What Is Premature Menopause: Causes And First Symptoms, Viral And Bacterial Infections

The menopausal period is characterized by the absence of menses for at least 12 consecutive months , by  changes in hormonal secretions  and other physiological changes.

The cyclical cessation of ovarian activity and the fertile season normally occurs around the average age of 50 years  (+ or – 5 years). However, due to ovarian dysfunction, certain diseases, genetics or particular medical procedures, some women enter menopause early, under the age of 40. This natural or induced condition is known as  early  (or premature) menopause .

In addition to dealing with  hot flashes , mood swings and other  typical symptoms that accompany climacteric , many women in early menopause have to cope with additional emotional and physical problems (infertility, reduction of  bone density , metabolic effects that can compromise numerous organs etc.).

Definition

What Is Early Menopause?

Early menopause coincides with the loss of ovarian activity (and the consequent disappearance of menstrual cycles)  before the age of 40 . This condition can occur  spontaneously  or induced  , due to bilateral ovariectomy surgery   or pharmacological or radiotherapy ovarian suppression . The phenomenon affects approximately 1-3% of Italian women of reproductive age.

Premature Ovarian Failure (Pof)

Premature Ovarian Failure (Pof): What It Means And What Causes It

Premature menopause is also indicated with the term  POF  ( Premature Ovarian Failure ); this term refers to premature ovarian failure with  amenorrhea , elevated serum gonadotropins ( FSH and LH ), and hypoestrogenism (  decreased plasma estradiol ).
In reality, the two conditions are not exactly equivalent:

• Premature ovarian failure  can be considered a  transitory phenomenon , since in many cases intermittent spontaneous ovarian activity can occur for years, characterized by occasional menstrual periods alternating with others of amenorrhea (absence of menstruation for at least three months). Women with premature ovarian failure are still able to produce estradiol (so ovulation can occur ) and can sometimes be able to become  pregnant .
• The patient with  early menopause  stops menstruating completely (and permanently) and is therefore unable to get pregnant.

In women with premature ovarian failure:

• There are dysfunctional primordial follicles, which are physiologically unpredictable and absolutely irregular;
• Ovulation can occur in 5-10% of cases.

When POF becomes a  permanent condition , it equates to early menopause.

Causes

What Are The Causes Of Premature Menopause?

At the basis of the onset of early menopause there is a follicular atresia  (arrest of the development of the follicle ), generated by multiple causes, some complex and others of a primitive nature.
In two thirds of cases, early menopause is considered  idiopathic : the specific cause at the origin of the condition cannot be identified and the  karyotype  does not show any alterations (ie there are no specific genetic abnormalities that predispose to early menopause).

The possible causes that promote early menopause are:

Genetic (Hereditary) Abnormalities

Some  genetic syndromes  and  chromosomal alterations , evident on karyotype analysis , are associated with premature menopause.
Some examples involve  mutations  on the X chromosome and include:

• Fragile X chromosome syndrome , caused by a particular mutation of the FMR1 gene, located on the X chromosome;
• Turner syndrome  (45,X) , in which menopause precedes  menarche  and ovarian function is absent;
• Swyer syndrome  (pure gonadal dysgenesis): involvesunderformed and non- functional gonads .

Systemic Causes

Inherited enzyme/metabolic defects may also   promote early menopause:

• Galactosemia : systemic pathology caused by the malfunctioning of  enzymes  that perform the function of metabolizing  galactose ; as a result, the body is unable to convert it into  glucose . Unconverted galactose is thought to produce an ovarian toxic  effect ;
• Congenital adrenal hyperplasia : autosomal recessive disease affecting the  adrenal glands  and characterized by disorders in the biosynthesis of  steroid hormones ;
• Mucopolysaccharidosis : systemic metabolic diseases, caused by specific enzyme deficiencies. These diseases are classified among the heterogeneous group of lysosomal storage diseases.

Autoimmune Diseases

The autoimmune diseases that coexist with early menopause can be of two types:

• The immune system mistakenly produces   anti-ovarian antibodies  (antifollicle, anti- corpus luteum , anti-  pituitary hormone receptors  , etc.);
• Premature ovarian failure can be associated with other systemic autoimmune diseases, especially of the  thyroid type  ( hypothyroidism ) or affecting the  adrenal gland , as in the case of  Addison’s disease  (it limits the production of hormones secreted by the adrenal glands). Other systemic autoimmune conditions to be considered in early menopause are  Crohn’s disease ,  systemic lupus erythematosus  , and rheumatoid arthritis .

The histological picture that characterizes patients with  autoimmune premature ovarian failure is the presence of oophoritis (inflammation of the ovary).

Viral And Bacterial Infections

Certain viral infections , such as  cytomegalovirus  or  mumps , or bacterial infections ( tuberculosis ) are thought to contribute to early menopause in some patients. Mumps  , in fact, has among its complications the inflammation of the ovary (oophoritis), which, if it becomes chronic , is able to compromise the functionality of the organ. The same process is triggered by  Koch’s bacillus , which in addition to affecting the  lungs , can trigger genital tuberculosis and consequently oophoritis.

Iatrogenic Causes: Induced Premature Menopause

In these cases the menopause is premature due to a therapeutic procedure which can be pharmacological (chemotherapy), radiation or surgery. These treatments produce different consequences on fertility, associated symptoms, etc.

• Pharmacological therapies : early menopause is a condition that can be promoted by  chemotherapy . Obviously, this effect depends on many factors, including the age of the woman, the types of drugs used and the dosage. Some of the chemotherapy drugs that can promote the condition are:  alkylating agents ,  cyclophosphamide  and  busulfan ; with minor ovarian toxic effects:  methotrexate  and  fluorouracil . The damage promoted by chemotherapy is gradual and, once the cure is finished, there can be a complete reactivation of ovarian activity.
• Radiotherapy : the damages induced by radiotherapy are irreversible only if the irradiation is carried out at the pelvic level and with a particularly high dosage. Ovarian recovery is, therefore, possible.
• Surgical menopause : bilateral ovariectomy  (removal of both ovaries) and hysterectomy (  removal of the uterus ) are surgical interventions that favor the precocity of menopause. These interventions may be necessary for the presence of a tumor,  ovarian cysts , severe  endometriosis  or other pathological conditions. Bilateral oophorectomy produces a rapid decrease in circulating levels of ovarian hormones and induces infertility permanently and immediately.

Other Causes

Even a  wrong lifestyle , especially  smoking  and alcohol abuse , seems to bring forward the age of menopause. Furthermore, the existence of a family predisposition must be considered  , for which the age at which the mother, grandmother or an older sister entered menopause should always be taken into consideration.

Early Menopause Symptoms

Early Symptoms Of Early Menopause: How Do You Recognize Them?

The symptoms are generally difficult to interpret and are often the same that accompany natural menopause.
The clinical picture of early menopause can include:

• Sudden cessation or irregular onset of menstrual flows, with evident changes in the  menstrual cycle :  oligomenorrhea  (alteration of the rhythm of the menstrual cycle),  polymenorrhea  (abnormal increase in the frequency of the cycle) and  menometrorrhagia (  hemorrhagic profuse blood  loss  which occurs in conjunction with menstruation and tends to prolong its duration). The evolution of these signs is amenorrhea, ie the absence of menstruation for at least three months and, subsequently, their definitive disappearance;
• Aggravation of  premenstrual syndrome ;
• Hot flashes : a sudden feeling of heat, followed by intense sweating , spreads over the upper body until the face and neck are flushed

These symptoms are a sign that the ovaries are producing less  estrogen .

Other symptoms associated with early menopause

Along with the symptoms listed above, some women may experience:

• Vaginal dryness  and  pain during sexual intercourse ;
• Bladder control issues  , such as incontinence or  increased frequency of  urination ;
• Irritability,  mood swings ,  mild depression  and  insomnia  (associated with decreased estrogen levels);
• Transient tachycardias  ;
• Hair loss ,  dry skin  and  weight changes  (weight gain);
• Decreased sex drive.