Young women in early menopause underdiagnosed, experts say

Female doctor explaining diagnosis to her female patient (javi_indy)

Susan Kolar, of Rochester, Minnesota knew something wasn’t right last year when she missed her period for three months, but multiple pregnancy tests gave negative results. The 37-year-old registered nurse was also irritable, restless and had trouble sleeping; she lost hair, had vaginal irritation and started to gain weight in her abdomen despite eating healthy and working out five days a week. Although she had hot flashes, they subsided after a month.

After her primary care physician and a specialist ran blood tests, Kolar was told her ovaries were no longer working— a condition known as primary ovarian insufficiency (POI). Kolar was told she was in premature menopause.

“I thought I was just going through some changes of getting older, but never did it go through my mind of early menopause,” Kolar said.

Women in early menopause are often missed
Studies show 1 percent of women under age 40 and 5 percent of those under age 45 experience premature menopause.

Experts agree that premature menopause is not a common diagnosis and doctors often overlook it. Although the signs are the same— lighter or missed periods, hot flashes and night sweats, changes in mood, sleep disturbances, memory problems, brain fog, rapid weight gain, skin changes and vaginal dryness, symptoms can be mistaken for other conditions.

For example, if a woman is in her 20s and she complains of memory problems, she may be diagnosed with ADHD and prescribed an antidepressant, said Dr. Prudence Hall, founder of The Hall Center in Santa Monica, California.

Likewise, women who have irregular periods are often put on the birth control pill. If a woman is a teenager when that happens and she then tries to get pregnant when she’s older and her periods don’t start, “that woman probably went through premature menopause years before but it was just never formerly diagnosed,” said Dr. Stephanie S. Faubion, director of the office of Women’s Health at the Mayo Clinic in Rochester, M.N., editor of “Mayo Clinic The Menopause Solution,” and Kolar’s physician.

Causes of early menopause

“There are many reasons why a woman might go through menopause early,” Faubion said. “Most of the time we don’t identify a specific cause.”

Premature menopause can be caused by chromosomal abnormalities such as Fragile X or Turner Syndrome, an autoimmune condition such as Hashimoto's Thyroiditis and Addison's disease or even a virus like Epstein-Barr or parvovirus. Women who have their ovaries surgically removed or who undergo chemotherapy or radiation can go into premature menopause.

An overload of heavy metals like lead, mercury and cadmium can also be a cause.

“The endocrine glands are very delicate and can absorb toxins easily,” Hall said.

Kolar’s doctor explained that the reason she was in early menopause was likely due to an autoimmune condition that was causing her thyroid to release an antibody that attacked her ovaries. To make matters worse, there was no treatment.

Hormone therapy is necessary
When premature menopause is suspected, a woman’s doctor will order blood tests that look at the levels of follicle-stimulating hormone (FSH) and estradiol.  This work-up should also include the thyroid and the adrenal glands because they can be affected too.

“What happens when the ovaries fail is there is very frequently a cascade of other hormones that start to fail,” Hall said.

In fact, between 14 and 27 percent of women with POI also have low thyroid function, according to a study in New England Journal of Medicine.

Women who are in early menopause must be treated with hormone therapy until they reach the natural age of menopause.

“The lack of hormones during this time frame is critical. We’re trying to protect bones, brain and heart from the long-term consequences of estrogen deprivation,” Faubion said.

If left untreated, women are at risk for high blood pressure, heart disease, osteoporosis, autoimmune diseases and inflammatory diseases, Parkinson’s and dementia at an earlier age. They’re also at an increased risk for colon and ovarian cancer, gum disease and dry eye syndrome.

Women will likely be treated with bioidentical hormones, and they may also need progestins, estradiol and testosterone.

Fertility options

In January, the Mayo Clinic told Kolar and her husband to consider a donor egg or adoption if they wanted to have children.

“For me that was hard to swallow at first because…the thought that ran through my head was ‘I should have had kids sooner.’ But at the same time I wasn’t ready to,” she said.

Yet premature menopause may not necessarily mean a woman is infertile. Some women may be able to freeze their eggs.

Plus, between 5 and 10 percent will spontaneously conceive on their own. Since the brain doesn’t get feedback from the ovaries that they’re working optimally, it can over-stimulate the ovaries and occasionally the ovaries respond, Faubion said.

Although she has managed her symptoms well on hormone therapy, Kolar’s doctors aren’t sure know what an optimal level should be or how long she will have to take it.

And when it comes to having children, she’s taking it one day at a time.

“Now my priority is my health first. If I’m meant to have children then that will happen but if I’m not, I’ve accepted that too,” she said.