Master's research from the Faculty of Medical Sciences (FCM) at Unicamp showed that the psychological disorders observed in women with premature ovarian failure (popularly called early menopause), before the age of 40, were exactly the same as those seen in women of the same age and with functioning ovaries. . “The results were comparable thanks to the treatment with hormonal therapy with estrogen and progesterone”, informed Cristina Laguna, professor at FCM, gynecologist at Hospital da Mulher - Caism and supervisor of the work.
The study, carried out between 2016 and 2017, evaluated the impact of this treatment years after diagnosis and found that it managed to reduce the negative psychological connotations of the period. However, despite this treatment being an ally for women with early menopause, disorders were still high. Depression occurred in around 30% of the women evaluated, it was of different degrees and women with moderate and severe depression were not always able to receive this diagnosis.
Psychologist Camila Menezes, author of the work, interviewed 61 women treated at Caism with a diagnosis of premature ovarian failure and 61 women considered healthy, from the point of view of hormonal production. The women answered questionnaires that measured disorders such as depression, anxiety and stress. They were asked how they felt about these aspects and the diagnosis of premature ovarian failure years after treatment.
Those evaluated had already been diagnosed with early menopause for an average of seven years, and had been taking hormones for at least a year. They were also receiving fundamental guidance for their lives regarding nutrition, physical activity and some healthy habits.
Camila Menezes noticed that many women said they were depressed and discouraged as soon as they received the information that they had early menopause, because this diagnosis was made at an unexpected age for them. These women demonstrated great resistance in accepting the diagnosis of early menopause, mentioning the impact this had on their relationships. Over time and with guidance from the hospital's multidisciplinary team (doctor, psychologist, physiotherapist, nutritionist), acceptance was greater and control of psychological changes was better.
The study showed that women with ovarian insufficiency showed more depression when they had more children and when they worked double shifts, no matter how much help they had from their partners.
“According to the World Health Organization, treatment for these women must be adequate and individualized, and must take into account psychological aspects, as there are predictions that depression will be the most prevalent disease in the world, even more so than cardiovascular diseases. , with major impacts on the population as a whole”, highlighted Cristina Laguna.
Brazil already holds the title of country with the highest number of people with depression in Latin America. Worldwide, the pathology already affects 322 million people and is expected to increase even further, with estimates that it will become one of the biggest public health concerns globally.
Disorders
Cristina Laguna revealed that 1% to 2% of women worldwide may experience early loss of ovarian function. This means that, out of every 100 women, one or two women's ovaries may stop working prematurely (1% before the age of 40 and 0,1% before the age of 30).
She clarified, however, that for women who enter menopause earlier, this dThe diagnosis does not necessarily mean that they will experience premature aging or the impossibility of getting pregnant. Rather, it means that her ovaries will no longer function, that this may have some implications and that she may need treatment.
The doctor said that, when women receive this diagnosis, they are referred to the Caism Endocrine Gynecology Outpatient Clinic, generally because they have never menstruated or because they menstruated and stopped menstruating before the age of 40 or because menstruation is irregular, occurring every three to four months.
When the diagnosis of ovarian loss is made before the age of 40, some of the consequences of this loss are explained to patients. One of them is that, in some cases, they may lose their reproductive capacity and have organic problems due to the lack of hormones. Thus, they receive guidance on preventive treatment so that they remain well over the years.
They receive explanations about the possible psychological consequences they will have, and can be monitored in the hospital, if they wish. Also, due to inadequate weight or inadequate health habits, they may opt for nutritional monitoring and, when complaints are pain or related to mobility, they may also opt for physiotherapeutic monitoring.
After evaluation by the multidisciplinary team, hormonal therapy will be prescribed, alongside a periodic assessment of bone, cardiovascular and other hormone health and, if necessary, a request will be made for patients to be seen by other specialists.
Treatment
Cristina Laguna teaches that the term “early menopause” is often used, but in fact the most appropriate expression would be premature ovarian failure, because what this woman suffers from is the lack of ovarian function before the time, this is because, When ovarian function is lost, reproductive function may be compromised. Therefore, women have more difficulty or inability to get pregnant spontaneously.
The gynecologist, however, considers that nowadays women have multiple roles to play in society, such as a productive role, for example, contributing financially to their family context. Perhaps some of these aspects are even more relevant to her than reproductive function. Many women today are concerned about academic achievement and building their career.
Another aspect that should be rethought, according to the advisor, is that the connotation that premature ovarian dysfunction is the same as that which occurs in menopausal women approaching the age of 50 should be removed. “If a woman has a menstrual disorder, either because she has never had a period or because her periods are irregular, she needs to see a doctor for a proper diagnosis, and not simply take hormones,” she highlighted. “These women are young and need hormonal therapy to prevent or reduce the consequences of lack of ovarian function. And they should view this health problem like other problems in life. Doctors must also seek a more proactive attitude to diagnose these women and refer them to more specific treatment.”
Menstrual irregularity must be very well understood, said the doctor, since many women, because they are still young, do not think about reproduction. “It is important that, at the first signs and symptoms, these women get a quick diagnosis because it can change the approach to the problem”, she highlighted. “Premature ovarian failure causes undesirable consequences due to a prolonged state of hypoestrogenism (decline in ovarian estrogen production), with a strong indication of hormonal therapy to minimize such changes.”
This study warns that multidisciplinary treatment should be offered and highlights that psychological problems are being underdiagnosed. “The results obtained serve to warn other services that serve women with this diagnosis about psychological changes, strengthening the idea of adherence to a more complete treatment”, informed Cristina Laguna.
