When we talk about menopause (which I don’t believe is as often as we should!) we tend to associate with midlife women. We possibly think of women in their early to mid 50s who have had their children, maybe even have a grandchild or two and who are now looking to start the next chapter of their life.
And for many women, that may well be a fairly accurate picture. The average age for a woman to go through menopause in the UK is 51 so you’d be forgiven for assuming that the description above is true.
In truth, many women go through menopause much earlier in their life. Sometimes they will have their menopause induced early as a result of surgery. Other times certain cancer treatments can cause an early menopause.
Before I continue let’s just get a better understanding of some of the terminology because it can all get just a little bit confusing.
Let’s start with pre-menopause. Generally speaking, this is the time before a woman’s sex organs begin their decline towards cessation of fertility. Basically, the time during which a woman is having regular menstrual periods and is fertile.
Menopause is a term that strictly means the pausing of menses (periods). Specifically, it is classed as one day, 12 months from the date of a woman’s last period.
Climacteric is the period of time leading up to, and immediately following, menopause. When we talk about women going through menopause we’re really referring to the female climacteric.
Peri-menopause is the start of the decline of the release of sex hormones from the ovaries in preparation for menopause and usually starts around 4-6 years before, although it can start up to 10 years prior to menopause.
Post-menopause is the time immediately following menopause and continues until the end of a woman’s life.
Women generally menopause somewhere between 45 and 55 however, where a woman goes through menopause between the ages of 40 and 45 it is classed as early menopause.
For women who menopause below the age of 40 the term used is Premature Menopause. It may also be referred to as Premature Ovarian Insufficiency (POI) which is becoming the more commonly used term or premature ovarian failure.
For many women a diagnosis of POI can be devastating, especially for very young women.
PREMATURE OVARIAN INSUFFICIENCY
According to the POI support charity The Daisy Network approximately 110,000 women in Britain between 12 and 40 years of age are affected by premature ovarian insufficiency.
Spontaneous POI below the age of 45 affects about 5% of women and under the age of 40 about 1%. This figure is increased if we include the number of women who are put into an early menopause as the result of surgery or chemo/radio therapy.
The causes of POI are still not fully understood, and for many women (about 90%) the underlying cause of their POI will remain unknown.
There is some research that suggests POI can occur as a result of an auto-immune condition, where the body’s immune system turns on its own tissues. If this occurs in the ovaries POI may result.
There could also be genetic causes due to chromosome abnormalities with the female X chromosome. There may be a familial link where women have a family history of POI .
Surgical procedures such as hysterectomy (removal of the uterus) and oophorectomy (removal of the ovaries) as well as certain cancer treatments can cause an early menopause.
In POI the ovaries often don’t fail completely, hence the term insufficiency, and it is possible that some women may still be able to conceive.
EFFECTS OF POI
For women diagnosed with POI infertility may result however approximately 5% of women who have POI do conceive. There may be scope to look at egg donation as an option to getting pregnant.
Hormones such as oestrogen and testosterone serve a wider purpose in the body than just fertility. Low oestrogen is associated with reduced bone density (osteoporosis) and an increased risk of developing heart disease. Oestrogen is also involved in cognitive function and a reduction can affect memory and concentration.
POI could affect libido and impact sex life due to discomfort during intercourse and a lowered sex drive.
The European Society of Human Reproduction and Embyology (ESHRE) suggest the following 5 tips to help manage POI symptoms:
- Follow a healthy lifestyle including eating a balanced diet and maintaining a healthy weight, taking regular, weight bearing exercise and limiting alcohol.
- Stop smoking
- Have cardiovascular risk assessed annually by a GP, to include blood pressure, weight and smoking status, as well as a clinical review for those using HRT.
- Comply with therapy
- Discuss any concerns with a doctor and seek help with phycological or physical symptoms that may be having a negative impact on well being.
Further help and support can be gained by contacting The Daisy Network, a charity dedicated to providing information and support to women diagnosed with POI. It provides a support network, information on treatments and research and helps to raise awareness among the medical profession.