What causes early menopause and how can women manage its risks?

Menopause is the permanent cessation of menstrual periods in a woman’s life, typically occurring between the ages of 45 and 55 years. The median age of menopause is around 51. Menopause that occurs between the ages of 40 and 45 is called early menopause, affecting about 5% of women. Premature menopause occurs when menstruation stops before the age of 40.

Both premature menopause and early menopause can be spontaneous or induced.

Common causes

• Genetic
• Iatrogenic (surgical procedures, chemotherapy, or radiotherapy)
• Autoimmune oophoritis
• Infections
• Environmental/lifestyle factors (e.g., cigarette smoking)
• Idiopathic or unknown causes

Regardless of the cause, women who experience estrogen deficiency before the median age of natural menopause are at an increased risk of premature morbidity. Hormonal changes vary with different types of early menopause, but the long-term health risks are almost the same.

Spontaneous Premature Ovarian Failure (POF)

Premature ovarian failure is a syndrome characterized by cessation of menstruation and low sex hormones in women younger than 40 years. It affects about 1% of women of reproductive age. These women are at an increased risk of:

• Low bone density, leading to osteoporosis and fractures
• Earlier onset of heart disease
• Decreased general and sexual well-being

Induced menopause following cancer therapy

Chemotherapy or radiotherapy can lead to induced menopause. Women who survive cancer in childhood may experience:

• Increased risk of miscarriages
• Low birth weight babies
• Reduced live births
• Prophylactic Oophorectomy

Early removal of ovaries due to family history of cancers or other medical reasons leads to early menopause. These women are at an increased risk of:

• Heart disease
• Dementia
• Mood and sexual dysfunction

The most common adverse effects include:

• Hot flashes
• Night sweats
• Vaginal dryness
• Painful sex
• Weight gain
• Osteoporosis

Bone mass decreases after menopause. The earlier menopause occurs, the lower the bone density later in life. Estrogen therapy can help prevent bone loss and reduce the risk of fractures in these women.

How to prevent early menopause

Prevention of early menopause is difficult, as it can have multiple causes. Genetic and autoimmune factors cannot be prevented. However, healthy lifestyle practices can help manage early menopause:

• Quit smoking
• Eat a balanced diet
• Maintain regular physical activity
• Manage stress and body weight

Consulting your doctor and understanding any surgical procedures involving the ovaries or reproductive organs may help reduce the risk of iatrogenic early menopause.