Early Menopause or Ovarian Failure

What Is Early Menopause?

[dropcap]E[/dropcap]arly menopause is the permanent cessation of menstruation in females before the age of 40 years characterized by vasomotor instability (hot flashes/cold episodes), psychologic and emotional symptoms and profound changes in the lower genital tract.

The most severe forms present with absent pubertal development and primary amenorrhea termed primary ovarian failure (50% of these cases due to ovarian dysgenesis), whereas forms with post-pubertal onset are termed secondary ovarian failure and are characterized by disappearance of menstrual cycles associated with premature follicular depletion.¹

Q: What is ovarian failure?

A: Ovarian failure is dysfunction of the ovaries to continue developing its eggs until about 51 years of age and to produce female hormones which results in infertility.  Ovarian failure  is  diagnosed by  this criteria:

• High levels in the blood of follicle stimulating hormone secreted by the pituitary gland, and
• Low levels of estrogen secreted by the ovaries.

The hypothalamus located in the brain is continually monitoring blood levels of estrogen so that when levels are low, it stimulates the nearby pituitary, or master gland, to secrete follicle stimulating hormone (FSH). FSH in turn stimulates the ovaries in females to produce estrogen. In ovarian failure, the ovaries do not respond to FSH. 

Some causes in the general population of women include cigarette smoking, viral infections, surgical removal of ovaries, chemotherapy, and autoimmune disorders such as celiac disease, Addison’s disease, hypoparathyroidism, diabetes mellitus, vitiligo, and pernicious anemia.

Who is Affected in the General Population? This heterogeneous disorder affects approximately 1% of women.²

What Is Early Menopause in Celiac Disease?

• Early menopause is a classic reproductive symptom of celiac disease and may be an uncommon presenting feature of untreated celiac disease. In this condition, celiac disease may impair the reproductive life of affected women by eliciting precocious menopause.³
• Early menopause is a severe disorder not only because it causes inability to conceive, but also because symptoms are usually worse than normal menopause. Moreover, sexual hormone defects represent an important risk factor for frequent and severe neurological, metabolic or cardiovascular disorders such as Alzheimer’s disease, hypercholesterolemia or ischemic diseases like stroke.² and osteoporosis.

• A study investigating menopause-associated disorders and fertile life span in women with celiac disease under untreated conditions and after long-term treatment with a gluten-free diet verified that late menarche and early menopause causes a shorter fertile period in untreated celiac women compared with control women. A gluten-free diet that started at least 10 years before menopause prolongs the fertile life span of celiac women.

  The scores for hot flushes, muscle/joint problems, and irritability were higher in untreated celiac women than in the control women (higher by 49.4%, 121.4%, and 58.6%, respectively). In comparison with untreated celiac disease, long-lasting treatment of celiac disease was associated with a reduction of 47.1% in muscle/joint problems.⁴

• Early menopause in celiac women is a risk factor for osteoporosis due to insufficient estrogen production needed for healthy bones.⁵

How Prevalent Is Early Menopause In Celiac Disease and/or Gluten Sensitivity?

Early menopause has increased frequency in celiac disease.³

What Are The Symptoms Of Early Menopause?

Early menopause is marked by these variable symptoms that may occur abruptly or slowly:

• Hot flashes.
• Nervousness.
• Fatigue.
• Apathy.
• Excitability.
• Irritability.
• Depression.
• Headache.
• Myalgia.
• Sleep disturbance.

How Does Early Menopause Develop In Celiac Disease and/or Gluten Sensitivity?

• Early menopause results from unclear etiology in celiac disease.
• Hyperprolactinemia (elevated blood level of prolactin hormone) is a cause of early menopause.

Does Early Menopause Respond To Gluten-Free Diet?

The possible prevention or treatment of early menopause in celiac disease can only be achieved through a life-long maintenance of gluten free diet.³

In comparison with untreated celiac disease, long-lasting treatment of celiac disease celiac disease was not associated with a significant difference in the duration of fertile life span, but was associated with a reduction of 47.1% in muscle/joint problems.⁴

6 Steps To Improve Early Menopause In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both reproductive and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁶
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁷
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁷
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁷.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁷
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁷
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁷[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

The mainstay of treatment for early menopause is hormone therapy which needs to be continued until the average age of the natural menopause.⁸

However, this treatment involves certain prescription drugs that cause many nutritional deficiencies as can be seen below.  Ask your doctor or pharmacist about this unwanted side effect that requires careful monitoring for proper supplementation as needed.

Do not stop prescribed medications without supervision.

This is not a complete listing.

FEMALE HORMONES disrupt intestinal permeability, which is definitely not wanted in celiac disease.

• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Vitamin B2, Vitamin B6, Vitamin B12, Vitamin C, Folic Acid, Magnesium, Zinc. [/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Additional supplements depend on individual need that may include any of the following: Vitamin B2, Vitamin B6, Vitamin B12, Vitamin C, Folic Acid, Magnesium, Zinc..

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Early Menopause In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“From menarche to menopause: the fertile life span of celiac women.” This study investigating menopause-associated disorders and fertile life span in women with celiac disease under untreated conditions and after long-term treatment with a gluten-free diet verified that late menarche and early menopause causes a shorter fertile period in untreated celiac women compared with control women. A gluten-free diet that started at least 10 years before menopause prolongs the fertile life span of celiac women.

The participants were 33 women with celiac disease after menopause (untreated celiac disease group), 25 celiac women consuming a gluten-free diet at least 10 years before menopause (treated celiac disease group), and 45 healthy volunteers (control group). The Menopause Rating Scale questionnaire was used to gather information on menopause-associated disorders. The International Physical Activity Questionnaire was used to acquire information on physical activity.

The perception of intensity of hot flushes and irritability is more severe in untreated celiac women than in controls. Low physical exercise and/or poorer quality of life frequently reported by untreated celiac women might be the cause of reduced discomfort tolerance, thus increasing the subjective perception of menopausal symptoms. The scores for hot flushes, muscle/joint problems, and irritability were higher in untreated celiac women than in the control women (higher by 49.4%, 121.4%, and 58.6%, respectively). In comparison with untreated celiac disease, long-lasting treatment of celiac disease celiac disease was not associated with a significant difference in the duration of fertile life span, but was only associated with a significant reduction in muscle/joint problems (a reduction of 47.1%).⁴

CASE REPORT SUMMARIES

“Unusual association of thyroiditis, Addison’s disease, ovarian failure and celiac disease in a young woman.”  This case report describes course of a 23 year old woman with a diagnosis of hypothyroidism due to Hashimoto’s thyroiditis, autoimmune Addison’s disease, and kariotypically normal spontaneous premature ovarian failure. Search for celiac disease revealed positive EMA antibodies and total villous atrophy at jejunal biopsy. Marked clinical improvement and a progressive decrease in the need for thyroid and adrenal replacement therapies occurred over a 3-month period. After 6 months serum EMA became negative and after 12 months a new jejunal biopsy showed complete mucosal recovery. After 18 months the anti-thyroid antibodies titre decreased significantly and thyroid substitution therapy was discontinued.

The early identification of celiac disease in polyglandular disease is clinically relevant not only for the high risk of complications inherent to untreated celiac disease, but also because celiac disease is a cause of substitute hormonal therapy failure in patients with autoimmune thyroid disease.⁹

Sources:

1. Beck-Peccoz P, Persani L. Premature ovarian failure. Orphanet J Rare Dis. 2006 Apr 6;1:9. [↩]
2. Beck-Peccoz P, Persani L. Premature ovarian failure. Orphanet J Rare Dis. 2006 Apr 6;1:9. [↩] [↩]
3. Stazi AV, Mantovani A. A risk factor for female fertility and pregnancy: celiac disease. Gynecologica endocrinology: the Official Journal of the International Society of Gynecological Endocrinology. Dec 2000;14(6):454-63. [↩] [↩] [↩]
4. Santonicola A, Iovino P, Cappello C, Capone P, Andreozzi P, Ciacci C. From menarche to menopause: the fertile life span of celiac women. Menopause. 2011 Oct;18(10):1125-30. doi: 10.1097/gme.0b013e3182188421. [↩] [↩] [↩]
5. Stazi AV, Trecca A, Trinti B. Osteoporosis in celiac disease and in endocrine and reproductive disorders. World J Gastroenterol. 2008 Jan 28;14(4):498-505 [↩]
6. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
7. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
8. Vujovic S, Brincat M, Erel T, Gambacciani M, Lambrinoudaki I, Moen MH, Schenck-Gustafsson K, Tremollieres F, Rozenberg S, Rees M; European Menopauseand Andropause Society. EMAS position statement: Managing women with premature ovarian failure. Maturitas. 2010 Sep;67(1):91-3. doi: 10.1016/j.maturitas.2010.04.011. Epub 2010 Jun 3. [↩]
9. Valentino R, Savastano S, Tommaselli AP. Unusual association of thyroiditis, Addison’s disease, ovarian failure and celiac disease in a young woman. Journal of Endocrinological Investigation. May 1999;22(5):390-4. [↩]