Gynaecologic Problems: Menopausal Problems

Premature menopause

Premature menopause can be the result of genetics or autoimmune processes. It has been linked to both familial and nonfamilial X-chromosome abnormalities. Premature menopause can also be caused by medical interventions, such as bilateral oophorectomy , chemotherapy, or pelvic radiation therapy.

Premature menopause and premature ovarian failure (POF) can be synonymous. Strictly speaking, however, menopause is by definition the very last menses. POF (i.e., hypergonadotropic amenorrhoea ), while having all the characteristics of menopause, may not be permanent.

Induced menopause

According to CAMS, the term induced menopause is defined as “the cessation of menstruation that follows either surgical removal of both ovaries (with or without hysterectomy) or iatrogenic ablation of ovarian function (e.g., by chemotherapy or radiation).”

Induced menopause is the cessation of menstruation that follows certain medical interventions such as those listed below. In women who experience surgically induced menopause, fertility ends immediately. With other types of induced menopause, fertility may end immediately or over several months.

• Surgical menopause . The term surgical menopause refers to induced menopause caused by surgical removal of both ovaries ( bilateral oophorectomy ) in a woman who is still menstruating. Bilateral oophorectomy is the most common cause of induced menopause. Surgical procedures that could include a bilateral oophorectomy include a hysterectomy (the surgical removal of the uterus). Depending on age and diagnosis, an oophorectomy may be performed simultaneously. A hysterectomy without oophorectomy does not usually cause menopause, but menstrual bleeding will stop. An abdominoperineal resection (removal of the lower colon and rectum) may require resection of the uterus, ovaries, and rear wall of the vagina. Total pelvic exenteration involves resection of the uterus, cervix, ovaries, fallopian tubes, vagina, urethra, urinary bladder, and rectum.
• Chemotherapy-induced menopause . Chemotherapy is a systemic treatment that commonly refers to the use of drugs to treat cancer. Chemotherapy can cause severe damage to both ovaries, thereby making them unable to produce sufficient levels of hormones to prevent menopause. Following chemotherapy, a woman may experience months or even years of irregular ovarian function. Depending on the woman’s age and the type of chemotherapy used, normal ovarian function may resume after a period of time. Permanent amenorrhoea is more likely when an alkylating drug is used, when chemotherapy drugs are used in combination, or when the woman is close to natural menopause.
• Radiation-induced menopause . Pelvic radiation therapy is more likely to cause permanent ovarian failure if the ovaries receive high doses of radiation (such as for treatment of cervical cancer). If smaller doses of pelvic radiation are used (such as for Hodgkin’s disease), the ovaries may recover.

Temporary menopause

The term temporary menopause describes a period when normal ovarian function is interrupted. The ovaries are functional, but they are unable to produce oocytes and the accompanying normal levels of hormones. Some POF patients and some women following chemotherapy or pelvic radiation therapy experience temporary menopause. Women who over-exercise or over-diet can experience amenorrhoea due to a hypooestrogenic state , but gonadotropin levels are usually normal to low normal. Drug therapy, such as GnRH analogues, can also result in temporary menopause.

The information in this page is presented in summarised form and has been taken from the following source(s):
1. The North American Menopause Society: http://www.menopause.org/