When menopause occurs following treatments such as cancer chemotherapy or radiotherapy, which impair ovarian function, or the removal of both ovaries before the age of 50, we speak of “iatrogenic” menopause.
Once early menopause sets in, pregnancy is not possible.
FAKE. Apart from cases of surgical menopause, menopause is considered to be definitively established after one year of cessation of periods. However, a temporary resumption of ovarian activity may occur beyond this period. This phenomenon, called follicular (or ovarian) resurgence, is rare but possible, particularly in cases of premature ovarian failure and especially after chemotherapy. In less than 5% of cases, a pregnancy can therefore take place without recourse to medically assisted procreation.
Treatment is often responsible for premature ovarian failure
FAKE. In reality, the causes of premature ovarian failure are often difficult to identify, apart from those related to treatment. A familial predisposition may be involved, with several family members, such as the mother, maternal grandmother or sisters, also affected. A genetic origin is found in 30 to 40% of cases. A context of personal or familial autoimmune disease is also possible. A check-up will then look for associated illnesses, such as thyroid disease, diabetes or other autoimmune disorders. But in 50 to 60% of cases, no precise cause is identified.
Premature ovarian failure and early menopause simply result in early cessation of periods and loss of fertility
TRUE and FALSE. As with “normal” menopause, the cessation of ovarian activity causes bothersome symptoms and can have an impact on health. But the big difference is that it is all the more marked when premature ovarian failure occurs before the age of 40.
The climacteric syndrome includes four main clinical signs: hot flashes (flushing), night sweats, genitourinary disorders (vulvo-vaginal dryness, urinary infections, urgent urge to urinate) and joint pain. Other signs, such as drier skin may exist, and sleep problems may result from hot flashes and lead to fatigue, mood swings, irritability, memory loss and difficulty concentrating.
But the impact on health can be much more considerable than in the case of “classic” menopause. Estrogen deficiency early in life affects future health, with increased risks of osteoporosis, cardiovascular disease and early cognitive impairment.
The risk of osteoporosis and cardiovascular disease is out of proportion to women having menopause at a “normal” age.
TRUE. The majority of women who have had premature ovarian failure have a decrease in bone mineral density after the age of 50, and often osteoporosis if no hormonal treatment has been followed.
Cardiovascular diseases, mainly linked to atherosclerosis, expose you to the risk of myocardial infarction, particularly in the arteries of the heart. Women in whom ovarian activity has stopped before age 45, especially before age 40, have a 2-3 times higher risk of myocardial infarction or stroke, and often at an earlier age . This increased risk results from various disturbances due to estrogen deficiency: metabolic disorders, such as increased total cholesterol and LDL fraction (bad cholesterol), elevated triglycerides, insulin resistance linked to accumulation of abdominal fat, thereby contributing to the risk of type 2 diabetes, as well as a change in blood clotting factors leading to hypercoagulability. In addition, there is a direct alteration of the vascular wall, favoring the development of atherosclerosis.
A healthy lifestyle in women with early menopause or premature ovarian failure benefits the heart
TRUE. and in particular a healthy diet. But above all, these women must be prescribed hormonal treatment (except in the case of a history of breast cancer). These opinions come from learned societies and the High Authority for Health (HAS).
Indeed, an early cessation of ovarian functioning is not a normal physiological phenomenon. As with any hormonal deficiency, the estrogen deficiency resulting from this cessation must be compensated, at least until the age of “normal” menopause. This is why we talk about hormone replacement therapy (HRT) and not menopausal hormone treatment (THM), the latter being reserved for situations where treatment is prescribed after the age of 50.
HRT has been shown to be effective in correcting bothersome menopausal symptoms, preventing vaginal atrophy, as well as post-menopausal bone loss and osteoporosis-related fractures. In addition, all epidemiological studies indicate that the risks of myocardial infarction or stroke are considerably reduced, or even eliminated, if HRT is prescribed, at least until the “normal” age of menopause.
Hormone replacement therapy consists of estrogen supplementation
FAKE. Hormone replacement therapy (HRT), like menopausal hormone treatment (THM), consists of administering estrogens (estradiol, or in certain cases of very young women, a classic estrogen-progestogen contraceptive pill) to compensate for the hormonal deficiency after menopause and mitigate the consequences. But it must always be combined with progesterone to reduce the risk of uterine (endometrial) cancer. The combination with vaginal estrogens helps relieve urogenital syndrome of menopause.
Note: The benefit of THM was called into question in 2002 after the publication of the American WHI study. However, all recent studies consider that the health benefits of HRT far outweigh its risks, which remain minimal when administered up to the age of 50.
Why has the number of deaths increased in France in 2024?
Source: Destination Santé
