Studies conducted tell us that there have been more and more cases of premature menopause. This is indeed an alarming trend and while there is nothing that can prevent such changes from happening, understanding the physical problem is a way of tackling it.

Menopause is derived from the Greek word pausis (cessation) and the root men (month). This describes the change in women where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruation or menses. The natural age for menopause worldwide is 51, but in India the natural age of menopause is around 49.
The onset of menopause that occurs before the age of 40 is called premature menopause. This may be natural or induced (post hysterectomy or radiation). Physical ageing triggers menopausal symptoms and also increases infertility.

The causes
Women with a poor quality of life and with poor nutritional status are likely to deal with premature menopause. The causes of premature meno-pause include genetic causes such as chromosomal abnormality, familial premature ovarian failure, metabolic disorders and autoimmune disorders. There are also many cases where infections like tuberculosis and mumps may lead to the onset of premature menopause. A host of autoimmune disorders may be associated with this too — like asthma, anaemia (acquired hae-molytic, pernicious), diabetes mellitus, hypothyroidism, Graves’s disease or lupus.
Physical trauma or interactions that result in the loss of oocyte-like irradiation, chemo-therapy, smoking (polycystic hydrocarbons found in cigarettes destroy the oocyte), surgery to the uterus or adnexa may also lead to early menopause.
Most patients who suffer from this premature onset have irregular or missed periods, hot flashes, vaginal dryness, dyspareunia, decreased sex drive, urinary problems, psychological problems and so on as menopause marks the end of the reproductive years. Emotional changes, osteoporosis, increased risk for colon and ovarian cancer, periodontal (gum disease) tooth decay and cataract formation, increased risk of cardiovascular disease and stroke are also the effects of an early menopause.
For women who have been postponing their pregnancies to the later 30s, this has some devastating results. This is particularly applicable today where women are having babies later than the norm.

The checks and measures
A diagnosis is reached by doing a blood test which includes a haemogram, FSH and oestradiol levels, thyroid function test, blood glucose levels and other specific investigations where required and an ultrasound.
Patients heading towards premature menopause are advised lifestyle modifications like a balanced diet, exercise and stress management. A high-fibre low-fat and low carbohydrate diet incorporating vitamins and minerals in one’s daily diet helps. One should eliminate tea, coffee, alcohol, caffeine, spicy food and smoking. Weight control is important. Soya, vitamin E and herbal supplements should be added to one’s diet to delay the onset of menopause.

The way forward
Estrogen replacement therapy to avoid the long-term consequences of premature meno-pause is considered in some cases. In younger patients desirous of pregnancy, exogenous administration of estrogen has been reported to lead to ovulation, however the probability is <10 per cent. Cortico-steroids and gonadotropins can also be recommended by a doctor. In-vitro fertilisation involving oocyte donation provides the greatest likelihood of pregnancy in women who are in this category. Doctors also suggest the cryopreservation of ovarian tissue as a potential alternative. This helps in sustaining the fertility in women at risk of premature ovarian failure leading to premature menopause.

The writer works as a consultant at Bhagwan Mahaveer Jain Hospital, Bengaluru