, the woman stops producing sex hormones, such as estrogen and progesterone, and stops ovulating, becoming infertile.

In addition to dealing with the typical symptoms of menopause such as hot flashes, vaginal dryness and mood swings, many women undergoing early menopause have to deal with major emotional problems, especially if a pregnancy was still in their plans. Women without children who are diagnosed with early menopause can be emotionally devastated.

Causes

Early menopause occurs when a woman is born with a reserve less than expected from ovarian follicles or when throughout life, for various reasons, her follicles are consumed faster than usual.

Studies show that:
  • 0.1% of women enter menopause before age 30.
  • 0.25% of women enter menopause before the age of 35.
  • 1.0% of women enter menopause before age 40.

In most cases, doctors can not clearly define a cause for ovarian failure. In some women, early menopause can be explained by genetic abnormalities, exposure to toxins or autoimmune diseases, but for most patients, ovarian failure ends up being classified as idiopathic, meaning no known cause . Even if most situations end up unanswered, medical research is important because in many cases it is possible to identify an origin.

Among the known causes of early menopause we can mention:

1. Chromosomal defects.


Genetic diseases linked to the sex chromosome X, such as Turner syndrome and fragile X chromosome syndrome, among others, can lead to early menopause by causing patients to be born with defective ovaries, containing fewer healthy follicles and many follicles that suffer from atrophy.

Genetic causes are usually diagnosed early and many women do not even enter puberty. However, there may be cases of women who develop normally, start their menses at the right time, but end up entering menopause early.

2. Drugs and toxins


The most common causes of early menopause caused by drugs or toxins are the treatments against cancers based on chemotherapy or radiation therapy. Among the chemotherapeutics that can cause ovarian failure are bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine and procarbazine.

Contact with pesticides can also lead to early menopause.

Cigarette smoking is also related to ovarian failure, with smokers being at higher risk for early menopause. On average, smokers enter menopause 2 years before nonsmokers, but in some cases this difference may be even greater.

Warning: use and birth control pills is not related to early menopause.

3. Autoimmune diseases


Your immune system can produce antibodies against your own ovary, damaging the ovarian follicles.

4. Removal of ovaries


Women of childbearing age who undergo surgical removal of the ovaries, usually as part of the treatment of malignant tumors of the female reproductive system, obviously also enter the menopause early. If there are no ovaries present, there can be no ovulation or adequate production of sex hormones.

Symptoms

Most women who develop early menopause develop normal sexual and reproductive development during life, with menarche (first menstruation of life) in the expected period and more or less regular menstrual cycles. It is not possible by assessing the menstrual pattern to detect early which women are at highest risk for early ovarian failure.

Only when the ovaries begin to show signs of bankruptcy does the early symptoms of early menopause begin to emerge. In fact, the symptoms of early menopause are similar to those of normal menopause, the only difference is that they begin to appear before the expected time.

Among the symptoms of early menopause, we can mention:
  • Menstrual irregularity
  • Absence of menstruation for more than 3 months
  • Hot flashes or hot flashes
  • Night sweats
  • Vaginal dryness
  • Mood changes
  • Decreased sexual desire
  • Infertility

In general, only 5 to 10 percent of women who start menopause early can get pregnant and have children before the total ovarian failure.

Diagnosis

If you are under 40 and your period is very irregular, with failures for 3 months or more, consult a gynecologist for a thorough evaluation. You may be entering menopause.

Laboratorial, women with early menopause have high levels of the FSH hormone in the blood. FSH is a hormone released by the pituitary gland, located at the base of the brain, whose function is to stimulate the ovaries to function. When the ovaries go bankrupt, the brain responds by increasing the production of FSH in a desperate attempt to make the ovaries work again.

If the patient shows signs of imminent cessation of menses associated with elevated blood FSH, the diagnosis of early menopause can be established. The next step will be to investigate the existence of a possible cause.

Treatment

The diagnosis of early menopause can be devastating for a woman, especially if she still wants to have children. Therefore, treatment for physical problems, such as prevention of osteoporosis, is not enough, it is also necessary to take care of the emotional part of the patient.

Once the ovaries stop working, the patient's estrogen and progesterone levels plummet. The replacement of these hormones is important, especially in the prevention of osteoporosis. In young women, hormone replacement therapy has more benefits and fewer risks than in older women. Vitamin D replacement is another way to prevent bone loss that occurs during menopause.

The treatment of infertility is a bit more complicated. As already mentioned, only 5 and 10% of women with early menopause are able to have children. Treatment with estrogen, fertility drugs, or other hormones does not help improve fertility. Generally, the solution is in vitro fertilization with donated ovule. This type of treatment for infertility has a high success rate but has the disadvantage of needing a donated ovule.

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