PMS now could mean double the risk of early menopause later, study shows

By Madeline Holcombe, CNN

(CNN) — Cramps, headaches and depression may not be the only impacts of PMS — there could be complications with menopause down the line, according to a new study.

People with premenstrual disorders, or PMDs, like premenstrual syndrome and the more severe premenstrual dysphoric disorder, have more than twice the risk of going through menopause early, according to the study.

“We found compared to women without PMDs, those with PMDs have 2.67 times the risk of having early menopause,” said lead study author Yihui Yang, a doctoral student at Karolinska Institutet in Sweden, in an email.

Menopause is considered early when it occurs before age 45, which will happen in 5% to 10% of women, Yang said.

Early menopause is concerning because of the shortened reproductive years, but also because of links to other health concerns, she added.

“It is important to identify women at risk for early menopause because of its link with poorer heart, brain and bone health,” said Dr. Stephanie Faubion, director of the Mayo Clinic Center for Women’s Health and medical director of The Menopause Society. Faubion was not involved in the research.

A 2010 study found that women who experience early menopause are at an increased risk for overall mortality, including cardiovascular diseases, osteoporosis and neurological diseases.

Women with PMDs were also more likely to have severe vasomotor symptoms — or hot flashes and night sweats, according to the study.

Prior research has shown a link between hot flashes and later cognitive decline and heart attacks.

How are PMS and early menopause connected?

The study, published Tuesday in JAMA Network Open, included data from more than 3,000 women — 1,220 with premenstrual disorders (PMD) and 2,415 without — who took part in the Nurse’s Health Study II, which investigates the risk factors for chronic diseases in women.

Beginning in 1991, the women self-reported their PMD diagnoses and answered a questionnaire to confirm symptoms, the study said. Researchers followed participants every two years until 2017 to assess when the women went through menopause and in three of those surveys asked about  the severity of their symptoms.

It is important to note, since this is an observational study, that it cannot say that having premenstrual disorders causes early menopause. Instead, the results show that there is a correlation between the two, said senior study author Dr. Donghao Lu, an associate professor in the Institute of Environmental Medicine at Karolinska Institutet.

The study is well designed, however, and “highlights an important reproductive health-related condition that is under-recognized and under-treated,” Faubion said.

Next, researchers need to discover why the two conditions are linked and whether there is a biological process that connects them, Faubion said in an email.

There has been some research to support the idea that PMDs and early menopause are connected, Yang said.

Studies have shown that the two have common risk factors such as development during puberty and smoking, which suggest that they may share common causes, Yang said.

It may be that the hypothalamus, the area of the brain that is responsible for hot flashes, is different in women with hormone-driven mood disorders, Faubion added.

“We also don’t know if treating these mood disorders would mitigate hot flashes or influence timing of menopause,” she said. “Lots of questions remain.”

What to do for PMS and early menopause

Research like this can help health care professionals identify who may be at risk for early menopause, said lead study author Dr. Elizabeth Bertone-Johnson, a professor of epidemiology at University of Massachusetts Amherst.

Premenstrual syndrome is a condition involving monthly physical and mood changes leading up to menstruation, according to the American College of Obstetricians and Gynecologists.

Symptoms can include anxiety, depression, irritability, insomnia, poor concentration, appetite changes, fatigue, aches and pains, headache, bloating, gastrointestinal symptoms, and abdominal pain.

A small percentage of people have premenstrual dysphoric disorder, or PMDD, which is similar to PMS but includes more severe symptoms like panic attacks, anger that may impact other relationships and lack of interest in regular activities, according to the Office on Women’s Health, which is part of the US Department of Health and Human Services.

While you can’t get rid of PMS or PMDD, medications and behavior changes can help to manage symptoms, Faubion said.

Women also need to know that there are ways to manage early menopause and the bothersome hot flashes, she said.

Faubion recommends talking with your provider or finding a menopause expert or Menopause Society Certified Practioner (MSCP), whom you can find through menopause.org.

There may not be much that people with PMDs can do now, but it is important to know a potential risk for the future, Yang said.

“They may consult health professionals for potential prevention and/or intervention when the time comes,” she said.

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