Premature menopause can come with 'serious' health risks, study says. A Canadian doctor says you shouldn't 'brush off' these symptoms

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From hot flashes to mood changes, there are plenty of disruptive menopause symptoms that are commonly associated with this period of a woman's life. But when it comes to health risks linked to menopause, particularly those for women who experience the phase earlier than usual, what should be top of mind?

A recent study out of Finland's University of Oulu and Oulu University Hospital indicates there are "serious" health risks women may face if they experience menopause before the age of 40, which is called premature menopause. According to the research, patients who go through premature menopause have a significantly higher risk of early death, particularly from heart disease and cancer.

Researchers compared the health records of 5,800 women diagnosed with premature ovarian insufficiency (POI) alongside records of 23,000 women who entered menopause at a standard age, which is around 51 in Canada. According to the study, women with POI are twice as likely to die from heart disease and four times as likely to die from any type of cancer.

Speaking with Yahoo Canada, one Calgary-based expert urges women to be aware they can enter menopause at an earlier age and to avoid brushing off symptoms. Read on to learn more about the health risks associated with premature and early menopause.

What's the difference between premature and early menopause?

Dr. Shafeena Premji, board member of the Canadian Menopause Society, explains there are often misconceptions when people describe menopause. She clarifies premature menopause is the term used when a patient enters the phase before the age of 40. However, early menopause is when someone experiences symptoms between the age of 40 to 45.

According to Cleveland Clinic, both premature and early menopause are quite rare. Early menopause occurs in around 5 per cent of women, where as premature menopause happens in around 1 per cent of patients. Moreover, premature menopause is very rare amongst people in their 20s, occurring in only around 0.1 per cent of patients.

"Both women in premature or early menopause are treated the same way in terms of the long-term consequences of early menopause," Premji, who own's Calgary's Milestone Menopause Centre of Southern Albert, shares. "But you do have to define what they are because the younger the age, the longer the risk."

How does premature or early menopause start?

Typically, menopause will begin around age 51. Toronto's Mount Sinai Hospital shares by age 55 or 56, more than 90 per cent of women are menopausal. For premature or early menopause, these phases can sometimes begin spontaneously with no explanation, according to Premji.

"Other times, it can be due to surgery," she adds. "So if you surgically have both your ovaries removed, either for a cancer or for endometriosis, or if you've undergone chemotherapy or radiation therapy for another malignancy.

"There are also some genetic conditions that can also do that. So for women who end up in menopause under 30, we do recommend genetic testing and karyotyping."

What are the health risks associated with premature and early menopause?

For both premature and early menopause, there are several potential long-term consequences. These include:

• Early on-set of cardiovascular disease

• Earlier on-set of premature mortality

• Increased risk of dementia

• Increased risk of osteoporosis

• Increased risk of genitourinary syndrome of menopause (GSM)

The most important health risk people should know about includes those related to the cardiovascular system. Premji explains that's because estrogen helps protect the heart, meaning if you enter menopause at an earlier age, it can have "detrimental effects" to that part of your body.

"We know that women in average menopause, they become more insulin-resistant, so there's higher risk of diabetes," she adds. "So, there are other comorbidities that also increase when you go into menopause."

In Canada, cardiovascular disease is the no,. 1 killer amongst women: "A lot of women worry about breast cancer as a cause of death, but we actually know that stroke and heart attack is the number one cause of death in women," Premji shares. "When a woman goes into menopause prematurely or early, and she's like, 'Oh, I don't have periods anymore, I don't have to worry about pads or tampons,' many women think this is nothing that they need to bring up to their family doctor."

What should you do if you're in premature or early menopause?

Premji, who's also on the medical advisory board at the Menopause Foundation of Canada, notes she sees women ignore their symptoms "all the time" at her practice. She adds it's important for patients to be aware and advocate for their own health, even if experts say they might be too young for something like menopause.

"If they don't, they are going to miss that window of opportunity to start hormone [replacement] therapy, which is going to protect them on so many levels with respect to their overall health, including their risk of cardiovascular disease," she notes. "I see patients in my practice very frequently who tell me, 'My doctor told me it's too early, I can't be in menopause,' and really just brush off their symptoms."

In one example, she says if a woman is under the age of 45 and hasn't had a period in four months, it's "not normal" and she should be getting a full health work-up with blood tests. Moreover, she adds it's important to catch these issues early, otherwise patients can miss windows of treatment where they'd possibly benefit greatly: "The longer the delay, the longer you're going to be at risk of developing these long-term consequences."

Premji says worldwide, menopause organizations recommend hormone replacement therapy (HRT) for premature and early menopause. According to a 2023 study published in the Canadian Medical Association Journal, hormone therapy should be the first treatment offered to women under the age of 60 who suffer from menopause symptoms.

"All women under the age of 45 who go into menopause need to be offered and be advised to take hormone replacement therapy until the age of 51, which is the average age of menopause," Premji notes.

What resources are available regarding premature and early menopause?

One resource Premji recommends includes the U.K.-based International Premature Ovarian Insufficiency Registry, or the POI Registry. This database lets people diagnosed with POI register and help improve research related to premature menopause.

Premji also says the Australia's AskEM is a "really good patient-advocacy website," where people can access more information about early menopause.

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