Early menopause: Why it happens and the risk factors

Only about 1-2% of Indian women go through early menopause, but it can put them at a higher risk of coronary heart disease, osteoporosis, dementia, or cognitive impairment.

• Why does early menopause happen?
• What are the causes behind it?
• How common is it in Indian women?
• What are the signs of early menopause?
• If someone knows that they have a family history of early menopause, is there anything that they can do to prevent it?
• What are the risk factors from early menopause?
• What are the kinds of treatment that are available for early menopause?

Early menopause happens to a miniscule percentage of women, as little as 1% in India and around the world. But even a small percentage translates into a significant number of women who experience it. It is not often talked about or discussed even by doctors, and the lack of information can make it harder for those who are undergoing it. Early menopause is not having your period for a year, before you are 45 years old. The average age of menopause in India is about 46 years. For some women, it begins as early as in their late thirties or early forties (if it happens between 35-40, it is classified as premature menopause). It also puts women at a higher risk of conditions like coronary heart disease, osteoporosis,  dementia, and cognitive impairment.

We spoke to Delhi-based gynaecologist Anuradha Sharma about the symptoms of early menopause, whether there are ways to prevent it, treatment options, and the risk factors. Edited excerpts:

Why does early menopause happen?

When you are born, you are born with a fixed number of follicles (fluid-filled sacs in the ovaries that contain an immature egg) or eggs in the ovaries. And every cycle every month, they are being depleted.  Menopause occurs when there is complete follicle depletion. There can also be follicle dysfunction which means that you have eggs but they don’t mature or get released. (Some women experience primary ovarian insufficiency or premature ovarian failure, wherein ovaries stop functioning normally before the age of 40). That’s when early or premature Menopause happens.  Menopause usually starts in women between the ages of 45 to 55 years. In India, the incidence is about 45-46 years normally.  Early Menopause falls in the ages of 40 to 45 years,  and premature is even earlier than 40 years of age.

Menopause usually starts in women between the ages of 45 to 55 years. In India, the incidence is about 45-46 years normally.  Early Menopause falls in the ages of 40 to 45 years,  and premature is even earlier than 40 years of age.

What are the causes behind it?

There can be many causes of premature menopause.  Family history is one of the causes. The age of menopause is mostly inherited. If your mother had menopause at around 40,  then maybe you will also have your menopause at 40,  or around 41, 42, or 43 years.  If your mother had her Menopause at 60,  then even you will have a late menopause, possibly after 55.  It is mostly inherited. Women should also know about perimenopause, which is irregular periods and spotting leading up to menopause. Menopause is when for a year you haven’t had your period. Early menopause occurs between 40 to 45 years, but only if you have not got your period for a year.

There are also other factors which can lead to early menopause.  There are genetic factors like abnormal chromosomes, or you have Turner syndrome (a condition when one of the X chromosomes is missing or partially missing in women), or if you have been exposed to chemotherapy or radiation, cancer treatment,  they all affect your ovaries. There are also autoimmune causes like thyroid; arthritis; even sometimes when you have infections like mumps, or you have undergone hysterectomy, these all can cause early menopause.

Family history is one of the causes. The age of menopause is mostly inherited. If your mother had menopause at around 40,  then maybe you will also have your menopause at 40,  or around 41, 42, or 43 years.

How common is it in Indian women?

It is not very common. Like I said, your genetics play a role.  If your mother has had an early menopause, you are likely to have it early as well.  It probably happens in 1-2% of women in India.

What are the signs of early menopause?

Your periods become irregular,  you will either have spotting or you can even have heavy bleeding, any of these irregularities can happen. You will also experience a lack of sexual desire, sleeplessness, mood disturbances, hot flashes, night sweats, painful intercourse, problems with bladder control. In some women, early cognitive problems can happen,  you could also have dementia and osteoporosis.

We sometimes have patients who have come with bone pain, and they are diagnosed with osteoporosis, and they are sometimes undergoing early menopause.

If someone had family history of early menopause, can they prevent it?

There is nothing like prevention, we can make some lifestyle changes and stop smoking and drinking, take care of our diet and manage stress. The one good thing about early menopause is that the breast cancer incidence falls.

What are the risk factors from early menopause?

Understanding the risk factors is very important.  Female hormones are protective and they help keep your bones intact and your brain intact. Women who undergo early menopause are more prone to coronary heart disease, osteoporosis as your bones become weak,  dementia,  cognitive impairment.  There are a lot of problems. The incidence of these conditions becomes higher.

What are the kinds of treatment that are available for early menopause?

You cannot bring back your menstruation. However, you can take vitamin D, calcium, and micronutrient supplements which are very important for you. The second is Hormone Replacement Therapy (HRT), it can help with symptoms like hot flashes and night sweats. You can start with protective hormonal therapy which consists of estrogen and progesterone. Estrogens are mostly responsible for everything but you have to bring in progesterone to bring down the bad effects of estrogen, which can lead to endometrial cancer. However, HRT has its own side effects — there is an increased risk of blood clots, increased risk of heart disease and breast cancer. So you have to be under observation, it has to be guarded. You have to go to a gynecologist for your consultations regularly, and need to understand how long you should continue with HRT. If you have had early menopause you would like to continue HRT till about the age of 45 or 46, but then conditions like thrombosis (a condition wherein of a blood clot forms inside a blood vessel) and other things have to be taken into account. You definitely have to be under observation.

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