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Premature and early menopause

Premature menopause is when your final period happens before the age of 40 years.

Early menopause is when your final period happens between the ages of 40 and 45.

Up to 8% of women have had their final period by the time they are 45. This percentage is likely to be higher if we include menopause caused by surgery and cancer treatment.

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What causes premature and early menopause?

Premature ovarian insufficiency (POI)

Premature ovarian insufficiency (POI) can cause premature and early menopause.

POI is when your periods stop suddenly at an earlier than expected age.

The causes of POI are not always clear. In about 60% of women, a cause cannot be found.

The first symptoms of POI may be:

  • irregular periods
  • no periods after stopping the oral contraceptive pill
  • inability to get pregnant.

Diagnosis of POI

If you are younger than 45 years and you haven’t had your period for more than three months, talk to your doctor.

They will need to do a full physical examination and investigate the cause.

Your doctor may refer you to a specialist to do a physical examination and some tests.

For example:

  • a pregnancy test
  • hormone tests (e.g. oestrogen, prolactin, FSH)
  • a vaginal or internal ultrasound – this procedure checks for evidence that your ovaries are functioning.

After POI is diagnosed, your doctor may ask you to do more tests to check for possible causes and associated conditions.

POI and fertility

If you have been diagnosed with POI and do not want to become pregnant, you should use contraception. Many women are unable to conceive a baby naturally after POI; however, there is a one in 50 chance of a spontaneous pregnancy.

If you do want to become pregnant, you can use different hormone therapies to bring on monthly periods. Talk to your doctor about the benefits and risks of these therapies.

If you have POI and you are finding it hard to fall pregnant, you can explore different ways of having children.

For example:

  • IVF using a donor egg
  • surrogacy with a donor egg
  • foster care or adoption.

Other causes of premature and early menopause

You may be more likely to have premature or early menopause if:

  • your periods start before 11 years of age
  • you have a family history of premature or early menopause
  • you smoke
  • you have epilepsy
  • you have had previous surgery on your ovaries.

Premature and early menopause can also be caused by:

  • genetic abnormality (e.g. Turner syndrome or Fragile X syndrome)
  • autoimmune disorders (e.g. Addison’s disease, thyroid disease, type 1 diabetes, Crohn’s disease or coeliac disease)
  • metabolic disorders
  • infection (e.g. mumps).

Watch this video to understand the causes of premature and early menopause, and available treatments

Symptoms of premature and early menopause

Symptoms of premature and early menopause are like those you would experience if you reached menopause at the expected age of 51–52 years, but symptoms can often be more severe due to the sudden change in hormone levels.

Managing premature and early menopause

If you are diagnosed with premature and early menopause, your doctor can refer you to different specialists. For example, an endocrinologist, gynaecologist, psychologist or psychiatrist.

Your doctor should also see you regularly over the years to reassess your health needs, including your medications and any health risks.

Hormone therapy

Due to reduced hormone levels, you will need to have hormone therapy (usually menopausal hormone therapy (MHT) or the Pill) until the expected age of menopause. MHT will reduce potential long-term health risks of osteoporosis and cardiovascular disease.

Like any treatment, MHT or the Pill can have side effects. If you use MHT or the Pill, there may be a small increase in the risk of thrombosis. Studies indicate breast cancer risks are not expected to increase until after the age of expected menopause. Serious adverse effects of MHT in younger women are very rare.

There are circumstances where MHT or the Pill should not be used (for example, women with a history of breast cancer).

Your doctor will discuss the best treatment options, taking into consideration your symptoms, risk factors and family history.

Emotional wellbeing

Women who experience premature or early menopause can be at greater risk of depression, anxiety and mood changes.

If you experience menopause in your 20s or 30s, it can be very upsetting. It’s normal to feel a sense of loss, sadness and grief.

You may also have mixed feelings about your body image, fertility, femininity and sexuality.

There are lots of things you can do to look after yourself during this difficult time.

It’s important to talk to someone if you feel very emotional, anxious or depressed after your diagnosis. Your doctor can help with symptom relief and refer you to a psychologist if needed.

Sex and relationships

After a diagnosis of premature or early menopause, physical and emotional changes may reduce your desire to be intimate with your partner.

It can be distressing to have hot flushes and sweats at a young age. You might also feel conscious of physical changes, like vaginal dryness, which can cause pain during sex and result in a reduced sex drive (libido).

Depending on your stage of life and family plans, this diagnosis may change your plans and affect your relationship.

It may be hard to communicate how you are feeling to your partner, but it’s important to communicate openly. You may find it helpful to go to your gynaecologist or doctor’s appointments together or seek counselling if required.

Cardiovascular disease

Women experiencing premature or early menopause may have a higher risk of developing cardiovascular disease and osteoporosis compared with women who reach menopause at the expected age, although we need more studies in this area.

Given the potential risks, it’s important to talk to your doctor about different treatment options.

You can reduce your risk of developing cardiovascular disease by having a healthy lifestyle, including a healthy diet, exercise and no smoking.

There is some evidence that suggests menopausal hormone therapy (MHT) can also reduce the risk of cardiovascular disease.

After your diagnosis, your doctor should monitor your blood pressure, weight, smoking status, and cholesterol and sugar levels regularly.

Osteoporosis

Women who experience premature or early menopause can start to lose bone density at an earlier age than women who experience menopause in their 50s. This puts them at a greater risk of developing osteoporosis earlier in life. MHT is the treatment of choice for women with osteopenia or osteoporosis – until they are about 60 years of age.

You can improve your bone health by changing your lifestyle. For example, eat more calcium-rich dairy products, do regular physical activity (including muscle-strengthening exercises) and increase your vitamin D intake if needed.

After your diagnosis, it’s also important to have regular assessments of your bone mineral density.

Neurological health

Women with POI who do not use hormone therapy may have reduced cognition and verbal memory functions.

All you need to know

Download our booklet 'Understanding premature & early menopause'.

Download our fact sheets

Ask Early Menopause is your personal guide to early and premature menopause. It was developed by a Monash University partnership with women, for women and includes high-quality health information and personal stories.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at August 2022.

Last updated: 08 September 2022 | Last reviewed: 19 August 2022

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