`It's where the menopause meets infertility in women who shouldn't have either problem." This succinct description of early menopause or premature ovarian failure - as medical professionals prefer to call it - is from Dr Maire Milner who runs the Menopause Clinic at Dublin's Rotunda Hospital. When you consider that up to 2 per cent of the female population - that's one in every 50 women under 40 you know - suffer in silence from this widely undocumented condition, you can only begin to realise the extent of the physical turmoil and emotional trauma of these women. "You are deprived of an experience of being female. You've had something huge taken away from you yet outwardly, you don't look any different," says Clare (see panel). With women as young as 23 and 24 referred to her clinic, Dr Milner is very concerned about the lack of public awareness of early or premature menopause.
Such a lack of knowledge results in such sufferers reacting with complete shock and disbelief following diagnosis, partly because they've never heard of such a problem. A long process of denial, acceptance and finally adaptation follows. "Even in the academic literature, there is very little written about it. Everything you read about the menopause is geared towards older women," Dr Milner says. "What usually happens is that these women have trouble getting pregnant. Then, when they go for IVF treatment, they discover that they are no longer ovulating. Sometimes, their periods have stopped, other times, they are still having periods," she continues. In the majority of cases, it is unknown why some women go through the menopause prematurely. However, it can occur in some genetic conditions such as Turner's Syndrome. And in autoimmune diseases (where antibodies are formed to the ovary), premature menopause can occur in conjunction with such conditions as Addisons Disease and Pernicious Anaemia. It is also known that ovarian surgery, chemotherapy and radiotherapy can bring on the menopause prematurely. In some cases, there is a family history of early menopause.
The symptoms usually associated with the menopause are often less dramatic in this younger group of women. Perhaps this is because they have busy lives and they don't have time to think about such things as vaginal dryness. Maybe, it's because - unlike older women - they are not looking out for hot flushes and night sweats. Either way, according to Dr Milner, they do not tend to complain of the normal gamut of menopause symptoms.
While she recognises the huge emotional and lifestyle implications of an early menopause, Dr Milner also stresses the importance of these women paying careful attention to their physical health. "It is very important that these women take oestrogen to prevent them from developing premature osteoporosis and to keep their coronary arteries clear." Dr Milner believes HRT can also enhance the sexual and psychological well-being of early menopausal women as well as relieving their physical symptoms. The medical literature also points to some cases of early menopausal women on HRT who begin ovulating again. Why this happens is still a mystery. Apart from these rare cases of spontaneous reversal of the menopause, there is no known cure for premature ovarian failure. When it comes to dealing with the very difficult issues of not being able to have children naturally, each couple reacts differently. Some choose to seek to adopt, while others consider egg donation (which is not, however, available in the Republic) or long-term fostering.
While there is nothing to suggest that there is an increase in the number of women who go through their menopause prematurely, our changing lifestyles have highlighted the problem. "People are postponing marriage and fertility for reasons of work, career or study. It is here we come across the problems of subfertility and infertility most often," Dr Milner explains.