Premature menopause

Menopause is considered to be premature if it begins before the age of 40. However, there are certain circumstances where menopause may be considered to be premature, no matter what age it begins, if it is medically induced. This may be for a number of reasons including a hysterectomy (removal of the womb) and medicines, such as chemotherapy drugs.

A premature menopause can be natural. The average age for the menopause is 51, but for some women, hormonal changes of the menopause start to take place much earlier without any obvious health condition present. The two main reasons for this happening are the genes you inherit and lifestyle factors:

• If your mother went through the menopause early, the chances are that you will do the same
• Smoking, a poor diet and obesity make it more likely that you will start the menopause early.

Having an early or premature menopause can initially be alarming, and if you are worried or much younger than 51, you should see your doctor who will eliminate medical causes.

Once confirmation of a naturally occurring premature menopause is received, many women go on to enjoy life without the inconvenience of monthly periods, sooner than planned.

There is a long list of medical conditions which can cause an early menopause. We describe two examples:

• Chromosome defects, such as Turner’s syndrome, can mean that ovaries never fully develop. This may lead to problems with fertility and a premature menopause
• Autoimmune conditions arise when the body mistakes normal working cells of the body for an invading organism such as a virus. In response, the immune system mounts an attack and if the ovaries happen to be the target, normal production of oestrogen and progesterone are affected, leading to the onset of premature menopause. This is seen more commonly in women who suffer thyroid disease and rheumatoid arthritis.

Having a hysterectomy (removal of the womb) can cause one to enter the menopause prematurely, depending on the type of operation required. There are two main types of hysterectomies:

• A sub-total hysterectomy (incomplete hysterectomy) is when the womb is removed, but one or both ovaries are left intact. Although periods stop (because there is no womb), the ovaries continue to produce hormones. However, women who have gone through this operation tend to enter the menopause prematurely after a few years. As you will not have a monthly period, it can be difficult to determine when this occurs
• A total hysterectomy (complete hysterectomy) is when the womb and both ovaries are removed. With this type of operation, you will enter the menopause straight away and may experience symptoms such as hot flushes as little as 24 hours after the surgery.

Some medicines and treatments prescribed by your doctor can cause a premature menopause:

• Some types of anti-depressants and other similar types of medications
• Chemotherapy and radiotherapy – these are perhaps the most common cause of premature or early menopause. These treatments are intended to treat cancerous cells but also cause damage to healthy cells, particularly the genetic material in them which enables them to naturally multiply. In some cases, periods may begin again once the treatment has been completed, in which case you are not considered to be menopausal.