The beginning of menstruation (also known as menarche) and the end of menstruation (also known as menopause) are considered to be two major landmarks in a woman’s sexual and reproductive health. Both have the capacity to change not only your quality of health and life, but also make women susceptible to physical and mental health issues owing to the changes. But, what happens when these changes occur earlier than they’re supposed to?
Globally, premature or early menopause is believed to affect around one per cent of women. But a study published in the journal Health and Social Work in 2017 suggests that when it comes to Indian women, the percentage of premature menopause is quite high: 5.5 per cent! The study also highlights that the percentage of women dealing with this phenomenon is highest in Andhra Pradesh, with a whopping 14.6 per cent of women suffering from this issue.
Clearly, we need to pay urgent attention to why premature menopause is gaining such a foothold in India, and is affecting Indian women more than ever before. We talked to Dr Asha Dalal, director of the department of obstetrics and gynaecology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, about the issue. Here’s everything you need to know.
Premature menopause: An emerging issueDr Dalal points out that the average age of menopause for Indian women is around 46.6 years. “Menopause occurs when your ovaries stop producing eggs, resulting in low oestrogen levels,” she says. “Oestrogen is the hormone that controls the reproductive cycle, and a woman is in menopause when she hasn’t had a period for more than 12 months.” This is therefore a gradual and natural process, which is why terms like perimenopause and post-menopause are used to describe a woman’s reproductive health before and after it actually occurs.
But, if it occurs before the age of 40 years, then it’s known as early or premature menopause. As the study above shows, it is an emerging issue for Indian women, and Dr Dalal explains why that is. “There are more and more women who have a sedentary lifestyle, smoke, exercise, and diet excessively. Women today delay pregnancy till their career is established. When they want a pregnancy they will have a low AMH or viable egg reserve. These not only contribute to early menopause, but also cause other complications. Infertility, for example, becomes a major issue with women who have this issue.”
Causes“Anything that damages your ovaries or stops oestrogen production can cause early menopause,” Dr Dalal says. The following are some of the key causes of premature menopause that she highlights:
1. Genetics If there’s no obvious medical reason for early menopause, the cause is likely genetic. If your mother or elder sister started it early, you’re more likely to do the same. Some problems of the genes can also cause early menopause.
2. Chromosomal defectsSome chromosomal defects can lead to early menopause. For example, Turner Syndrome (also called monosomy X and gonadal dysgenesis) involves being born with an incomplete chromosome. Women with Turner Syndrome have ovaries that don’t function properly. This often causes them to enter menopause prematurely. Similarly, women with Fragile X Syndrome, or who are genetic carriers of the disease, may also have this issue. This syndrome is passed down in families. Women should discuss genetic testing options with their doctor if they have premature menopause, or if they have family members who had it.
3. Lifestyle Smoking has an anti-oestrogenic effect, and can cause early menopause—at least two years before non-smokers, Dr Dalal points out. The study mentioned above also concurs that smoking and tobacco consumption are two of the greatest contributing factors for it. The study also says that nutritional deficiencies can have a long-term effect on hormone production and balance, and may lead to premature menopause too. This apart, Dr Dalal points out that excessive caffeine consumption, excessive dieting, exposure to radiation, a low-nutrient vegetarian diet, lack of exercise, and lack of sun exposure can also cause the early onset of this issue.
4. Low BMIWomen with a low body mass index have low oestrogen due to reduced fat. These women can tend to suffer from early menopause. Dietary restrictions and excessive dieting, even during early adulthood, can lead to low BMI and premature menopause.
5. Autoimmune disordersThere are many types of autoimmune diseases that people may suffer from, and recent research shows that women may have added risks of suffering from autoimmunity. Autoimmune disorder affects your immune system, as well as all the major organ systems and functions. Hormone imbalance and deficiencies are also more likely to occur if you suffer from autoimmunity. Dr Dalal says that premature menopause can be a symptom in people with autoimmune disorders, like thyroid disease and rheumatoid arthritis.
6. SurgeryExtensive surgery on ovaries, like for ovarian cyst and endometriosis, removal of ovaries, or even removal of the uterus (hysterectomy), can cause early menopause.
7. Chemotherapy and radiotherapy If you have received chemotherapy for any cancer, or you have had radiotherapy near the ovaries, the risk of developing early menopause get much higher.
Symptoms Whether you have symptoms of early menopause or not, going in for a consultation with a gynaecologist regularly is important for every woman. Apart from letting you know that everything is fine, these visits can also help catch problems before they manifest fully or become irreversible. Dr Dalal says the following are the major symptoms you should be looking out for:
• Irregular or missed periods
• Periods that are heavier or lighter than usual
• Hot flashes, or a sudden feeling of warmth that spreads over the upper body
• Excessive sweating
• Mood swings
• Vaginal dryness
• Reduced sleep
• Decreased sex drive
• Sudden increase or decrease in weight
“Although it is not always possible to prevent early menopause, some lifestyle changes might help,” says Dr Dalal. She suggests the following preventive tips:
• Stop smoking
• Don’t consume excessive caffeine
• Avoid exposure to radiation
• Eat healthy, balanced meals comprising of fruits and vegetables
• Exercise regularly