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Shilpa Rao, a dentist, felt like her life had hit rock bottom when she was first diagnosed with premature menopause at 36. The first sign she experienced was hot flashes. A couple of months later, she started having extremely dry skin along with hair fall. Going forward a year, she had achy joints and irritability in the eyes. Her mood swings also got worse, and she started putting on weight despite exercising and eating healthy.
When Rao visited her gynaecologist, she was told that her endometriosis — characterised by a tissue similar to the endometrium growing outside the uterus — had induced medical menopause in her. She was naturally devastated.
“The joy of life was gone. The normalcy of life was missing… My body did not seem mine, and I felt terrible as women of my age were still enjoying life, and here I was mending my ache and moods,” she said.
She was far too young to reach menopause. However, she is not alone. The statistics are bleak. Nearly 4 per cent of Indian women experience signs of menopause between 29 and 34 years of age, says a recent survey conducted by The Institute for Social and Economic Change (ISEC). The figure goes up to 8 per cent in the case of women between 35 and 39 years of age.
Dr Astha Dayal, obstetrics & gynaecology, CK Birla Hospital, Gurgaon, explained that menopause is the permanent cessation of menses, a natural part of ageing. She added that normally, menopause happens between 45 and 55. “Menopause occurring at 40 to 45 years is called early menopause, and menopause occurring before 40 is known as premature menopause, or premature ovarian insufficiency (POI).”
The symptoms of premature menopause are similar to those experienced during natural menopause. “This may include irregular or absent periods, hot flashes, vaginal dryness, mood swings, sleep disturbances, and decreased libido. Infertility is also a significant concern for women with premature menopause, although pregnancy can still occur, albeit with lower chances,” Dr Chitwan Dubey, full-time consultant obstetrics, gynaecologist & laparoscopic surgeon at Dr LH Hiranandani Hospital, Powai, Mumbai told indianexpress.com.
The rising incidence of premature menopause can be attributed to various reasons. Dr Divya Singh, senior surgeon, at Ram Manohar Lohia Hospital; and director, Maaiya Social Change Front Foundation, said premature menopause could be either spontaneous or induced.
“Environmental factors, including exposure to toxins and endocrine disruptors, may interfere with the normal functioning of the reproductive system. Unhealthy lifestyle choices, such as smoking, increased stress and poor nutrition, can also contribute to earlier onset of menopause. Delayed childbearing, medical treatments like radiation or chemotherapy, genetic factors, chromosomal factors, immunological factors and autoimmune disorders can further increase the risk,” she said.
Concurring, Dr Manjula Anagani, gynaecologist, laparoscopic and robotic Surgeon, clinical director and HOD, Care Hospitals, Hyderabad said, “Premature menopause has increased significantly among Indian women in recent years. Significant factors that contribute to premature menopause are stress and pollution. Due to high levels of stress and hectic schedules, women sometimes feel hormonal imbalances in their body which damage ovarian function and hasten menopause. Being exposed to environmental toxins can damage the reproductive system and decrease egg production, which raises the danger of a premature menopause.”
Citing a case study, Dr Shweta Mendiratta, senior consultant, Department of Obstetrics and Gynecology, Amrita Hospital, Faridabad, explained that a 34-year-old woman presented to her gynaecologist with amenorrhoea for more than a year and was concerned about her fertility.
“She had been trying to conceive for the last three years without success. Her family history did not indicate any early menopause cases, and she had no known autoimmune disorders or previous surgeries. After a thorough gynaecological evaluation, including blood tests to measure hormone levels and assess ovarian function. The results revealed significantly elevated follicle-stimulating hormone (FSH) levels and low estrogen levels, indicating ovarian insufficiency. She was diagnosed with premature menopause,” Dr Mendiratta said, adding that it is important to note that each case of premature menopause is unique, and individual experiences, diagnoses and treatment plans may vary.
Premature menopause can have significant effects on a woman’s health, both in the short term and the long term, according to Dr Singh. Some of these are listed below.
Infertility: One of the primary concerns of premature menopause is the loss of fertility. With the decline in ovarian function, the release of eggs becomes less frequent or ceases altogether, making it difficult for women to conceive naturally.
Osteoporosis: Estrogen plays a crucial role in maintaining bone density. The decrease in estrogen levels associated with premature menopause can lead to an increased risk of osteoporosis, a condition characterised by weakened bones and a higher susceptibility to fractures.
Cardiovascular disease: Estrogen helps protect against cardiovascular disease by maintaining healthy blood vessels and regulating cholesterol levels. The decline in estrogen during premature menopause can contribute to an increased risk of heart disease, including heart attacks and stroke.
Cognitive changes: Estrogen has a significant impact on brain function, and its decline can contribute to cognitive changes such as memory problems, difficulty concentrating and mood swings.
Sexual health issues: Decreased estrogen levels can lead to vaginal dryness, reduced libido and discomfort during sexual intercourse, impacting a woman’s sexual health and well-being.
Psychological and emotional effects: The sudden hormonal changes and loss of reproductive potential may lead to mood swings, anxiety, depression, or feelings of loss and grief.
Increased risk of certain health conditions: Premature Menopause has been associated with a higher risk of certain health conditions such as autoimmune disorders, thyroid disease, psychiatric disorders and certain types of cancer.
Premature menopause is not always preventable since some cases are due to genetic factors or underlying medical conditions. However, there are certain steps that can be taken to potentially reduce the risk or delay the onset of premature menopause.
“Maintaining a healthy lifestyle can positively impact reproductive health. This includes regular exercise, a balanced diet rich in fruits, vegetables, whole grains, and lean proteins, as well as avoiding smoking and excessive alcohol consumption,” advised Dr Mendiratta.
Similarly, Dr Singh recommended regular visits to your healthcare provider to help monitor your reproductive health and identify any potential issues early on.
“Regular screenings, such as mammograms and pap smears, are also important for overall women’s health. Additionally, if you have a family history of premature menopause or other genetic conditions, it is important to consider seeking genetic counselling. This can help you understand your risk factors and discuss potential preventive measures,” she said.
Dr Dubey said if you are undergoing medical treatments that may affect your reproductive system, such as chemotherapy or radiation therapy, discuss the possible risks with your healthcare provider. In some cases, fertility preservation methods may be available before treatment begins.
Most importantly, educate yourself about the signs and symptoms of premature menopause, and if you notice any irregularities in your menstrual cycle or experience symptoms associated with menopause at a younger age, consult with your healthcare provider.
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