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Dangers of Early Menopause

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It increases your risk for heart attack, dementia and other serious conditions…

For the average woman in the US, menopause occurs between the ages of 45 and 55. But what if it happens earlier than that?

Up to 5% of American women do reach menopause earlier than normal—due, for example, to genetics, chemotherapy, surgical removal of the ovaries or a seemingly unrelated condition such as an autoimmune disease (see details below).

What’s new: A growing body of evidence is now uncovering dangers associated with early menopause. Fortunately, research is showing that there are steps that women can take to protect themselves.

WHY MENOPAUSE HAPPENS EARLY

A woman is said to have reached menopause when a year has passed since her last menstrual period. The same symptoms that occur with regular menopause usually are present with early menopause, such as hot flashes, decreased sex drive, vaginal dryness and sleep problems.

When menopause comes early because of genetics or an autoimmune disorder, it’s a specific medical condition—doctors call it primary ovarian insufficiency. Decreased activity of the ovaries causes a drop in estrogen that leads to menopause. Autoimmune diseases that can trigger early menopause include thyroid disease, rheumatoid arthritis and lupus, among others.

Medical treatments also can cause early menopause. Women who undergo surgical removal of the ovaries experience menopause right away. Chemotherapy and pelvic radiation can damage the ovaries, resulting in menopause that occurs earlier than normal.

Another area of study: Scientists also are learning more about a link between environmental toxins and early menopause. Smoking—and exposure to cigarette smoke—has been found to promote early menopause by damaging the ovarian cells that release estrogen. Women who smoke should do their best to stop. Research shows that female smokers start menopause an average of two years earlier than nonsmokers.

Talk to your doctor: If your periods have stopped and you’re also experiencing weight loss, dizziness or low blood pressure, you may need a test for Addison’s disease—a condition that affects the adrenal glands and is associated with about 3% of cases of primary ovarian insufficiency.

STAY SAFE AFTER MENOPAUSE

For the majority of women, the dangers of early menopause can be nearly eliminated with the use of supplemental estrogen, along with lifestyle approaches…

    • Heart attack and stroke. Menopause that occurs even at a normal age increases heart disease risk—the decline in estrogen causes about a 10% boost in LDL “bad” cholesterol, reduces the ability of the coronary arteries to expand and contract and hastens the development of atherosclerosis.Important study: Women who experienced early menopause were found to be twice as likely to suffer from a heart attack or stroke as those with a later menopause.My advice: Follow a cholesterol-lowering diet—include plenty of fish, vegetables and whole grains and limit red meat and other foods high in saturated fat. And exercise regularly (ideally, for at least 30 minutes, most days of the week).

Also: Be sure to get your cholesterol tested every one to two years. If it’s high, your doctor may recommend niacin and/or a statin medication, such as simvastatin (Zocor).

  • Memory loss/dementia. “Brain fog”—a common complaint among menopausal women of all ages—appears to be temporary, but there is another, more serious risk.Important finding: Women who experience early menopause have nearly twice the risk of developing dementia as women whose menopause comes later.My advice: Don’t delay estrogen therapy. Research shows that women who start estrogen replacement within five years of menopause (the earlier the better), and continue to take it for 10 years or more, are about one-third less likely to get Alzheimer’s than those who avoid estrogen until later in life. Despite well-publicized research that found dangers associated with hormone-replacement therapy (HRT) years ago, there are safe ways for most women to use it (see below).
  • Osteoporosis. Your risk of developing osteoporosis is roughly doubled if you have early menopause. When estrogen declines, the rate at which your bones break down outpaces your body’s ability to build new bone.My advice: After menopause, eat plenty of high-calcium foods, such as leafy greens and low-fat dairy. Postmenopausal women need a daily total of 1,200 mg of calcium (from food and supplements).They should also get their vitamin D levels tested and take vitamin D supplements, if needed, as directed by their doctors. Vitamin D is just as important as calcium for healthy bones.

    Remember: Weight-bearing exercises, such as walking, tennis and weight-training, are keys to building and maintaining bone density.

Early Menopause and Estrogen

It has been more than a decade since a high-profile study in The Journal of the American Medical Association (JAMA) reported that HRT increases risk for heart disease, stroke, breast cancer and blood clots in the lungs.

After the study was reported, prescriptions for HRT, commonly used to help ease menopausal symptoms, dropped by 50%—and today millions of women still refuse HRT.

What most people don’t realize: Many women in the JAMA study began HRT 12 years after menopause. Also, the increased risks linked to HRT use have been shown to mainly occur in women who took the hormone progestin along with estrogen.

If women start estrogen soon after early (or regular) menopause, research shows that they’ll have lower risk for heart disease, Alzheimer’s disease and osteoporosis than those who take it later in life.

My advice for women with early menopause: Consider taking estrogen for at least 10 years, but talk to your doctor to be sure estrogen’s benefits outweigh any potential risks (such as stroke). An estrogen patch may be safer than the oral form. If you’ve missed the window described in this article for estrogen therapy, consult your doctor.

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Source: Machelle Seibel, MD, a professor of obstetrics and gynecology at the University of Massachusetts Medical School in Worcester. He is editor in chief of My Menopause Magazine and coauthor, with Karen Giblin, of Eat to Defeat Menopause: The Essential Nutrition Guide for a Healthy Midlife. Date: October 1, 2013 Publication: Bottom Line Health

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