Early menopause

What is it

Early menopause is a condition that occurs when a woman’s fertile period ceases before the age of forty.

There are two types of early menopause: the first is called Pof, from the English Premature ovarian failure, or spontaneous early menopause.

The second is considered a consequence of medical treatment. In the latter case we speak of iatrogenic menopause.

The causes

Early spontaneous menopause is caused, in about 30 percent of cases, by genetic factors. In practice it is a hereditary factor that is handed down from generation to generation.

It is very likely to happen in cases where the mother, grandmother or older sister have experienced spontaneous early menopause.

In the remaining 70% of cases there are no specific reasons. It is generally due to different pathologies, which can also be autoimmune.

In the case of iatrogenic early menopause, at the origin there may be surgical interventions, with bilateral removal of the ovaries, or chemotherapy or radiotherapy treatments performed for the treatment of tumors.

The most common symptoms

The first symptom is usually irregular period. Menstruation may occur ahead of time (polymenorrhea) and the amount of flow may be high (metrorrhagia).

Menstruation itself may last longer (menometrorrhagia).

At some point it can happen that you skip an entire cycle, in the sense that the interval between one menstruation and another becomes about two months.

Sleep disorders may also appear, such as:

• frequent awakenings
• nocturnal tachycardias
• feeling exhausted during the day
• mood disorders (irritability, melancholy)
• irrepressible appetite

The body also sends quite unmistakable signals. Many women gain weight, wrinkles appear, the skin becomes drier, and in some cases unusual hair loss is observed.

Finally, there is often a decrease in sexual desire, a reduction in vaginal lubrication and greater difficulty in reaching orgasm.

Diagnosis

For the diagnosis of early menopause, the FSH hormone, the follicle stimulating hormone, is usually dosed through a simple blood sample.

If it is higher than 30 mIU / ml it means that the reserve of ovarian follicles is now scarce and that the climacteric is beginning, or the transition from the reproductive state to the non-reproductive state, or menopause.

This is confirmed when, in two consecutive samples one month apart, the FSH is above 40 mU/ml.

You can also perform the dosage of estrogen (17-beta-estradiol): if the result is less than 30 picograms / ml it means that the reappearance of menstrual flow is unlikely.

If 17-beta-estradiol is less than 20 pg/ml, the ovary has exhausted follicle stores and produces estrogen residually.

However, there are also other parameters that the doctor may find useful to keep under control to assess the situation.

Treatments and therapies

Faced with a diagnosis of early menopause, the doctor may prescribe individualized hormone replacement therapy.

In the period that precedes it, that is, when the cycle begins to occur irregularly, some doctors prescribe a hormonal contraceptive.

Once menopause is over, the doctor may prescribe cyclic hormone therapy in order to get menstruation again, obviously without the possibility of procreation.