The cessation of menstrual flows can be sudden or preceded by irregularities in the cycle. Symptoms of early menopause are mostly associated with estrogen deficiency and can include hot flashes , mood swings , vaginal dryness , decreased sex drive, and sleep disturbances . In addition to confirming hypoestrogenism, diagnostic investigations can demonstrate elevated levels of serum gonadotropins ( FSH and LH), which provide an early signal of reduced ovarian function. Early menopause increases both the risk of osteoporosis (and related fractures ) and cardiovascular risk , as well as early exposure to alteration of the physiological function of numerous organs.
General Information On Available Treatments
Unfortunately, there are currently no treatments available to restore regular ovarian activity. Even in the case of immunosuppressive or corticosteroid therapies, proposed for cases of premature ovarian failure (POF) on an autoimmune basis, the results produced have been disappointing, especially if the potential side effects are considered. Women suffering from early menopause are expected to have a long post-menopausal life; for this reason, compared to women who enter menopause around the age of 50, they are exposed to an increased risk of consequences – such as the early onset of osteoporosis o cardiovascular problems – associated with changes in hormonal balance. For these reasons, the goal of therapy is to ensure patients a good quality of life, while implementing effective measures to reduce the risk of developing particular diseases, especially associated with estrogen deficiency . Symptoms and health risks can be managed with methods similar to those used for natural menopause. An effective therapy for early menopausal disorders must first of all be personalized; a pharmacological regimen is not always necessary and in any case the disturbances and possible associated complications must be taken into account, but above all the risk-benefit ratio.
The different types of treatment provided for symptom relief include:
Hormone Replacement Therapy
Hormone therapy usually involves the administration of estrogens combined with progestogens , hormones that the ovaries are no longer able to produce in sufficient quantities. Sometimes, treatment may also include testosterone or its derivatives. After having obtained the diagnostic confirmation, the doctor prescribes a therapy to be repeated cyclically, approximately until the age of 50, the average age of “natural” menopause. The treatment protocol (duration, dose, etc.) must be carefully evaluated with a specialist and weighted for each patient. Estrogen therapy helps prevent osteoporosis , relieve hot flashesheat, vaginal dryness and other symptoms caused by estrogen deficiency, but will not restore youthful ovarian function. Typically, estrogens are prescribed in combination with progesterone , to provide additional protection to the endometrium (the lining of the uterus ) from precancerous changes that can be induced by estrogen alone . If the patient shows the desire to get pregnant, by combining these hormones you can try to restore the menstrual cycle , to take advantage of the limited possibilities of attempting a pregnancy . Hormonal treatments they can be administered in different forms: there are pills, gels, patches that are applied to the skin or a vaginal ring , which is replaced after a few months. In older women, long-term combination replacement therapy has been associated with an increased risk of cardiovascular disease ( heart attack and stroke ) and breast cancer . In these cases, experts advise following hormone therapy at the lowest effective dose, for the shortest possible time. In young women with premature ovarian failure, however, the benefits of HRT usually outweigh the potential risks.
In the transition phase, in which the menstrual cycle is still present in an irregular form, the doctor may indicate therapy with oral contraceptives to relieve the symptoms of menopause and reduce the unpredictability of the onset of menstruation. The pill also satisfies any need to avoid unwanted conception if the woman does not want to have children.
Selective serotonin inhibitors ( SSRIs ) and some related drugs have shown good efficacy in controlling symptoms, such as hot flashes, in up to 60% of women.
Gels, Creams And Lubricants
They are localized treatments suitable for preventing or relieving vaginal dryness.
Assisted Reproductive Techniques To Deal With Infertility
Infertility is a common complication of early menopause, and there are rarely effective treatments to restore fertility in women with this condition. However, according to some studies, about one in 10 women diagnosed with spontaneous premature menopause can become pregnant, for reasons that are not yet clear.
For women in early menopause who wish to become pregnant, options can be discussed with the help of a specialist. In case of strong desire for motherhood, there are specialized centers where it is possible to try an ovulation induction therapy , stimulated by the administration of FSH ( follicle-stimulating hormone ) , LH ( luteinizing hormone ) and hCG ( chorionic gonadotropin ) . The combination of these three hormones induces the ovary to produce oocytes : the response to the stimuli is monitored by ultrasound and makes it possible to evaluate whether the therapeutic regimen has achieved a satisfactory outcome (a condition that is achieved in less than 10% of patients). In case of effective hormonal induction, the assisted reproduction protocol is applied .
Other Therapeutic Measures
- When early menopause is associated with medical conditions , such as thyroid disease or diabetes , additional medical treatment may be required.
- As noted earlier, women with early menopause are exposed for longer than life to low levels of estrogen ; this puts them at greater risk of developing conditions such as osteoporosis . The MOC (Computerized Bone Mineralometry) , a survey also carried out in the diagnostic phase, allows you to monitor any impairment of the basal bone density; therefore, patients should repeat the analysis at least every two years.
Furthermore, to prevent bone demineralization it is possible to resort to:
- Calcium and Vitamin D supplements ;
- A ‘ constant physical activity , which – especially if in the open air – can help maintain healthy bone tissue and improve mood;
- In case of osteopenia and high risk of osteoporotic fractures , it is possible to adopt an adequate systemic treatment.
Can Premature Menopause Be Prevented?
At this time, there is no therapy available that can prevent early menopause.
Some measures can be taken to preserve good general health conditions and adopt a correct lifestyle :
- A balanced diet with a low fat content allows you to avoid weight gain, which generally accompanies early menopause;
- Regular physical exercise , preferably of an aerobic nature , allows you to keep fit and fight against weight gain . Furthermore, it can help protect bone mass and the heart , and allows to counteract the forms of osteoarthritis associated with menopause and joint pain (in particular, in the hands, knees and back ).
- To control some symptoms, it is possible to resort to taking food supplements . Some examples are:
- Soy isoflavones : help control hot flashes;
- Vitamin D and calcium : in case of osteoporosis;
- Melatonin : for sleep disorders ;
- Omega 3 fatty acids : against high cholesterol .
- Avoid smoking and alcohol : smoking and alcohol abuse are risk factors that can potentially anticipate menopause, so they need to be minimized.