Women with primary ovarian insufficiency face a plethora of consequences such as infertility and an increased risk for mortality, cardiovascular disease, osteoporosis, psychosexual dysfunction, cognitive decline and neurological disease, leading to poor quality of life. An aggressive approach is needed to recognize and treat these patients, according to Cynthia A. Stuenkel, MD, NCMP.
In her plenary symposium at the North American Menopause Society Annual Meeting, Stuenkel, of the University of California, San Diego School of Medicine, focused primarily on CV and bone outcomes.
“Many of these young women can go several years without being diagnosed,” Stuenkel told Endocrine Today. “Early menopause is falling between ages 40 and 45; premature menopause under 40. Primary ovarian insufficiency is a different entity. Some of them can even conceive.”
CVD effect of early menopause
Stuenkel cited the Nurses’ Health Study conducted from 1976 to 1994. It demonstrated a greater multivariate relative risk of coronary heart disease at natural menopause in women younger than 40 years (RR=1.53), according to data.
“But after all the adjustments in the Nurses’ Health Study, women who had never smoked were removed from the data. That was provocative,” Stuenkel said.
CVD determines menopausal age, rather than the reverse, according to the Framingham Heart Study cohort. She said each 1% higher premenopausal Framingham risk score was associated with a decrease in menopausal age of 1.8 years.
“Is it the reproductive aging that increases CV risk or is it the premenopausal cardiometabolic risk that leads to an increase in reproductive aging?” Stuenkel asked.
She said obesity could be a factor that might help explain the links between reproductive aging and cardiometabolic risk.
Effect on BMD, fractures
According to Stuenkel, cross-sectional studies show that early menopause before 45 years leads to lower bone mineral density and increased risk for osteoporosis. The reduction of estrogen may play a role in the increased risk for fractures, she added. If a woman goes through menopause a decade earlier than average, her BMD could be reduced by one T-score once she reaches 65 years.
“From a frustration standpoint, we really do not have the clinical trials to support these recommendations in general. We are largely going on clinical expertise at this time. But I think patients appreciate that,” Stuenkel said.
For women without contraindications, estrogen therapy could relieve symptoms, prevent bone loss and could be beneficial for overall health preservation, according to data presented by Stuenkel.
“There are efforts underway through the NIH to establish a registry not only for patient health information, but to glean more data from an observational standpoint of some different types of premature menopause and how the long term might be different for these women,” she said, adding that the development of preventive strategies are essential for CV and bone health.
“We need to do all the things we know for lifestyle management in order to prevent osteoporosis, make sure patients are taking enough calcium, vitamin D; replacing them with hormone therapy is globally the best approach to managing and preserving the bone density,” Stuenkel said. – by Samantha Costa
For more information:
Stuenkel CA. Plenary Symposium #3: When ovaries retire too soon – risks for CVD and fracture. Presented at: the North American Menopause Society 24th Annual Meeting; Oct. 9-12, 2013; Dallas.
Disclosure: Stuenkel reports consultancy for Ligand Pharmaceuticals and Pharmavit, a manufacturer that develops a soy derivative for Pfizer.