Causes Of Early Onset Menopause

Introduction

The monthly cycle (or menstrual period) is a normal part of the life of people who were assigned female at birth, and they also know that this part comes to an end as they grow up, we call it the menopause age. However, some of these people might enter menopause earlier than usual as a result of different reasons and factors. We’ll get to know what might cause early-onset menopause.

What is menopause?

• According to recent guidelines by the World Health Organization (WHO), menopause is defined as the permanent discontinuation of menstruation as a result of the loss of ovarian follicular activity. In other words, menopause means the stopping of the menstrual period and the ability to get pregnant.¹
• The word menopause comes from the Greek language (men means month or monthly cycle, and pausis, which is pause in Greek, means end or stop). People assigned females at birth transition gradually from the fertility period into the menopause age, and this age usually starts in the fifth decade of life. Several studies indicated that it often starts sometime between the ages of 45 and 55 years old.²
• Common symptoms of menopause include: changes in your period, mood swings, anxiety, hot flashes, difficulty sleeping, headaches, weight gain, reduced sex drive, vaginal dryness and pain, etc.

What is early onset menopause?

When people assigned female at birth have their final menstrual period between the ages of 40 and 44, they are defined as having early-onset menopause.³

Causes of early onset menopause

Different causes and factors contribute to the time of menopause:

Age of menarche (the first menstrual period)

There have been a lot of studies about the relationship between the age of menarche and the age of menopause. In a large study, it was found that people assigned female at birth who had menarche at the age of 16 or older had their menopause one year later than the ones who had their menarche at younger ages. Consequently, these findings suggest that the age of menarche could have an effect on the age of menopause.⁴

Oral contraceptives

In a large study, it was estimated that the use of oral contraceptives by people assigned female at birth under 35 years old isn’t correlated with early menopause. However, using oral contraceptives at the age of 35 and older was positively associated with the risk of early menopause.⁵

Smoking

Numerous studies have been conducted to examine the effects of smoking on menopause. In a large study, it was observed that the risk of early menopause was doubled for smoking people assigned females at birth compared with non-smokers. This risk also differentiates according to the amount, duration, and age of smoking. The risk of early menopause was 50% higher in those who smoked more than 20 cigarettes a day. Moreover, former smokers who had smoked for more than 15 years were observed to have an increased risk of early menopause as well. Furthermore, smokers who quit by age 25 and smoked less than a pack per day had no increased risk of early menopause, while smokers who quit by age 35 and smoked more heavily had a significantly increased risk of early menopause.⁶

Body mass index (BMI)

The effect of BMI on menopause was studied, and it was observed that underweight people assigned females at birth were at a higher risk of early menopause compared with those with normal BMI. Moreover, overweight and obese people assigned females at birth were at increased risk of late menopause. Consequently, it has been estimated that underweight people assigned female at birth had over twice the risk of experiencing early menopause, while the overweight and obese ones had over 50% higher risk of experiencing late menopause.⁷

Family history

Around 10% of people assigned female at birth with a family history of early menopause have an increased risk of having it as well.⁸

Certain conditions

A recent study estimated that there is a 50% increased risk of early menopause for people assigned female at birth with laparoscopically confirmed endometriosis.⁸

Genetic causes: Sex chromosome abnormalities

• Aneuploidies: It has been established that aneuploidies, or chromosomal rearrangements, are the most common cause of premature ovarian insufficiency (POI) or early menopause. One example is Turner syndrome, in which there is a loss of one X-chromosome.⁹
• Mutations: An example is the fragile X syndrome, which leads to premature ovarian insufficiency or early menopause.⁹

Chemotherapy and radiation

Chemotherapy and radiation work by destroying rapidly dividing cells in order to treat cancer, and this effect leads to some defects in the DNA and somatic and germ cells, which, in turn, leads to apoptotic death in oocytes. The degree of damage depends on the chemotherapeutic agent used, the given dose, the age of the patient, and her baseline ovarian reserve.⁹

Autoimmune disorders

It has been estimated that 10% of patients with Addison’s disease would develop premature ovarian insufficiency (POI) 5-14 years before adrenal disorder. Moreover, POI could also be associated with other autoimmune diseases, such as:⁹

• Hypothyroidism and hypophysitis
• Type 1 diabetes mellitus
• Non-endocrine autoimmune haemolytic anaemia
• Pernicious anaemia
• Vitiligo
• Alopecia areata
• Celiac disease
• Inflammatory bowel disease
• Primary biliary cirrhosis
• Glomerulonephritis
• Multiple sclerosis
• Sjogren's syndrome
• Myasthenia gravis

Infections

There are some infections that could be a factor in causing early onset menopause, such as mumps, oophoritis, HIV (AIDS), varicella, cytomegalovirus, and malaria. These infections have been reported to cause POI.⁹

Some surgeries

There are some surgeries that have been found to be a possible cause of early onset menopause, such as the surgery of removing your uterus (hysterectomy) and the surgery of removing your ovaries.

Other causes

It has been observed that people assigned female at birth who do heavy physical activity are more susceptible to early menopause, unlike those who do light physical activity. Moreover, the consumption of high amounts of polyunsaturated fats was found to be associated with early menopause, unlike the consumption of a healthy diet. Furthermore, hypertension and low exposure to the sun were also found to be associated with early menopause.²

Treatment of early onset menopause

There are some steps that could help alleviate the outcomes of early menopause:

• Lifestyle interventions: Following a healthy lifestyle is critical to reducing cardiovascular risk (quitting smoking) and enhancing bone health (weight management and a calcium-rich diet).¹⁰
• Hormonal treatments: Generally, it was observed that hormonal treatments were effective in relieving some symptoms, such as oestrogen replacement and a combination of oestrogen and progesterone.¹⁰
• Non-hormonal treatments: These treatments are offered for those who can’t have oestrogen treatments. It has been found that psychological interventions, especially cognitive behavioural therapy, help enhance sleep and mood disturbances in addition to relieving vasomotor symptoms (hot flashes).¹⁰
• It’s also essential to give calcium and vitamin D supplements to those with low bone density.¹⁰

Prevention of early onset menopause

A lot of factors are associated with early menopause, such as low education, unemployment, nulliparity, a vegetarian diet, and a prior history of heart disease. Consequently, we can follow some tips that might help in the prevention of early menopause:¹¹

Physical activity

It has been observed that a higher BMI at 20 years of age, moderate-high weight gain at mid-life, exercise participation, and increasing physical activity during adulthood and adolescence are all associated factors with late menopause and a longer reproductive span.¹¹

Lifestyle factors

One of the most critical factors affecting menopause is smoking because it contains a substance that is toxic to ovarian follicles, which leads to a decrease in oestrogen levels and, in turn, leads to early menopause. Therefore, quitting smoking as soon as possible is extremely critical to preventing early menopause. On the other hand, some studies found that moderate consumption of alcohol might delay menopause. Moreover, sustainable consumption of tea also helps delay your menopause, and the reason is mostly because of the antioxidant and nonsteroidal estrogenic effects of the flavonoids in the tea.¹¹

Diet

There aren’t enough studies on the influence of diets on menopause. Nevertheless, it has been observed that caloric restriction, especially during early childhood, might lead to early menopause. On the other hand, increased consumption of fruits, vegetables, total calories, high carbohydrates, and high protein is associated with delayed menopause. Therefore, a healthy diet and lifestyle play an important role in the onset of menopause.¹¹

Summary

Menopause is an unavoidable phase that all people who were assigned female at birth will go through eventually, and it causes some unpleasant symptoms and, sometimes, might lead to some serious outcomes. Early-onset menopause is when these people enter this phase earlier than usual as a result of various causes and factors. There are some recommendations that could be beneficial in preventing early-onset menopause-  and managing it is the same as managing natural menopause.