Early Menopause Increases Risk of Osteoporosis

28 April 2022

Women who stop menstruating early are at a higher risk of having osteoporosis as they lose calcium earlier than normal. Hence, women who have stopped menstruating for at least four months before the age of 40 are encouraged to seek treatment.

“In general, women experience menopause between the ages of 45 and 55 and is normal for her to stop menstruating at 40 to 42 years old. Menopause is a considered premature if a woman stops menstruating before the age of 40. This represents an early decline in ovarian function which may be a pathological condition that requires treatment,” said Dr Thow Sun Ta, Consultant Obstetrician and Gynaecologist at Sunway Medical Centre, Sunway City.

About 1% of women aged 40 experience premature menopause. Bad lifestyle habits, stress, living environment and chronic disease are associated with premature menopause and there is no single factor that causes it.

Genes are also a factor in early menopause. If a girl has only one X chromosome (i.e. the X haplogroup), or if part of the X chromosome is missing, Turner Syndrome can occur. Women with Turner syndrome are born with underdeveloped ovaries or may never have menstruation. If they do ovulate, they do so in very small quantities. Despite this, these women have a normal developing uterus and can still conceive normally with IVF treatment using borrowed eggs.

Chemotherapy procedures, the cause of menopause

It is important to rule out the possibility of tumours, especially ovarian cancer. Chemotherapy can cause premature menopause simply because chemotherapy drugs not only target cancer cells but also affect normal cells, resulting in a reduction in the number of eggs as well. Although breast cancer is only in the breast, post-operative chemotherapy is systemic and can cause early menopause.

Any surgery on the ovaries, such as removal of a hydatid tumour, haematoma or cyst, can also cause early menopause. When a surgeon removes a hydatid tumour, the scope is enlarged to achieve a complete cleanse, inevitably removing some normal tissue and thus causing early ovarian failure.

Vascular disease also leads to early menopause, particularly diabetes and high blood pressure. Vascular disease causes narrowing of blood vessels, reducing blood flow and affecting organs such as the ovaries.

Risk of osteoporosis

Apart from menopausal symptoms, the biggest crisis for women once they stop menstruating is osteoporosis. After the age of 50, we lose bone mass at an increasing rate, which affects bone density and increases the risk of fractures. Early menopause means early onset of osteoporosis. Imagine if you have stopped menstruating at 30, you could have osteoporosis at 40, 10 years earlier than the average person.

Women who stop menstruating earlier also have a higher chance of developing heart disease, however there are still many factors that contribute to heart disease such as poor diet and lifestyle habits. When we think of heart disease, we generally think of men, but once women stop menstruating, their chances of developing heart disease are gradually increasing in line with men.

Confirming the diagnosis

Women under 50 years old are considered to have stopped menstruating if they have not had a period for at least 2 years, and for women over 50 years old, it is one year. Women who have not had period for four months can only be considered amenorrhoea (absence of menstruation) or oligomenorrhoea (infrequent period), which is still not considered menopause.

A doctor will usually ask questions, scan the uterus or ovaries and take blood tests to diagnose menopause based on three criteria: menopausal transition symptoms, follicle stimulating hormone (FSH) and menstrual cycle.

In the blood test report, the doctor will use FSH to determine the age of the ovaries, from gradual decline to complete cessation of ovarian function, to determine if the woman is in her menopause stage. Women with early menopause also have menopausal symptoms such as hot flushes, insomnia, mood swings, vaginal dryness and reduced sex drive.

Hormone therapy for menopause

Once a woman has been diagnosed with menopause, she may be able to receive hormone therapy. It is generally not recommended that women receive hormone therapy immediately, as they will need to have regular follow-up appointments and a mammogram to monitor the progress of treatment. It is also important to check the woman's liver and kidneys to ensure that they are functioning properly.

Women who have stopped menstruating under the age of 40 will be given a light dose of oestrogen (contraceptive pills), while those over 40 will require Hormone Replacement Therapy (HRT). The treatment period depends on the condition of the patient, with a gradual reduction or change of medication to a lower dose if her condition improves.

Hormone therapy is not suitable for patients with diabetes and high blood pressure as this can increase the risk of developing vascular disease, so doctors will assess a woman's fitness for hormone therapy. Long-term hormone therapy does increase the risk of developing breast, uterine or ovarian cancer.

Prevention before it's too late

Women after menopause need to take calcium and vitamin D supplements, especially if they stop menstruating early, but as long as they eat a balanced diet, they don't need to take any special calcium supplements.

Post-menopause women need to exercise to prevent osteoporosis. Exercise stimulates the bones, thickens the bone density and maintains bone health, especially aerobic exercises such as running and swimming.

In fact, exercise is a very good activity, as it constantly builds strength, bones and muscles, and also trains our concentration. The important thing is to start young in order to prevent disease, not to realise the importance of exercise only when you get older and have serious illness.

Increasing health consciousness

Many women come to the clinic unable to accept the fact that they have stopped menstruating, and doctors need to counsel these women to accept the reality and to face and accept menopause with a positive attitude.

“Of course, it is also important for smokers to stop smoking. I am glad to see that modern people are more health conscious and have taken the initiative to maintain their own health with the advent of information. However, I still recommend women after the age of 40 to have regular medical check-ups so they can receive proper treatment and detect abnormalities early.”

Source: Sin Chew