The average age for menopause is 51 years (normal range 47-55 years). However, because of genetic, illness or medical procedures, some women go through menopause before the age of 40 years.
Menopause that occurs before the age of 40 years, whether natural or induced is known as premature menopause.
In addition to the hot flushes, mood swings and other symptoms that accompany menopause many women undergoing premature menopause have to cope with  additional physical and emotional concerns, for example infertility.

Symptoms of Premature Menopause

Irregular or missed period:- Premature menopause implies a cessation of menstruation. Six months amenorrhea (cessation of menstruation) is arbitrarily taken to imply that menopause is occurring in association with other hormonal test and symptoms.

Hot Flushes:-
This is a sudden feeling of warmth that spreads over the upper body. This is related to low oestrogen levels.
It lasts for a few seconds to several minutes. Sudden onset of reddening of skin over head, neck and chest accompanied by feeling of heat and followed by sometimes profuse perspiration. It may be precipitated by heat or anxiety. It may last for at least a year in the majority of those affected or for several years in a minority. Oestrogen therapy is the best treatment for true hot flushes and for the sleep disturbance associated with it.

Psychological Problems:-
Emotional changes such as irritability, mood swings mild depression arises usually in those who have had previous problems.

Decreased libido (sex drive):-
This may arise due to the decreased oestrogen levels, and may also arise due to the changing social circumstances of sudden cessation of periods.

Skeletal Changes:-
After the age of 40 years the bone density in women begins to decrease. Sudden decrease in oestrogen level below age 40 years in premature menopause fastens the process of bone problems such as osteoporosis.

Vaginal Dryness:-
The vagina may also become thinner and less flexible in premature menopause due to the decrease in oestrogen hormone.
Bladder irritability and worsening of loss of bladder control (incontinence) may also occur in premature menopause.

Diagnosis of Premature Menopause

To diagnose premature menopause, your doctor will perform a physical examination and draw blood to rule out other conditions such as pregnancy and thyroid diseases.
He will do a blood test to measure your oestrogen level; low levels of oestrogen can indicate that your ovaries are starting to fail. When the oestrogen level is less than 36, it may signal that you are in menopause.
The most important test used to diagnose premature menopause is a blood test that measures follicle stimulating hormone (FSH). FSH causes the ovaries to produce oestrogen. When the ovaries slow down production of oestrogen, the FSH level increases. When the FSH level rises above 30 or 40mill/ml, it usually indicates that menopause has set in.

Health Issues Facing Women Undergoing Premature Menopause

Premature menopause occurs in women less than 40 years. Many women are in the age range of when they should still be fertile.
Infertility is a big concern to many women in premature menopause.
Invitro fertilisation (IVF) with egg donor is the treatment of choice for many women who have premature menopause with infertility.
Like all menopausal women, women in premature menopause experience lowered oestrogen levels as the ovaries stop most of their production. Low levels of this hormone can lead to changes in the woman’s overall health and may increase risk associated with loss of oestrogen such as osteoporosis, colon and ovarian cancer, gum diseases, tooth loss  and cataract formation.
However, compared with women who go through natural menopause women undergoing premature menopause spend a longer time of their lives without the protective benefits of oestrogen. This puts them at a greater risk than natural menopausal women.
Premature menopause is usually irreversible once the process has started. The symptoms and health risks of premature menopause as well as the emotional issues that may arise from it can be managed with the methods similar to those for natural menopause. Women dealing with infertility should discuss their option with their infertility specialist.

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