When she was 26, Lara Dietz learned she had breast cancer -- a shock to this mother of two very young children. Then came the second blow. When treatment began, so did premature menopause. "I was having hot flashes," she says. "I felt like I was 55 years old."
When menopause occurs between ages 45 to 55, it is considered "natural." When it occurs before age 40 -- regardless the cause -- it is called premature menopause. The ovaries no longer produce an egg each month, so monthly menstrual cycles stop or become erratic. Because the ovaries stop producing estrogen and testosterone, menopause symptoms such as hot flashes, insomnia, mood swings, and vaginal dryness set in.
What Causes Premature Menopause?
As in Lara's case, cancer treatment is one common cause of premature menopause -- even though she still had her ovaries, says her doctor, Arthur Shapiro, MD, professor of obstetrics and gynecology at the University of Miami School of Medicine.
Depending on the type of chemotherapy used -- and whether the ovaries take a direct hit from radiation therapy -- the ovaries' egg-producing follicles can be damaged or destroyed, he explains. That puts fertility in serious jeopardy.
But there is a "window of opportunity" before cancer treatment when steps can be taken to preserve fertility, Shapiro explains. "We can decrease risk [of infertility] by using specific types of chemotherapies. We can store embryos. There are new methods of freezing eggs that are promising."
Lara was lucky, says Shapiro. "She was young, and her body naturally recovered. It happens sometimes, usually between four to six years after treatment ends." Fertility treatments helped boost the odds of pregnancy. Lara became pregnant with twins.
Premature menopause can also occur when:
- A woman’s ovaries are surgically removed for medical reasons such as uterine cancer or endometriosis. This is known as surgical menopause.
- A woman has an autoimmune disorder such as lupus or rheumatoid arthritis.
- A woman has chromosomal abnormalities that affect ovary development, causing ovaries to quit producing eggs -- or produce them erratically -- before age 30.
Premature menopause is not always permanent, as in Lara's case. That's one key reason why, if at all possible, women should keep their ovaries -- or protect them as much as possible, says Shapiro.
Too many women who undergo hysterectomy remove their ovaries unnecessarily due to fear of ovarian cancer, Shapiro says. Yet, he notes, when ovaries are removed before age 55, other risks are much higher:
- A woman is 16 times more likely to die from heart disease.
- A woman is 3 times more likely to die from problems resulting from hip fractures.
"There is a lot of evidence to show we should preserve the ovaries," Shapiro tells WebMD.
Coping With Premature Menopause
For young women, the sudden onset of menopause symptoms -- loss of the menstrual cycle and onset of hot flashes -- is very difficult to accept, says Melissa A. McNeil, MD, MPH, chief of Women's Health at the University of Pittsburgh School of Medicine.
"When hot flashes happen at 50, you expect it, you know it's part of the deal," she tells WebMD. "If you have them at 35, it's demoralizing -- especially if you still have children on the agenda. To find out unexpectedly that (childbearing) is no longer an option is extremely difficult."
Mood changes and insomnia triggered by premature menopause can be especially challenging for younger women, she adds.
"If you have a 5-year-old at home -- and you're not sleeping, you're having mood swings -- it can be very difficult. We call them 'dueling hormones.' If your hormones are raging as much as your children's are, it adds to family stress."
Addressing Sexual Problems Caused by Premature Menopause
A woman's enjoyment of sex -- even her sex drive -- may also take a swan dive if she's in early menopause, Shapiro says. Vaginal dryness occurs when the body's estrogen levels are low, which can lead to painful intercourse. "Vaginal estrogen tablets work well," he says, as does vaginal cream. "These [estrogen hormones] don't get into the body, only into the vagina."
Women without working ovaries also suffer lower testosterone, the male hormone that women have in small amounts. There’s been a lot of attention in the media about testosterone’s ability to boost libido in women as well as in men. But Shapiro says he doesn’t think the evidence justifies testosterone treatment for most women. "There are so many factors in a woman's sex drive," he tells WebMD. "No one has ever shown that libido is solely related to male hormones."
Hormone therapy can be a valuable tool in treating symptoms of premature menopause, says Shapiro. "We can re-establish normal menstrual cycles, implant fertilized eggs. It's like there's no difference."
Talk to your doctor, says Shapiro. "We believe in giving patients the information they need -- like whether to have ovaries removed or not. Don't make that decision based on age alone. Discuss it with your doctor. Talk about your priorities. Make your decision based on information, not on what you've heard from a friend."