Menopause Health Article

Premature (spontaneous) menopause

Premature menopause occurs spontaneously, without any outside interventions or stresses, and affects about 0.3% of women. It is generally due to ovarian failure and occurs before age 40. Because hormonal levels plummet dramatically, these women experience severe vasomotor symptoms that can last as long as 8.5 years. Fertility may end over several months or immediately.

Surgical menopause

What a woman would normal experience between a two to eight-year period during normal menopause, women with surgical or premature menopause experience immediately and at a very young age. Some of these women are as young as 15. Fertility ends immediately.

Bilateral oophorectomy, or the surgical removal of both ovaries, can be the result of several different procedures. A complete hysterectomy, or the removal of the uterus and the ovaries, results in menopause. It is performed to remove cancerous growths in the ovaries, uterus, or cervix, and may be done in some types of colon cancer surgery. It can also be done to remove non-malignant fibroid tumors in the uterus or to mitigate the effects of endometriosis (although these procedures do not always require the removal of the ovaries). If surgery leaves one or both ovaries, often menopause is avoided. However, in some cases, menopause occurs regardless of whether the ovaries are left intact.

Induced menopause

Induced menopause occurs when a woman has been exposed to pelvic radiation or chemotherapy. The drugs in chemotherapy used to combat cancer can seriously damage the ovaries. This condition may be temporary, lasting only a few months or years. Permanent menopause is more likely if a combination of drugs are used or the woman is close to perimenopause. Pelvic radiation therapy usually produces permanent menopause. Other types of radiation therapy, away from the ovaries, may not affect ovarian hormones at all, thus avoiding induced menopause.

Causes

The cause of most menopausal symptoms has been attributed in part to low estrogen levels in the body. Increased amounts of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are also involved. If a woman is overweight, she may experience milder symptoms because the fat stored in her body is converted to estrogen when the hormone levels fall. Also, women who endure premenstrual syndrome (PMS) are more apt to report mood swings. This may be due to differences in hormone levels. New research is beginning to tie psychological factors to these symptoms as well. For example, women who are depressed and angry, especially if they are unhappy in their relationships, often report more pronounced symptoms.

Ethnicity may also be a factor in the development of symptoms. Since most of the menopausal research has been conducted on white women, cross-ethnic studies in 2000 were conducted to discover any racial or ethnic variables. The frequency and type of symptoms reported varied widely between ethnic groups. Japanese American and Chinese American women reported fewer symptoms than the other women. African-American women experienced more hot flashes and vaginal dryness. Hispanic women had more vaginal dryness, urine leakage, and heart palpitations. Non-Hispanic white women reported more sleep difficulties.

It is unclear whether cultural or biological factors are involved in these differences. As for causal agents, that may be too early to tell. In any case, the health care team should be aware that ethnic differences in symptom manifestation do exist in menopause.