Menopause is when you have your final menstrual period. Your periods stop because your ovaries stop producing certain hormones and stop producing eggs (Hormones and menopause).

In Australia, most women (around 3 in 4) reach “natural” menopause between the ages of 45 and 55 years, but it can happen earlier or later. The average age of “natural” menopause is 51.

Premature menopause

• is when your final menstrual period happens before the age of 40
• In Australia, around 1 in 10 women will go through premature menopause.

Early menopause

• is when your final menstrual period happens before the age of 45
• In Australia, around 1 in 10 women will go through premature menopause.

Women who go through premature menopause or early menopause are more likely to have heart and bone diseases than women who have gone through “natural” menopause. It’s important to see a doctor to prevent bone loss and heart disease even if you don’t have menopausal symptoms.

If you go through premature or early menopause, you will have menopausal symptoms that are similar to women who go through “natural” menopause.

You might have more severe symptoms because you have a more sudden drop in hormone levels.

Watch this video to learn more about premature and early menopause

Many of the causes of premature and early menopause are the same. In around half of all women with premature or early menopause, the cause is not known.

Some women experience menopause earlier than 45 years because of:

• surgery that removes your ovaries
• cancer treatments (e.g. chemotherapy, some types of radiotherapy)
• some autoimmune diseases (e.g., rheumatoid arthritis)
• some genetic disorders (e.g., Fragile X, Turner’s syndrome)
• some infections (e.g., mumps, HIV)
• a family history of early menopause.

Risk factors for premature and early menopause

Many risk factors for premature and early menopause can’t be changed. For example, if you:

• started your menstrual periods started before the age of 11
• have a family history of premature or early menopause
• have a genetic condition (e.g. Turner syndrome or Fragile X syndrome)
• have a disorder or condition that cannot be treated
• have an infection (e.g. mumps).

One way you can lower your risk of premature or early menopause is to make sure you don’t smoke tobacco.

Different health professionals can help you manage menopausal symptoms and your risk of longer term health issues. For example:

• Endocrinologists (doctors who specialise in hormones)
• Gynaecologists (doctors who specialise in reproductive health, or how the ovaries, uterus and vagina works)
• Psychologists (a health care professional who specialises in emotional health).

You should also see your own doctor regularly over the years to check your health needs, medicines and any health risks.

Monash University’s Ask Early Menopause explains premature and early menopause, including stories from women who have experienced it.

Hormone medicines

If you have premature or early menopause, your doctor will probably recommend you use medicines containing hormones, either menopausal hormone therapy (MHT) or the contraceptive pill (the Pill), at least until the usual age of “natural” menopause (about 51 years of age). These medicines will reduce your long-term health risks of bone loss (osteoporosis) and heart 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 (a condition where blood clots block blood flow). Serious side effects of MHT in younger women are very rare.

Some people might not be able to use MHT or the Pill. Your doctor will discuss the best treatment options for you based on your health and family history.

Emotional wellbeing

Women who experience premature or early menopause can have a greater risk of:

• mood changes
• anxiety
• depression.

It can be upsetting to experience menopause earlier than expected. It’s normal to feel a sense of loss, sadness and grief.

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

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

It’s important to talk to someone if you feel 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.

It can be distressing to have hot flushes and night sweats at a young age. You might also have physical changes, like vaginal dryness, which can cause painful sex and result in a lower sex drive (libido).

A diagnosis of early or premature menopause might change your plans to have a family or affect your relationship.

It’s important to seek support from people close to you. If you have a partner, they might not know about menopausal symptoms or what you’re going through. You can suggest going to your gynaecologist or doctor’s appointments together or seek counselling if required.

You can also suggest they read our information for partners.

Heart disease

Women who go through premature or early menopause might have a higher risk for developing heart disease compared with women who reach “natural” menopause between 45 to 55 years of age.

Given this risk, it’s important to talk to your doctor about different treatment options.

It is also important to have regular heart health checks, including:

• blood pressure
• weight
• cholesterol levels
• sugar levels.

You can reduce your risk of developing heart disease by having a healthy lifestyle.

Bone loss (osteoporosis)

Women who go through premature or early menopause might have a higher risk of developing bone loss, leading to a disease called osteoporosis, earlier in life. So, it’s important to have regular bone health checks.

Primary ovarian insufficiency (POI) is a condition where a woman’s ovaries stop working properly before the age of 40. It is different from premature menopause, which is where menstrual periods stop permanently before the age of 40.

POI affects around 4 in 100 women. In about half the women with POI, a cause cannot be found.

The first signs of POI might be:

• irregular or no periods
• finding it hard to get pregnant.

How is POI diagnosed?

If you’re younger than 45 and haven’t had a menstrual period for more than 3 months, talk to your doctor. They will need to do a physical examination and investigate the cause.

Your doctor may refer you to a specialist to do some tests. For example:

hormone tests – such as oestrogen, prolactin and follicle-stimulating hormone (FSH)

an internal ultrasound – to check if your ovaries are functioning.

After POI is diagnosed, your doctor may organise more tests to check for possible causes and other conditions.

POI may be associated with autoimmune conditions such as:

Addison’s disease

thyroid disease

type 1 diabetes

Crohn’s disease

coeliac disease.

How does POI affect fertility?

Many women are unable to conceive a baby naturally after POI, but there is still a small chance of pregnancy.

If you have been diagnosed with POI and don’t want to get pregnant, you should use contraception.

If you do want to get pregnant, you can use hormone medicines to bring on regular periods. Talk to your doctor about the benefits and risks of these medicines.

If you have POI and you’re finding it hard to fall pregnant, you can explore options like IVF or surrogacy using a donor egg.