Can an Early First Period lead to premature or early Menopause

Menarche, or the first menstrual flow, and menopause, or the complete cessation of menstrual bleeding, are perhaps two of the most significant events in a woman's life since they mark the beginning and end of her reproductive years. Menarche typically occurs between the ages of 12 and 13, with menopause occurring between 50 and 51 years of age.

 

This article will discuss these crucial stages and if starting period early may lead to the early onset of menopause.

Early menarche refers to the onset of menstrual periods before the age of 11. Premature menopause is when menstruation stops before the age of 40, while early menopause is when a woman ceases to have menstrual cycles between the ages of 40 and 44. Incidentally, premature and early menopause is associated with a higher disease burden ^[1] and decreased life expectancy, whereas delayed menopause is associated with greater longevity.

 

Menarche

Puberty marks the transition of a child into adulthood. The physiological changes of puberty in girls are initiated by a growth spurt that progresses to the development of secondary sexual characteristics. These pubertal changes are divided into the following stages:

• Thelarche or budding of the breasts.
• Pubarche or pubic hair growth.
• Menarche or first menstruation.

The period between the onset of breast development and a girl’s first period is usually 2-3 years ^[2]. Menarche, which is commonly known as the first period or the first menstrual bleeding, signals the end of puberty in girls and the possibility of conception. Even though initial menstrual cycles are often irregular and anovulatory (without egg/ovary release), pregnancy can still take place after the onset of menarche.

Although genetic predisposition is believed to play a dominant role in determining the onset of menstruation, environmental triggers have been considered to impact menarche significantly. Other stressors showed to predispose early menarche are:

• Poor socioeconomic conditions.
• A stepfather’s presence.
• Familial dysfunction.
• Parental separation.
• Military conflict exposure.

Also, environmental determinants such as nutritional deficiencies, excessive physical activity, and certain chronic health conditions have shown to delay the onset of menstruation.

 

Menopause

Menopause can be defined as, menstrual bleeding that has ceased for over 12 months or more following the onset of menarche ^[3]. Most women reach menopause between the ages of 45 and 55, with the average age being 51. Estrogen is the primary hormone involved in regulating reproductive cycles. Menopause causes the ovaries to stop producing eggs or ova, resulting in progressively reduced levels of estrogen. As a result of these hormonal changes, women ‌may develop symptoms such as:

• Hot flushes.
• Changes in mood (irritability).
• Sexual dysfunction (vaginal dryness).
• Sleeplessness.
• Night sweats in the perimenopausal period, which immediately precedes menopause.

Although premature or early menopause appears to be protective against estrogen-dependent cancers like certain types of breast cancer; it can, on the other hand also predispose women towards developing potentially serious long-term conditions such as:

• Cardiovascular disease (heart attacks and strokes).
• Bone loss (osteoporosis, also known as a brittle bone disease).
• Sexual dysfunction (dyspareunia).
• Anxiety.
• Depression.
•  Neurodegenerative disorders (dementia and Parkinson’s disease).
• Infertility.

Menopause, like menarche, has a high genetic predisposition; as a result, women are likely to reach menopause at around the same age as their mothers, with some exceptions. Non-genetic factors such as smoking, cancer treatment, and ovarian surgery have been shown to significantly reduce the age of menopause onset, thus contributing to premature or early menopause. Many research studies have also found that the age of the first menstrual period, pregnancy, breastfeeding, hormonal birth control, and race/ethnicity does not affect menopausal age.

 

Is there a link between early menarche and early menopause?

Despite contradictory and ambiguous evidence from previous work examining the relationship between early menarche and premature or early menopause; a landmark, multi-national study involving a large sample of postmenopausal women from the United Kingdom, Japan, Australia, and Scandinavia concluded that early menarche coupled with not having children significantly increased the likelihood of premature or early menopause ^[4].

Gita Mishra of the University of Queensland in Australia conducted the largest study of its kind, involving more than 50,000 postmenopausal women. It was carried out as part of an international collaboration to determine if there was a link between starting periods at a younger age and the occurrence of premature and/or early menopause.

According to the results of the study, when compared to women who had reached menarche at 12-13 years of age, women who had their first period at 11 years or younger were found to be at a significantly higher risk of experiencing premature menopause before the age of 40. ‌They also had a higher chance of attaining early menopause between 40 and 44 years of age.

Similarly, women who had their first menstruation early but did not have any children during ‌their lives were more likely to have premature or early menopause than women who had two or more children, despite having early menarche. The study further concluded that child-free women (nulliparous) after experiencing early menarchal bleeding were several times more likely to experience early and premature menopause compared to women who had their first period at 12-13 years old and had two or more children.

 

Criticisms

The research study is not without its criticisms. Critics argue that the research findings may not apply to modern times as most of the study’s participants were born between 1930 and 1960. Aside from that, nutrition and lifestyle factors such as body weight, the use of hormonal birth control, exposure to pollutants, increased stressors, and puberty onset at a younger age are contemporary issues that were most likely not prevalent during that time. It is also worth noting that many previously published studies on the subject found no statistically significant correlation between the onset of menstruation at a younger age and the premature or early cessation of menstrual periods.

 

 

Conclusion

Amidst its potential shortcomings, the conclusions from this and other related research have important public health implications. Understanding the relationship between the first and last periods would no doubt enable health practitioners to oversee and respond to early menopause-related health conditions as early as possible. Healthcare workers would also be encouraged to gather this information from women during consultations intending to inform at-risk women about the potential for early menopause and prevent chronic conditions that may emerge‌ as a result.

Women should be educated about their elevated risk of early and premature menopause if they began menstrual cycles at a young age; particularly those with fertility problems and other long-term health issues, so that they can make informed decisions regarding their future health and fertility.

By:  Dinoosh De Livera M.D.