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Causes of Early Menopause
All women will go through menopause in their lives, but not all women will go through menopause at the same time. Some women experience early menopause, some women experience late menopause, and some women experience premature menopause. Early menopause, although less common than natural menopause, is not rare. In fact, it’s estimated that about 5 percent of women in the U.S. will undergo early menopause.
What is Early Menopause?
Early menopause is when the cessation of the menstrual cycle for the first 12 consecutive months occurs in women under the age of 45. Early menopause is often associated with a decreased risk of breast cancer and other cancer developments. However, it doesn’t come without its own risks and can be affected by many things.
What Causes Early Menopause?
Early menopause can be caused and affected by a variety of factors. Some women are born with genetic disorders or other medical conditions that naturally increase the risk of inducing early menopause. Some women go into natural menopause due to the impact of certain lifestyle habits, especially smoking. However, early menopause can also be caused by certain surgical procedures or medical treatments (i.e. cancer treatments).
Surgical Procedures
The most common causes of early menopause are surgical procedures that specifically remove of “disable” sex organ functions. There are three types of surgeries that have the greatest impact on the risk of early menopause: a hysterectomy, a bilateral oophorectomy, and a unilateral oophorectomy.
Hysterectomy
A hysterectomy is the complete surgical removal of the uterus. While some women may only have the uterus removed and not the ovaries, most often both the uterus and the ovaries will be removed during this process, which completely ends sex hormone production. If you undergo a hysterectomy but keep the ovaries intact, you may not immediately go into menopause but the chances of experiencing menopause earlier than the average age are still high. While the majority of women do not undergo this surgery, there is a smaller percentage of women who have to undergo this surgery for health reasons.
A hysterectomy may be necessary for women who experience the following conditions:
- Uterine fibroids: Noncancerous growths in the uterus that most often develop during a woman’s reproductive years. Symptoms include: heavy menstrual bleeding, pelvic pain, and prolonged periods.
- Uterine prolapse: A condition in which the uterus begins to clip and descend into the vaginal canal, causing severe pain in the pelvis and abdomen.
- Uterine cancer: A type of cancer that typically begins in the layer of cells that form the endometrium (the lining of the uterus). Symptoms of uterine cancer include vaginal bleeding after menopause, bleeding in between periods or other forms of irregular menstruation, severe weight loss, pain in the pelvis and vagina.
- Pelvic Inflammatory Disease (PID): PID is an infection of the reproductive organs (it can infect the uterus, fallopian tubes, and ovaries altogether depending on the severity and stage of the infection. It occurs when sexually transmitted bacteria (i.e., chlamydia or gonorrhea) spread and infect the sex organs. Usually PID can be treated with antibiotics but in extreme cases of untreated PID complete removal of the uterus may be necessary. Some common symptoms of PID include pelvic pain, pain while urinating, unusual vaginal discharge.
- Endometriosis: A tissue disorder in which endometrial tissues grow outside of the uterus. Abnormal endometrial tissue growth can affect the ovaries and fallopian tubes. The most common symptoms of endometriosis are abdominal pain and menstrual irregularities. Most women can help treat this with certain hormonal treatments but some women may need to undergo surgical procedures to help remove these tissues more effectively.
- Adenomyosis: A condition in which the endometrium (the inner lining of the uterus) breaks through the myometrium (the muscle wall of the uterus). This condition often appears in the later years of a woman’s reproductive cycle and typically disappears after menopause. However, extreme forms of this condition can cause severe pain and increase the risk of uterine cancer if endometrial tissue breaks through the myometrium and continues to grow. Symptoms include heavy or prolonged menstrual periods, severe cramping, blood clots that pass during periods. Removal of the uterus is the only cure for this condition.
Bilateral & Unilateral Oophorectomy
An oophorectomy is the surgical removal of the ovary/ovaries. There are two types of oophorectomies, a bilateral oophorectomy and a unilateral oophorectomy. A unilateral oophorectomy is the surgical removal of one ovary. A bilateral oophorectomy is the removal of both ovaries. Both of these surgeries can have an impact on the risk of early menopause since the ovaries are where the sex hormones estrogen and progesterone are produced.
A bilateral oophorectomy removes both ovaries, which means it completely ends ovarian function and immediately induces menopause. You will no longer menstruate after a bilateral oophorectomy. A unilateral oophorectomy removes just one of the ovaries. This does not completely end ovarian function but it does significantly reduce the production of sex hormones. You may not stop menstruating after a unilateral oophorectomy but you may start to exhibit some menopausal symptoms.
Women undergo a bilateral oophorectomy or a unilateral oophorectomy for a variety of reasons, including the following:
- Ovarian torsion: A condition in which the ovary/ovaries twists around the ligaments that connect it/them to the rest of the sex organs (the uterus and fallopian tubes). This twisting can cut off blood circulation to the ovaries and fallopian tubes. Symptoms of ovarian torsion include extreme abdominal and pelvic pain. Women with ovarian cysts are at higher risk of experiencing ovarian torsion.
- Benign or malignant ovarian masses: Ovarian masses (cysts and tumors) are abnormal growths of cells and fluids that attach to the ovaries. Oftentimes, surgical removal of benign masses, like benign cysts, are enough to decrease the risk of certain cancers or other ovarian health concerns. However, if severe enough, an oophorectomy may be carried out to reduce the risk of ovarian cancer as much as possible. Symptoms of ovarian masses include abnormal bleeding, abdominal pain, pelvic pain, and severe cramps.
- BRCA gene mutations (breast cancer genetic markers): BRCA genes/gene mutations are genetic markers that increase the risk of breast cancer in certain individuals (both women and men can have these markers). BRCA 1 and BRCA 2 genes are the two primary genetic markers that indicate this high risk. If there is a history of breast cancer runs in your family, you may want to ask your doctor if there is a way to determine whether or not you have these specific markers. A positive result doesn’t necessarily mean that you will develop breast cancer.
Chemical and Other Medical Causes of Early Menopause
For some women, menopause may start earlier due to chemically-induced or other medically-induced means (other than surgery). Chemotherapy and radiation have been associated with a higher risk of inducing early menopause in some women. There are other factors that can contribute to the effects of both these treatments on menopause or the onset of menopause. These can include anything from genetic factors to the type of cancers being treated as well as the cancer stage.
Damage can be done to the ovaries by both chemotherapy and radiation. The damage done to ovarian cells can decrease or end the production of estrogen, which can lead to early menopause.
Chemotherapy is a drug-treatment that uses very powerful chemicals to end cell-growth of fast-growing cancer cells that create tumors. It does this by damaging genes inside the nucleus of a cell. Although the drugs in chemotherapy are designed to attack and damage cancer cells, there are cases in which it can damage other cells, depending on the dose and the duration of treatment. For women being treated for ovarian or uterine cancer, this risk is especially high.
Radiation therapy is a type of cancer treatment that uses certain types of intense energy to kill and damage cancer cells. Radiation therapy ends cancer cell growth by damaging DNA within those cells. When cancer cells’ DNA is seriously damaged, they stop dividing and their growth becomes stagnant. When these damaged cells eventually die, they’re broken down by the body and their energy is used to create new, healthy cells. Radiation therapy can damage non-cancerous cells depending on the duration of the treatment and the type of cancer being treated. Women with ovarian or uterine cancer are obviously at higher risk of beginning early menopause.
Again, the risk of early menopause depends on the type of therapy being used and the duration of the treatment. Women of younger ages tend to have a reduced risk of this occurring, but women receiving these treatments around 40 or older have an increased risk of early onset menopause.
Medical Conditions That Can Cause Early Menopause
Some women with pre-existing conditions are at higher risk of early menopause. Medical conditions that affect the immune system, the sex organs, and hormone production or regulation often contribute to an increased risk of both early onset menopause and late onset menopause. What medical conditions have the highest risk of inducing early menopause?
Chromosomal Disorders
Chromosomal abnormalities are disorders that change or damage the chromosomes, the pair of nucleic acid chains that carry genetic information. Chromosomal abnormalities exist from birth and they affect the regulation of many different cell types and processes within the body, including the production of sex hormones. There are different types of chromosomal abnormalities. Some occur when an extra chromosome is made. Some occur when sections of chromosomes are duplicated or deleted.
One type of chromosomal abnormality that contributes to premature ovarian failure and subsequently early menopause, is Turner Syndrome (TS). Turner syndrome is a chromosomal disorder that exists in females, in which a female is born with a missing X chromosome. Some symptoms and signs of turner syndrome include short stature, delayed or late onset puberty, infertility, and heart defects.
Although a rare chromosomal abnormality, there are two variations of turner syndrome, Monosomy X and Mosaic. Women with the Monosomy X variation only have one X chromosome in each cell, an entire X chromosome is missing in every cell. About 45 percent of women with TS have this variation. Mosaic Turner Syndrome is a variation in which some of a woman’s cells are missing an x chromosome (or a part of a chromosome) but other cells have both pairs of x chromosomes. Mosaic TS makes up about 30 percent of TS cases and it happens randomly during cell division in pregnancy.
Autoimmune Disorders
Some autoimmune conditions can increase the risk of early onset menopause. Autoimmune disorders are diseases in which the body’s immune system attacks naturally occurring, healthy cells in the body. This causes healthy cells to decrease in number and make it more difficult for the body to regulate its various systems effectively. These diseases can affect the production of healthy cells in the sex organs as well as the function of the ovaries, the uterus, and the fallopian tubes which can contribute to the risk of early menopause. Some common autoimmune conditions that contribute to early onset menopause and premature menopause include rheumatoid arthritis, certain thyroid diseases, and scleroderma.
Hormonal Disorders
Some naturally occurring hormonal disorders also contribute to symptoms of early menopause. Hyperthyroidism is one of the most common hormonal conditions that can affect and contribute to early menopause. Hyperthyroidism is a condition in which the thyroid gland produces too much thyroxine, a hormone that helps maintain multiple bodily processes and systems. Hyperthyroidism is not rare, some 200,000 cases of hyperthyroidism are treated every year. Untreated hyperthyroidism may contribute to the development of early menopause, especially for women with more extreme cases of hyperthyroidism. However, not all women who are diagnosed with hyperthyroidism are at high risk of early onset menopause.
In fact, oftentimes the two are confused. Some women younger than 40 experience hyperthyroidism early on in their lives, which causes them to experience irregular periods or even miss a few. However, just because a woman misses a few periods (and isn’t pregnant) doesn’t necessarily mean that she’s in early menopause. Sometimes it’s just a case of hyperthyroidism. One of the symptoms of hyperthyroidism is irregular periods, this includes having short or extremely light periods.
If you’re a woman who has been diagnosed with hyperthyroidism you can get treated for it. There are a number of medications that can help reduce high levels of thyroxine. Surgical means may need to be taken depending on the severity and the impact or lack of impact of medications on hyperthyroidism.
Lifestyle Factors That Cause Early Menopause
Some lifestyle factors and habits can contribute to the development of early menopause. Things like diet and nutrition, exercise habits, alcohol consumption, and so on have a strong impact on how the body regulates itself. Smoking is the most significant lifestyle factor that can contribute to the development of early menopause.
Smoking
For current smokers and former smokers, the impact of smoking on the body runs deeper than just the respiratory system. Toxins from smoking cigarettes, and similar products, can radically change cellular development and regulation in every system of the body, especially where immune cells are concerned.
The changes made to cellular regulation and development made by smoking was observed to impact estrogen levels in the body, although the exact relationship is yet to be identified by researchers.
In prenatal smoking cases, women who were exposed to smoking by their mothers while they were in the womb, it was observed that the toxins from smoking had an affect on the development of the ovaries and fallopian tubes. It was also observed that levels of certain sex hormones like estradiol and progesterone were much lower in prenatal smoking cases than non-smoking cases.
Are You In Early Menopause?
With so many variables to consider, it can be hard to determine if you are in early menopause or at risk of going into early menopause. If you’re presenting menopausal symptoms and you’re concerned that these symptoms could be a sign of early menopause, schedule an appointment with your healthcare provider to run a blood test to measure your hormone levels. If you are still menstruating, you are more likely experiencing perimenopause symptoms, which are completely normal. If you have missed a few periods and are not pregnant, or your periods have been very short and light, then you may want to do a blood test just in case. This could be a sign of early menopause or it may just be a case of fluctuating hormones and should be confirmed by a doctor.
