Premature menopause—defined as the permanent cessation of a woman’s menstrual period before the age of 40—can be a devastating blow. While the majority of women can expect to deal with the “change of life” around 51, about 1 percent of women between 30 and 39 will experience the menopausal transition earlier than expected.
The hardest part for many of them? The loss of fertility during their childbearing years, on top of the many uncomfortable physical and emotional symptoms of menopause—including hot flashes and mood swings.
Symptoms of premature menopause The absence of monthly periods for more than one year—before the age of 40—signals that a woman is likely in menopause.
Hot flashes and night sweats are very common, and can lead to difficulties with sleeping.
Memory and concentration difficulties may also crop up.
Urination can also become more frequent and even uncomfortable.
These symptoms, coupled with decreased libido, can also lead to mood swings and irritability. A dramatic decrease in the female sex hormone, estrogen, is responsible for the majority of the issues experienced during this time.
Causes of premature menopause Women are born with the all the eggs they will every have—approximately one million. At the time of her first period, a woman has about 400,000 eggs left. By the time she is 30, 10 percent of her eggs remain. By 40, only 3 percent are left.
For the vast majority of women who enter menopause prematurely, the cause is unknown. “Most of the time, we can’t find an explanation for it,” says Marjorie Dixon, physician and fertility specialist at Sunnybrook Health Sciences Centre and co-founder of First Steps Fertility, both in Toronto.
Other known causes include genetic conditions such as Fragile X or Turner syndrome, where a woman doesn’t have the normal complement of X chromosomes. Autoimmune disorders, infections, cancer treatment and ovarian surgery can also damage a woman’s egg reserve.
How do I know for sure if I have premature menopause? A fertility specialist can make a definitive diagnosis of premature menopause, which is also known as hypergonadropic hypogonadism.
He or she will run a series of blood tests to look for levels of the following hormones: follicle stimulating hormone (FSH), luteinizing hormone (LH), anti-Mullerian hormone (AMH), estrogen and progesterone, among others.
According to Dr. Dixon, high levels of FSH and LH are a sign that your brain “is screaming at your ovaries, but your ovary is not responding by growing any [follicles].” Low levels of estrogen and progesterone—the two primary female sex hormones—also indicate a woman is not ovulating properly, or at all. For women whose ovaries are not completely depleted of eggs, there is still a 5 to 10 percent chance she can still achieve a pregnancy on her own, or with fertility assistance.
What are the treatment options for premature menopause? Women with premature menopause should request regular bone mineral density scans from their GP.
Declining estrogen levels put perimenopausal women at increased risk of bone loss, fractures and even osteoporosis. “Bone loss ups its ante right around age 30, regardless of whether your ovaries fail or not,” says Dixon. “If you have no estrogen, it really kicks into high gear.”
Some research suggests that low estrogen also puts women at risk of heart disease. Most fertility specialists will prescribe a low-dose birth control pill (BCP) containing estrogen and progesterone to this group of women, until they reach the age of natural menopause, just past 50.
The estrogen in BCPs helps women cope with some of the debilitating symptoms of menopause and protects against bone less as well. The progesterone helps protect a woman’s uterus from endometrial abnormalities by causing her to shed her lining every month.
Eating a healthy, balanced diet and exercising regularly can also help menopausal women maintain bone, heart and overall wellness.
Can I still get pregnant? Yes! Although you can’t use your own eggs, you can find an egg donor to achieve a pregnancy.
Donors are typically women under 33, who are medically screened by a fertility specialist before having their ovaries stimulated and eggs retrieved. The donor’s eggs are then fertilized with a husband, partner or donor’s sperm to create an embryo. Prior to commencing her own IVF cycle, an egg donor recipient needs to have an ultrasound to ensure that her uterus is in good shape to house a pregnancy. According to Dixon, the pregnancy rate using donor eggs can be as high as 80 percent.
In Canada, using an egg donor to conceive is legal as long as the process complies with this country’s Assisted Human Reproduction Act.
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