Premature Menopause

Women who go through menopause naturally do so around the age of 51, give or take a few years. Due to a combination of factors—usually genetics, smoking, or both—about one out of 20 women goes through menopause earlier, between the ages of 40 and 44.

Exposure to chemicals that may destroy ovarian follicles—solvents used in some workplaces, environmental chemicals, or some chemotherapy drugs, foe example—also causes early menopause.

A few women undergo menopause even earlier, before age 40.  Premature menopause, also called premature ovarian failure, is rare, however.  “Only about 1 percent of women go through go through menopause before age 40,”says Ralph Schmeltz, M.D., an endocrinologist and associate chief of internal medicine at McGee Women’s Hospital in Pittsburgh.

Premature ovarian failure tends to run in families.  In about half the women affected, the ovaries still function intermittently, Dr. Schmeltz says.  “A woman might be diagnosed with premature ovarian failure and then, a few years later, find out she’s pregnant,” he says.  The situation is similar to perimenopause, but happens earlier, while a woman is in her thirties.

Other causes of premature menopause include surgical removal of the ovaries, radiation therapy, hysterectomy, mumps, and an autoimmune reaction, all of which are described below.

Surgical Removal of the ovaries:  This is by far the most common cause of premature menopause.  Both ovaries must be removed for menopause to occur, since a single ovary, or even a portion of an ovary, can continue to produce ova (eggs) and hormones as efficiently as if both ovaries were still present.

Radiation Therapy:  Menopause may come early if the ovaries have received significant doses of radiation, for example, during treatment for cancers of the abdomen and pelvis.  This is why the ovaries should be protected by a lead apron when X-rays are taken.

Hysterectomy:  After a hysterectomy in which the ovaries are left behind, women usually experience a loss of ovarian function five years earlier than they would do normally.  Tubal ligation, a sterilization procedure, should not have the same effect.  If it does, it is due to interference with the blood supply to the ovaries.

Mumps:  Very rarely, the ovaries can be damaged by the mumps virus, leading to premature menopause.  Mumps may cause irreparable damage to the ovaries, in the same way that it may damage a man’s testes.

Autoimmune Reaction:  Autoimmune diseases, such as lupus erythematosus (a disease of the connective tissue), or rheumatoid arthritis, may cause a woman’s body to start producing antibodies that react against her ovaries as foreign tissue, and attach them.  This process may destroy the supply of eggs in the ovaries and reduce the output of female hormones.

Women who do have a premature menopause can suffer an early onset of symptoms and may need a higher than average dose of hormones in bio-identical hormone therapy to alleviate them. 

Source:  Dr. Miriam Stoppard

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