You're in your 40s. But you feel like your periods aren't what they used to be. Some months they come, some months they don't. You feel a strange burning sensation, and you wake up in a night sweat. "Oh, can I still have menopause at this age?" You might be wondering. Yes, it can happen. We call this condition early menopause. Many people are afraid and embarrassed to talk about it. But this is a very important topic that needs to be talked about. So let's talk about it all clearly, like a friend.
What is this early menopause?
Simply put, menopause is the permanent cessation of a woman's monthly menstrual cycle. Just like the last bell rings in a school, there comes a time in our bodies when the ovaries stop functioning. After this time, the ability to have children naturally disappears. This usually happens to a woman in Sri Lanka around the age of 51. When she has stopped menstruating for 12 consecutive months, we say she has reached menopause.
But sometimes this "last bell" rings a little early. Let's break it down into two parts:
- Early Menopause: If menopause occurs before the age of 45, we call it 'Early Menopause'.
- Premature Menopause: If menopause occurs before the age of 40, it is called 'Premature Menopause'.
Both of these occur before the expected normal age. About 5% of Sri Lankan women experience menopause before the age of 45. And about 1% experience this condition before the age of 40.
Are Premature Menopause and Primary Ovarian Insufficiency (POI) the same thing?
Yes, these two are slightly confusing, but they are two different conditions. Although many people think of them as the same thing, there is a slight difference medically.
- Premature Menopause: In this, the ovaries stop functioning permanently . You will never menstruate again, and you will not be able to have children. It's like permanently closing the door to a store and throwing away the key.
- Primary Ovarian Insufficiency (POI): This is when the ovaries suddenly stop working. But this is not permanent . Sometimes menstruation can start again. There are times when some people are even able to have a baby. It's like a shop door being closed, but sometimes the owner comes and opens it again.
Therefore, if your period stops before the age of 40, it is very important to talk to your doctor to find out exactly whether it is premature menopause or POI.
Why is this happening? What are the reasons for this?
In many cases, the exact cause may not be found. Surveys suggest that about 50% of women have no clear cause for this. However, there are several main factors that can contribute to this condition.
| Cause | Simple Explanation |
|---|---|
| Cancer treatment | Things like chemotherapy or radiation therapy can destroy cancer cells, but they can also damage our healthy ovaries. |
| Surgery | If you have an oophorectomy, which removes both ovaries, you will experience immediate menopause. Even if the ovaries are left intact during a hysterectomy, sometimes the blood supply to them can be reduced, causing premature menopause. |
| Family history | If someone like your mother, sister, or aunt had early menopause, you are at a slightly higher risk. This is something that comes from your genes. |
| Genetic conditions | Some chromosomal problems, such as Turner's syndrome or Fragile X syndrome, cause the ovaries to not develop properly. |
| Autoimmune Diseases | This is when our body's own immune system attacks our own ovaries. People with diseases like rheumatoid arthritis and thyroid disease are at risk. |
| Smoking | Women who smoke have lower estrogen levels, which can cause them to go through menopause a year or two earlier than non-smokers. |
| Other infections and diseases | Certain viral infections like mumps, HIV/AIDS, and conditions like chronic fatigue syndrome can also damage the ovaries. |
Remember, this often happens for reasons beyond your control. So never think, "This is my fault."
How do I know if I have this condition? What are the symptoms?
The first and most important symptom of this is irregular menstrual cycles . Menstruation may stop for months and then start again. Or the number of days of menstruation may increase or decrease, and the amount of bleeding may change. In addition to this, all the symptoms seen during normal menopause can also be seen in this case.
| Symptom | What does this make you feel? (What You Might Feel) |
|---|---|
| Hot Flashes | A sudden feeling of heat and sweating all over the body, especially the face and neck. This can last for several minutes. |
| Night Sweats | Waking up at night sweating. Even the bed sheets may get wet. |
| Vaginal dryness | Vaginal dryness and pain during sex. Itching may also occur. |
| Insomnia | Having difficulty falling asleep at night, or waking up frequently. |
| Mental changes | Getting angry easily, getting hurt over small things, just feeling sad (depression), and feeling irrational fear (anxiety). |
| Urinary system problems | Frequent need to urinate. Frequent occurrence of urinary tract infections (UTIs). |
| Other features | Dry skin, eyes, and mouth, joint and muscle pain, decreased sexual desire, decreased memory and attention, hair loss, and weight changes. |
How does a doctor accurately diagnose this condition?
If you are under 45 and have the symptoms mentioned above, definitely see your doctor. Don't try to diagnose yourself by looking at things on the internet. Your doctor will do the following:
1. They will ask you questions: about your menstrual cycle, whether anyone in your family has had this, and about any other medications you are taking.
2. Performs a physical examination: Performs a general physical examination.
3. Blood tests: This is the most important. Your blood will be checked for hormone levels, especially a hormone called FSH (Follicle-Stimulating Hormone). This hormone level increases significantly during menopause. In addition, things like thyroid hormones will be checked to see if there are any other medical conditions.
After these tests, the doctor will determine whether you have premature menopause or another health problem.
What are the treatments for this? Can it be reversed?
Unfortunately, menopause is not reversible. That is, the ovaries cannot be reactivated. However, there are many effective treatments to help manage the symptoms and reduce long-term health risks.
The main treatment is Hormone Replacement Therapy (HRT) , which involves replacing the body's lost estrogen and progesterone hormones with external medications.
Why is HRT treatment important?
- It largely controls bothersome symptoms like burning sensation, insomnia, and vaginal dryness.
- Helps prevent osteoporosis in the long term.
- Reduces the risk of heart disease .
- It helps maintain your quality of life.
Doctors usually recommend taking HRT until you reach the age of natural menopause (around 51 years old). However, it is not suitable for everyone (for example, those with a history of breast cancer). Therefore, you should discuss the pros and cons of this treatment with your doctor to decide what is best for you.
What about the hope of having children?
One of the biggest disappointments of early menopause is the loss of hope for a child. It is not possible to get pregnant naturally after menopause. However, you don't have to give up hope completely. There are options for this too:
- IVF Treatment: A child can be created through IVF technology using eggs obtained from another donor (Donor Eggs).
- Egg Freezing: If you take your eggs and freeze them before starting something like cancer treatment, you can use those eggs to have a baby later.
- Adoption: Another option is to adopt a child.
You can talk to an obstetrician and gynecologist about this and discuss the best option for you.
What are the long-term risks of early menopause?
These are not just some annoying symptoms. The hormone estrogen is a very important protector in our body. Losing that hormone years ago can lead to several long-term health risks.
- Osteoporosis: Estrogen helps keep our bones strong. When it is lost, bones quickly become brittle. Even a minor fall can cause a bone to break.
- Heart Disease: The hormone estrogen protects our heart and blood vessels. As that protection wears off prematurely, the risk of heart disease and stroke increases.
- Depression: Depression can occur due to hormonal changes and the stress caused by this condition.
- Nervous system diseases: Some studies show that the risk of developing diseases such as dementia and Parkinson's disease may be slightly increased.
This is why it is so important to talk to your doctor about treatments like HRT.
Take-Home Message
- Cessation of menstruation before the age of 45 is called 'Early Menopause', and cessation before the age of 40 is called 'Premature Menopause'.
- If you are under 45 and have symptoms like irregular periods and hot flashes, definitely see a doctor.
- There can be many reasons for this, but most of the time there is no clear cause. This is not your fault.
- Although this condition cannot be reversed, there are effective treatments, such as HRT, to control symptoms and reduce long-term health risks.
- If you are hoping to have children, talk to a specialist about your options.
- You are not alone. Talking about this with your partner, family, or a trusted friend can help you feel more comfortable.
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