Premature menopause may increase risk of death from heart disease and cancer

Women who reach menopause before age 40 are more likely to die at a younger age, according to a study from Finland presented at the 26th European Congress of Endocrinology.

Experts note that this increased mortality risk also applies to women who have experienced premature menopause.

“This study confirms what we already know and believe in the gynecology profession,” explained Dr. Vanessa Soviero, an OB-GYN at Northwell Health's Katz Institute for Women's Health, who was not involved in the study.

Soviero emphasized the need for in-depth research on women's health, a historically understudied area. Although only 1% of women experience premature menopause, also known as primary ovarian insufficiency (POI), Soviero noted that this research applies to other women.

“This doesn’t just apply to women who have had early menopause,” Soviero said. “Women who have their ovaries removed at a young age also face these risks.”

A woman may need to have one or both ovaries removed for reasons such as endometriosis and benign tumors (cysts), or if she is at significant risk for breast or ovarian cancer and is having preventive surgery.

Details of the study of premature menopause

Researchers from the University of Oulu and Oulu University Hospital in Finland studied approximately 5,800 women who were diagnosed with spontaneous or surgically induced MOF between 1988 and 2017.

They compared the results with almost 23,000 women without MODS.

Their findings, which have not yet been published in a peer-reviewed journal, are that women with MODS are twice as likely to die from cardiovascular disease and four times as likely to die from any type of cancer. They were also listed as being twice as likely to die from any cause.

There was no significant difference in the risk of death in women with naturally occurring MODS compared with surgically induced MODS.

Although previous studies have focused on the link between premature menopause and a woman's risk of death, this study is the largest to date. This is also the first study to include surgically induced menopause.

“To our knowledge, this is the largest study conducted on the association between primary ovarian failure and mortality risk,” explained Hilla Haapakoski, lead author of the study and a graduate student at the University of Oulu, in a press release.

Although past research has highlighted the link between menopause and heart health—regardless of a woman's age—menopause before age 40 carries significantly greater risks.

“The risks are highest in women who experience menopause before age 40, but every woman should consider taking hormones, even before menopause,” Soviero said.

“I encourage women to start [hormone replacement therapy] before menopause, when perimenopausal symptoms begin to develop,” Soviero said. “The sooner you start hormone therapy, the greater the cardiac, cognitive and bone benefits you will experience.”

Hormone replacement therapy and premature menopause

“In our practice, we recommend birth control pills to anyone who has MODS or has had their ovaries removed because it reduces all the risks associated with low estrogen levels,” Soviero explained.

In their study, the researchers reported that women who used hormone replacement therapy for at least six months were half as likely to die from cancer or other causes.

"Women can reduce their risk with birth control, but many women think they don't need birth control during menopause because they can't get pregnant," Soviero said. “Hormonal therapy will reduce your risk of heart attack and stroke, but will also reduce your risk of cognitive disorders such as dementia and Alzheimer's disease, as well as osteoporosis and fractures.”

Soviero said she educates her patients to combat common misconceptions about birth control, hormones and HRT.

"Most people don't understand the benefits of hormones, especially estrogen," Soviero said. “And they have seen information on social media that is not accurate for most women. Estrogen and progesterone should both be considered."

After menopause, estrogen protects the heart, brain and bone health, Soviero said. Progesterone protects the uterus.

Women who should not consider hormone therapy include anyone with a history of breast cancer, uterine cancer, or bleeding disorders.

Despite some risks associated with hormone replacement therapy, Soviero said the benefits of HRT outweigh the risks.

The researchers said their next steps will be to evaluate the long-term effects of hormone therapy.

“The various health risks for women with primary ovarian failure are not well recognized, and the use of [hormone replacement therapy] is often ignored,” Haapakoski said. “We hope to improve the health of these women by raising awareness of the risks among health care workers and the women themselves.”