Early menopause: what to do?

Normally the ovaries stop working around age 50.  In a lot of women however this event happens unfortunately early. The Premature Ovarian Failure it is an important problem that it puts a lot of questions. We speak about Early Menopause with an expert in this field Dr. Filiberto Di Prospero.

Dr. Filiberto Di Prospero is the Head of the Gynecologic Endocrinology Unit and the Menopause Center at the Civitanova Marche General Hospital, Contrada San Domenico - 62012 Civitanova Marche - Italy. A very important healt service that provide visits, Day Hospital and a modern Bone Ultrasound Densitometry for the prevention  and diagnosis of osteoporosis. The Menopause Center organizes periodic informative meetings with the patients. Most relevant the scientific activity in the areas of the feminine obesity and  risk factors for early menopause.

When the early menopause? When appears an ovarian  insufficiency (absence of the menses, flushes, marked reduction of the ovarian hormones) in a woman under age 40.

But because we can ave an early menopause before age 40 ? It is always not possible to identify a precise cause; a frequent association has been found with other endocrine illnesses (frequent those of the Thyroid) or immunological diseases (particularly autoimmune). In some cases, genetic causes or the involvment of viral agents are been identified (virus of the Parotite). There are some forms of menopause also said “iatrogenic”, dependent from surgical castration or radioactive, pharmacological damage (i.e. cancer therapies).
Recently our Center has shown that also certain habits can reduce the period of ovarian functionality. In a study that we are publishing on a prestigious English medical magazine  we  show as in the smokers the menopause middly happens two years before the normal time and as in the women with menopause before 46 y.o. the percentage of smokers is significantly superior in comparison to those with menopause in the successive ages.

It is possible to individualize the subjects at risk? Sometimes a family history is present (for instance the mother with a menopause happened surprisingly very soon ). I would also suggest to the women with illnesses of the Thyroid or  autoimmune diseases a particular attention.

Contraception is able to influences the appearance of the menopause? To the moment it does not exist any scientific evidence that women thaking oral contraceptives, also for a lot of time, may have a change in the age at onset of the menopause.

What are the after-effects of the precocious menopause? The lack of estrogens can determine a more rapid loss of bone mineral content, a progressive alteration of the vaginal mucosa (sometimes with sexual discomfort) and in general of the genital-urinary area (also called distrophy), a more rapid aging of the skin, possible neurovegetative troubles (flushes, sudden perspiration, insomnia, anxiety, irritability) with reduction of the performance (the ability of adaptation and control of the environment in which we live), possible increase of the cardiovascular risk.
Another very important aspect is incapability to have children (sterility): the accident of an ovarian insufficiency picks a lot of women still without a previous reproductive success. From this point of view, the damage, is even more dramatic.

It is possible a prevention? Unfortunately a prevention is not possible. We advise to consult a gynecologist in front of an unexpected mestrual irregularity, particularly when there is a disappearance of the menstruations for a period superior  to 3 months (amenorrea). In this manner it will be possible an early diagnosis.
In consideration also of our studies the young smokers women should be informed about the risk of an abbreviation of their reproductive period and however of a possible ovarian damage.

When we talk about early "spontaneous" menopause  we exclude surgical and medical causes? Yes, certainly. The spontaneous menopause, does not be confused with the iatrogenic menopause that is determined from a therapeutic (medical or surgical) action, therephore predictable.
By the way,  you want to say that premature menopause, precocious menopause, premature ovarian insufficiency, premature ovarian failure, early menopause are to consider equivalent, due to a deficit of the ovarian function. 

Is ovarian premature failure can be considered as an irreversible condition? Clinical experience showed us in a lot of women this disease ave a capricious course, sometimes with periods (generally some months) of complete remission of the symptoms and complete normalization of the hypophysial and ovarian hormonal picture  These situations put very delicate problems in the therapeutic management of this patients and are difficult to be predicted: some researchers have indentified patients where the FSH is much more elevated than LH. During these periods of remission sporadic cases of conception have also been described. 

Why a temporary remissions? Unfortunately we do not know it. Sometimes we observe them after a short period (1-3 months) of treatment with estrogens and progestogens in a  schedule similar to the typical hormonal monthly secretory pattern of the ovary. It's possible that this exogenous hormones can induce some ovarian receptors. In these patients the  ultrasonography   (better that with the color-doppler) show an ovarian activity to.

What are the remedies that you advise to the women with early menopause? First of all it's necessary and most important to keep calm and do not consider him women “different”.  The hormonal replacement therapy (HRT) guarantees a normal  life, regular menses, normal sexuality,  quality of life similar to other people. 

You can speack about the reproductive problem? It is essential the consultation of an expert in  Reproductive Medicine.
Only in selected patients with residual ovarian activity (borderline) an "heroic" tentative of ovarian stimulation can be considered with very little possibility of succes.
A technique of third level with donation of ovocita is the treatment of choice with good results.