Too young for the menopause

When she was 26, Lara Dietz learned she had breast cancer - a shock to this mother of two very young children. Then came the second blow. When treatment began, so did a premature menopause. “I was having hot flushes,” she says. “I felt like I was 55 years old.”

When the menopause occurs between ages 45 to 55, it is considered natural. When it occurs before age 40 (regardless of the cause)it is called a premature menopause. The ovaries no longer produce an egg each month, so monthly menstrual cycles stop or become erratic. Because the ovaries stop producing oestrogen and testosterone, menopause symptoms such as hot flushes, insomnia, mood swings, and vaginal dryness may occur.

What causes a premature menopause?

As in Lara’s case, cancer treatment is one common cause of a premature menopause, even though she still had her ovaries, says her doctor, Dr Arthur Shapiro, professor of obstetrics and gynaecology at the University of Miami.

Depending on the type of chemotherapy used - and whether the ovaries take a direct hit from radiation therapy - the ovaries’ egg-producing follicles can be damaged or destroyed, he explains. That puts fertility in serious jeopardy.

But there is a window of opportunity before cancer treatment when steps can be taken to preserve fertility, Shapiro explains. “We can decrease the risk [of infertility] by using specific types of chemotherapies. We can store embryos. There are new methods of freezing eggs that are promising.”

Lara was lucky, says Shapiro. “she was young, and her body naturally recovered. It happens sometimes, usually between four to six years after treatment ends.” Fertility treatments helped boost the odds of pregnancy and Lara became pregnant with twins.

A premature menopause can also occur when:

• A woman’s ovaries are surgically removed for medical reasons such as uterine cancer or endometriosis. This is known as a surgical menopause.
• A woman has an autoimmune disorder such as lupus or rheumatoid arthritis.
• A woman has chromosomal abnormalities that affect ovary development, causing ovaries to stop producing eggs - or produce them erratically - before age 30.

A premature menopause is not always permanent, as in Lara’s case. That’s one key reason why, if at all possible, women should keep their ovaries - or protect them as much as possible, says Shapiro.

Too many women who undergo a hysterectomy have their ovaries removed unnecessarily due to fear of ovarian cancer, Shapiro says. Yet, he notes, when ovaries are removed before age 55, other risks are much higher:

• A woman is 16 times more likely to die from heart disease.
• A woman is three times more likely to die from problems resulting from hip fractures.

“There is a lot of evidence to show we should preserve the ovaries,” Shapiro says.