Premature menopause means going through the changes of menopause earlier than normal. Menopause usually occurs in women in their late 40s to early 50s. Menopause is premature if it occurs before the age of 40. Premature menopause is not a normal phenomenon; it is associated with many common diseases that are prevalent in our society.

Having premature menopause means

1. Your fertility will be reduced due to the loss of eggs from the ovaries
2. Your bone health will be reduced and you can develop osteoporosis
3. You are at an increased risk of heart disease

Symptoms of menopause include hot flushes, vaginal dryness, reduced duration of periods, reduction in sex drive and mood changes

As you can see, the symptoms of early menopause can be vague; most women will not experience symptoms until the function of the ovaries has become very very reduced. At this point, it becomes very difficult to provide options for fertility and child-bearing. We, therefore, strongly recommend that all women who are AT RISK of premature menopause should have their ovarian function tested 1-2 times per year, and report immediately to a fertility specialist if they develop symptoms of menopause.

Some conditions that increase your risk of premature menopause (also known as premature ovarian insufficiency or failure) include

• Autoimmune disease – this is one of the commonest causes in our society. Many women know they have autoimmune disease (for example, Hashimoto thyroiditis, Graves’ disease of thyroid, ankylosing spondylitis, SLE, autoimmune kidney disease, type 1 diabetes, Myasthenia gravis, Rheumatoid arthritis, multiple sclerosis, psoriasis); HOWEVER, none of the women with autoimmune disease who were diagnosed elsewhere and reviewed at ICSI or Medicsi were aware that their disease can cause premature menopause.
• Endometriosis – this is a well-documented cause of premature menopause
• Chromosomal and genetic disease
• Premature menopause related to treatment – this includes chemotherapy, radiotherapy, and surgery on ovaries
• Premature menopause in your mother or sister – studies have shown that the tendency of a women to develop early menopause is significantly affected by her mother’s age at menopause

How to monitor your ovarian function

Ovarian function is assessed by the following blood tests for hormones.

1. Serum FSH and LH – these must be done on day 2-5 of your periods. If they are done later than this the results are not reliable for diagnosing menopause
2. Serum AMH – this is a marker of how many eggs your ovaries have left in ‘reserve’; this test can be done on any day of your cycle
   There is a possibility for cysts of the ovary to interfere with these tests. If your ultrasound shows ovarian cysts, please discuss your blood test reports with a fertility specialist.

NOTE: do not wait for a doctor to prescribe these tests for you. If you are known to have autoimmune disease, please get your hormones done at regular intervals.

What treatment options are available for women with premature menopause?

1. For Bone and Heart Health – women have the option of starting HRT (hormone replacement therapy), which replaces the female hormones that were naturally being produced by your ovaries before menopause. These hormones include oestrogen and progesterone and play a protective role in bone and heart health.
   
   
2. For Fertility – women have the option of preserving their fertility by freezing their eggs or embryos. This option is available to all women who have reached puberty, including unmarried women as they can freeze their eggs (which can be fertilised later on once she gets married). This option is also suitable for those who have been diagnosed with cancer and are due to start chemotherapy or radiotherapy – in such cases, urgent egg/embryo freezing is done so that cancer treatment is not delayed.
   It is also possible to remove a small piece (less than 1cm) of your ovary and freeze it – this is known as ovarian tissue freezing. This is not currently available in Pakistan, but liaison can be made with fertility clinics abroad to avail this option.

For more information regarding premature menopause, hormone replacement therapy, and fertility preservation, please email us at info@icsi.com.pk and we will get back to you promptly.