Does having menopause before age 40 cause major health problems later in life? Scientists are trying to find out
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Most women enter menopause in their mid-40s or 50s, but for those who have already gone through this transformative stage of life, scientists warn there may be an increased risk of future health effects such as heart attacks and dementia.
A headline-making study, Published earlier this month In JAMA Cardiology, a link was found between natural premature menopause – referring to the cessation of menstruation before the age of 40 – and a 40 percent higher lifetime risk of coronary heart disease.
Entering menopause early may also increase the risk of Alzheimer’s disease. And it has long been known that the earlier menopause occurs, the more quickly this major hormonal shift will affect one’s bone density, The risk of osteoporosis is increasing.
Is any woman who goes through early menopause doomed to have weak bones or heart attacks? No. Still, researchers say the increased risk is real, even if its mechanism is not fully understood.
“Changes in the circulation of different types of hormones affect all these different body systems, which can then impact your brain health, your sleep, your diet, and your bones,” said Alison Sekuler, president and chief scientist of the Baycrest Academy for Research and Education and a professor at the University of Toronto.
Some individuals who naturally go through premature menopause – or experience sudden surgical menopause – may also suffer serious side effects, such as hot flashes, sleep disturbances and night sweats, which can have a profound impact on their overall health.
“And so you just have more decades, more years, where If you don’t address it properly, you are at such a significant period of increased risk,” Sekul warned.
Women can combat the increased risk through healthy habits or, in some cases, hormone therapy, as scientists say long-term health problems are not inevitable after early menopause — and can even be prevented.
New research from Northwestern University found that women who experienced premature menopause, that is, before the age of 40, had a 40 percent higher risk of heart attack. Doctors say this study provides evidence that more research and education is needed about women in this age group.
The connection between menopause and health risks is not fully understood.
Menopause is a natural biological process for about half the world’s population, marked by the end of one’s menstrual cycle and fertility, and preceded by hormonal fluctuations and irregular periods known as perimenopause that can last for years.
The number of women who actually experience an early, permanent end to their menstruation is relatively small. It is believed that less than four percent of women experience premature menopause by age 30, while just over five percent of women enter menopause by the age of 45, with most individuals experiencing it at some point between 45 and 55.
When it comes to the impact of early, natural menopause on heart disease, the latest research from JAMA Cardiology finds a significant increase in risk in both white and black women — who are three times more likely to enter menopause early.
The study did not identify any clear mechanism or cause, but lead author Dr. Priya Freni, assistant professor of medicine in the department of cardiology at Northwestern University Feinberg School of Medicine, suspects a combination of social, environmental and health factors are involved.
He said further studies are needed to examine how an earlier loss of estrogen — which is permanently reduced through menopause — might reduce someone’s chances of developing a heart attack or heart failure.
Researcher Glenn Pyle, who runs the Laboratory for Women’s Heart Health at the University of Guelph in Ontario and who was not involved in the study, praised the research for an “important finding” that suggests both a large increase in heart disease risk and a longer period of decades where women may benefit from better monitoring.
Pyle said the study also controlled for factors like high blood pressure and high cholesterol, which can contribute to one’s risk level, which suggests that premature menopause itself is a contributor to heart disease.
He added, “How this happens is not well understood.”
Such is the case when it comes to fascinating findings about the relationship between early menopause and the development of Alzheimer’s disease, the most common cause of dementia.
Entering menopause earlier can lead to faster cognitive decline and increase the risk of Alzheimer’s, According to Canadian research by 2025. Another recent analysis from a separate Canadian team showed that women who had early menopause, due to having both ovaries removed, were four times more likely Developing Alzheimer’s later than people who have natural menopause.
Yet its causes are still unclear, many experts stress, because menopause – and especially early menopause – has not been studied.
“What’s the mechanism?” questioned Secular. “Because if you can understand the mechanisms better, maybe there’s a way to improve the treatments you need at an earlier stage.”
Can sweating help beat your heat? Amy Bell’s series “Hot and Bothered” takes a look at how exercise can help your hormones during perimenopause and menopause.
Early menopause ‘not a nail in the coffin’
These signs of increased risk also do not mean that health problems are inevitable after menopause. And, many researchers agree that issues like dementia or heart disease can be prevented to some extent.
“It’s like a nail in the coffin: Anyone who has early menopause is going to have a heart attack. And that’s not right,” said Dr. Jerilyn Pryor, a longtime researcher on menopause and emeritus professor at the University of British Columbia.
They questioned how much of a role timing plays in developing long-term health effects, compared to the severity of menopause side effects. Night sweats, hot flashes, insomnia — the most serious menopause-related effects, which often appear early as hormones begin to shift dramatically — are more than unpleasant, Pryor explained.
“These are disruptive experiences throughout the body that lead to higher stress hormone levels, and which are very consistently and very dramatically associated with increased risk of (heart disease),” he said.
Sekul agreed that future research needs to address the severity of side-effects as well as the impact of the timing of menopause, given how detrimental years of lost sleep and fever-like sensations can be to women’s health.
initial version7:48Hot and bothered series: staying strong during perimenopause and menopause.
CBC’s Amy Bell works with fitness trainer Lindsey Honey to find out how important exercise can be in perimenopause and menopause.
“When you think about what happens in standard menopause, you kind of get an indication of what’s happening, but over a larger, longer time frame with early menopause,’ she said.
Restful sleep is important to give the brain a chance to renew itself, Sekuler said. He compared it to a dishwasher rinse cycle, which flushes out toxins overnight.
He added, “We also know that if you’re not getting enough sleep, you’re going to have additional cognitive problems and physical problems — so it’s linked.”
“If you just feel crappy, you won’t want to go out and exercise, you won’t want to take time to go shopping and prepare healthy meals, you won’t want to go out and socialize with your friends. And loneliness … is one of the most significant risk factors for dementia.”
Many of those risk factors are within women’s control, barring all the ups and downs of menopause.
Reducing stress, staying cognitively engaged, avoiding alcohol and cigarettes, and getting your hearing and vision checked — and getting treatment if necessary — are all ways to keep your brain sharp and avoid dementia, Sekul said. Both Sekuler and Pryor said fitness and diet also matter, with clear, long-term benefits for both your brain and heart.
Perimenopause and menopause can bring a lot of physical symptoms, but what about the mental and emotional toll? CBC medical columnist Dr. Melissa Lamm explains what’s happening in a woman’s body that affects her mental health.
Hormone therapy may be an option
In cases where women are struggling with serious side effects during menopause, hormone therapy is also an option.
It’s worth talking to your primary care provider about the best approach, because for decades, research and messages have flip-flopped regarding who should actually get hormone therapy, and whether it Worth any potential health risks.
“Women’s health is not as well investigated or understood or cared for as men’s health issues are,” Sekuler said. “And so we’re really in the early stages of understanding what’s happening in menopause and what’s the right way to treat it.”
Freeney of Northwestern University agreed. “Women have been largely underrepresented in cardiovascular science for decades, so we have a lot to learn.”
Still, she said findings like hers should give physicians pause — even if they don’t tell the whole story behind what exactly causes women to experience an increased risk.
“If you can understand a woman’s risk for heart disease throughout her life early, you can … develop a prevention plan earlier,” Freney said.
