Early and Late Menopause

Most women expect to continue having a monthly period and be able to have children well into their 40s, though maybe with greater difficulty. So it can be a nasty shock for some women when they start having menopausal symptoms in their 30s. This can be devastating, and happens in about 1% of women.

What is early menopause?

Early (premature) menopause refers to a situation where a woman stops menstruating completely before the age of 35 years.

Causes of early menopause

1. Removal of the ovaries through surgery.

This is the commonest cause of early menopause. For menopause to occur, both ovaries must be removed completely. Possible reasons for surgical removal of both ovaries include:

-Ovarian cancer

-Severe pelvic infection which may damage the ovaries

-During a hysterectomy for other problems

The removal of the ovaries during hysterectomy (removal of the uterus) is attracting a lot of controversy. Some gynecologists do this routinely to avoid development of disease of the ovaries if they are left behind e.g. an ovarian cyst or cancer.

Others argue that most women will not develop these diseases in their lifetime. So women are subjected unnecessarily to the effects of menopause by removing ovaries that are still functional.

2. Radiation treatment

Some women may need radiation therapy for treatment of cancer in the abdomen or pelvis which damages the ovaries. Shielding the ovaries may help to prevent this.

Some women may opt to have some of their eggs removed and stored to stop them from being damaged during radiation treatment. These can be used later for in vitro fertilization. Note that even routine x-rays of the pelvis may damage the ovaries.

3. Removal of the uterus (hysterectomy)

After a hysterectomy, you may experience menopause several years earlier than if your uterus was left intact. This is because the procedure inevitably damages the blood supply to the ovaries which eventually shrink and stop functioning.

4. Infections

Mumps in early childhood may damage the ovaries leading to early menopause.

5. Auto-immune diseases

These are diseases where your body's defense system starts to attack organs and tissues of the body, thinking that they are foreign, meaning that they lose the ability to recognize self. This can lead to rheumatoid arthritis, some types of thyroid disease and SLE (lupus). The ovaries may also be attacked and destroyed.

6. Genetic abnormality

Some women who have incomplete chromosomes may experience early menopause.

Late Menopause

This is menopause which takes place after the age of 55 years. If you are overweight or have uterine fibroids, it would not be unusual for you to still be menstruating in your 50s.

Dangers of late menopause

1. Increased risk of breast cancer

2. Increased risk of uterine cancer

If you are still having periods in your 50s, have a medical check-up just to rule out any health problems. If your doctor gives you the all clear then assume this is your own normal pattern.