Premature menopause on the rise

Premature menopause

 on the rise

When Ananya Raman noticed that her periods started getting irregular and then suddenly ceased altogether, she visited her gynaecologist, who told her that it was due to premature menopause.

Ananya was devastated, and naturally so. At 35, she was far too young to reach menopause, also keeping in mind that she was yet to start her family. She isn't alone. Thousands of women are said to be affected. While the average age of menopause is 48 years in India, if it occurs before the age of 40, it is termed as premature menopause.

Incidence in India
Gynaecologist Dr Suman Bijlani says that the incidence of premature menopause is on the rise. "One of the reasons is the increased survival of childhood and other cancers. Cancer survivors have a higher risk of premature menopause due to the effects of chemotherapy and radiotherapy. Smoking also contributes to increased risk for premature ovarian failure," she says.

Consultant gynaecologist and laparoscopic surgeon Dr Mahesh Patwardhan says that premature menopause is marked by cessation of periods, increased gonadotrophin levels (FSH typically over 40) and oestrogen deficiency. "It can be spontaneous or induced. It affects 1% of all women under 40 years of age, is seen in 10-28% of primary amenorrhea (when a girl has not yet started her monthly periods) and 4-18% of secondary amenorrhea (when a woman who has been menstruating normally stops getting her periods). It is not a rare condition, is frequently idiopathic (when the cause is unknown) and can also be due to autoimmune disorders, genetic causes, infections, enzyme deficiencies or metabolic syndromes," he says.

Symptoms
The most prominent symptom is absent or irregular periods. "A woman may not get her natural period or not get a period after she stops using the birth control pill. Some women experience shorter cycles or spotting before or after periods, followed by gradually decreasing flow and finally no flow. Some women experience hot flashes, mood swings, irritability, loss of interest in sex and vaginal dryness. Others experience difficulty in conceiving or poor response to fertility drugs as the first sign of failing ovaries. These symptoms would soon be followed by changes in the menstrual cycle as mentioned above. The diagnosis is made by a blood test — serum FSH level. As the ovary produces less oestrogen, the level of FSH in blood rises. So, high FSH is an indicator of premature menopause," explains Dr Bijlani.

Reasons for premature menopause
Causes include thyroid diseases, mumps, hyperparathyroidism and Addison's disease. "The ovarian biopsy in these conditions show infiltration of the follicles with plasma cells and lymphocytes. Women with autoimmune premature menopause are at increased risk for adrenal insufficiency, hypothyroidism, diabetes mellitus, myasthenia gravis, rheumatoid arthritis and systemic lupus erythematosis. Mumps is the commonest infection associated with premature menopause. Pelvic tuberculosis can cause secondary amenorrhea and ovarian failure. Apart from smoking, it may be associated with poor health, poor nutrition and increased parity. Other causes include radiation and chemotherapy but the effect is reversible and the ovary may resume ovulation and menstruation after one year of amenorrhea. Ovarian failure following hysterectomy is seen in 15-50% cases. Premature menopause is associated with vasomotor symptoms (hot flushes and night sweats), vaginal symptoms (vaginal dryness and dyspareunia), urinary symptoms (frequency, urgency, incontinence and atrophic cystitis), sexual dysfunction, and sleep disturbances. Other symptoms are headache, depression, anxiety, irritability, joint pains, cancer phobia, pseudocyesis and lack of concentration," adds Dr Patwardhan.

Is it hereditary?
"Heredity does play a role although we don't know exactly in what way and how much. Certain genes which run in a woman's family may predispose her to premature menopause. For example, if your sister has had premature menopause, your risk is about nine times that of other women," says Dr Bijlani.

Consequences
"Short term consequences include hot flushes, night sweats, palpitations and headaches, weight gain, vaginal dryness, urgency and stress incontinence. There may be irritability, forgetfulness, insomnia and poor concentration. Long-term consequences include infertility, osteoporosis, cardiovascular diseases and stroke," says Dr Patwardhan.