Menopause: How premenstrual disorders can raise risks

  • Researchers are reporting that premenstrual disorders could contribute to early menopause.
  • Understanding who is at risk for early menopause can help medical professionals target women who may experience health conditions later.
  • Symptoms of early menopause are the same as menopause. Treatments are available to help relieve the discomfort of these symptoms.

Researchers who evaluated health data from 3,635 women in the United States are reporting that premenstrual disorders (PMD) and premenstrual dysphoric disorder (PDD) are associated with early menopause and moderate to severe vasomotor symptoms (VMS).

Their findings were published today in the journal JAMA Network Open.

In their study, the scientists defined menopause as not having menses for 12 consecutive months. Participants self-reported the age at which they reached menopause.

  • Early menopause was defined as occurring before age 45.
  • Normal menopause was defined as occurring between the ages of 45 and 54.
  • Late menopause was defined as occurring after age 55.

Women also assessed whether VMS symptoms were mild, moderate, or severe as well as the duration of symptoms, such as less than 5 years, 5 to 9 years, or 10 or more years.

A total of 1,059 participants with PMD and 2,235 women without PMD reached menopause during the study period.

After evaluating the data, researchers determined that:

  • Women with PMD had an increased risk of early menopause.
  • There was an association between PMDs and VMS, although this was a plus/minus result.

Health information came from the Nurses’ Health Study II, which collected data from 1991 to 2017.

The researchers note that this information could help medical professionals target women in their reproductive years with the highest risk of health conditions due to early menopause.

Early menopause puts women at risk for premature mortality, cardiovascular, neurological disease, psychiatric disease, and osteoporosis, according to the National Institutes of Health.

In some cases, it is possible to reduce adverse reactions of early menopause with estrogen treatment.

The lower the age, the higher the risk.

Experts react to premenstrual disorders study

“This study provided interesting information but not necessarily practical or useful information for changing how I treat my patients,” said Dr. G. Thomas Ruiz, an OB/GYN lead at MemorialCare Orange Coast Medical Center in California who was not involved in the study.

“I see women with early menopause, but it isn’t that frequent,” Ruiz told Medical News Today. “What I see more often is women who are in their early 40s and want to get pregnant for the first time do not have the same quality of eggs as someone younger, and that is why it is more difficult for them to get pregnant.”

“When I treat younger women with severe bleeding or cramps – severe dysmenorrhea or premenstrual dysphoric disorder – I don’t connect it with menopause,” Ruiz added. “It is more important to me to treat their current complaints than to look into the future when there isn’t anything we can do to change the age of menopause. Therefore, I do not talk to them about potential heart or other health conditions that can arise from early menopause. If they do experience early menopause, then we can discuss the potential health concerns.”

Understanding early menopause

“Menopause occurs when one’s menstrual cycles have stopped for an entire year – 12 months. Some signs of potential early onset menopause are the same as perimenopausal symptoms,” said Dr. Asima Ahmad, the chief medical officer and co-founder of Carrot Fertility and a practicing reproductive endocrinologist and fertility expert who was not involved in the study.

“These include irregular periods or bleeding, a lower ovarian reserve, vasomotor symptoms (e.g., hot flashes, night sweats), changes in one’s libido, and insomnia,” Ahmad told Medical News Today.

According to Ahmad, some of the causes of early menopause include:

  • Family history
  • Genetic factors, such as Fragile X permutation
  • Smoking
  • Autoimmune disease
  • Iatrogenic, for example, chemotherapy or oophorectomy – surgical removal of ovaries or part of the ovaries
  • Infectious diseases, for example, pelvic tuberculosis

Women who go through menopause early may have symptoms or health problems similar to those of regular menopause, according to the Office on Women’s Health.

However, some women with early or premature menopause may also have:

  • More severe menopause symptoms
  • A higher risk of heart disease and osteoporosis

Since menopause signals the end of a woman’s ability to get pregnant, some women feel sadness or develop depression because they lost their ability to have children.

“It is hard to predict when a woman will go through menopause and there isn’t anything we can do to change it,“ said Dr, Jennifer Wu, an OB/GYN at Northwell Lenox Hill Hospital in New York who was not involved in the study.

“While menstrual disorders can contribute to early menopause, it isn’t the only factor,” Wu told Medical News Today. “There was some discussion about inflammation in the study and I think we need more research into that area to find out how that contributes too early menopause.”

Symptoms of early menopause

According to the National Institute on Aging, the symptoms of early menopause are the same as they are with menopause. These include:

  • Irregular periods
  • Heavy bleeding
  • Extended time without a period and then having it resume
  • Hot flashes
  • Difficulty with bladder control
  • Insomnia or problem sleeping
  • Night sweats
  • Vaginal dryness
  • Changes in how you feel about sex
  • Mood changes
  • Fatigue
  • Depression
  • Changes in the shape of your body
  • Temporary memory problems, including word recall

Menopause is different for everyone.

Some people may experience many or all of these symptoms, some may experience none, and some may experience some.

Treatments of menopausal symptoms

Some women do not need any treatment because their symptoms are transient and go away on their own.

However, for some women, symptoms interfere with their quality of life.

For these women, treatment is available. Some of the treatments, according to the Office on Women’s Health, include:

  • Low-dose hormonal birth control
  • Menopausal hormone therapy
  • FDA-approved medications
  • Over-the-counter lubricants and vaginal moisturizers for vaginal discomfort

What you can do

Dr. Laura DeCesaris, a health and performance consultant as well as a coach, provided Medical News Today with these tips on how women can lower their discomfort when going through menopause:

  • Know your options – there’s bioidentical hormone replacement therapies that are helpful for many women, in addition to various lifestyle changes that can really change the trajectory of your experience during this time of hormone transition.
  • Limiting alcohol intake and improving your nutrition, focusing on increasing your protein and fiber and keeping your blood sugar in check. Taking care of your metabolic health is important.
  • Talk with your practitioner about supplements that may be helpful. For example, some herbs such as black cohosh can be helpful for women experiencing vasomotor symptoms, while creatine can be extremely beneficial for brain health during this transitional time.
  • Stress management becomes key. Support adrenal health, do plenty of walking and add strength training to the mix, find self-care options that work for you to keep it in check
  • Ask for support – Start educating yourself on what’s happening in your body. It’s hard to ask for what you need when you’re not certain what’s happening, and working with someone to help you guide you through it can take some of the pressure of you to figure it out all on your own.
  • Finding community and having a strong network around you is linked to a longer health span for women – it helps to not feel like you’re along during a major transitional time and to have connections with others who get it.
  • Always talk to your doctor before taking any supplements or herbs. They can interfere with other medications and you should always check to make sure that they will be safe for you.

Limitations of the early menopause study

One limitation of this study was that the answers to the questionnaires were self-reported.

The second limitation is that symptoms of PMDD in the Diagnostic and Statistical Manual of Mental Disorders (5th edition) did not line up with the questionnaire, therefore there could be discrepancies in the results.

The self-reported issue arises again in answers to vasomotor symptoms.

Finally, the study was homogeneous in terms of occupation, race, and ethnicity, so the results can only be generalized to white women.

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