Premature and early menopause

What are premature and early menopause?

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

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

Menopause (your final period) usually happens between the ages of 45 and 55. About 8% of women have their final period by the time they are 45.

Symptoms

Symptoms of premature and early menopause are like those you would experience if you reached menopause at the expected age. But symptoms can be more severe if there is a sudden drop in oestrogen hormone levels, for example, when your ovaries are surgically removed.

Causes

Primary ovarian insufficiency (POI)

POI is when your periods stop at an earlier than expected age. It affects about 1% of women.

POI is associated with autoimmune diseases such as Addison’s disease, thyroid disease, type 1 diabetes, Crohn’s disease and coeliac disease. But in around 60% of cases, a cause cannot be found.

How is POI diagnosed?

If you are younger than 45 and haven’t had your period for more than three months, talk to your doctor. They will ask questions about your situation and may do a physical examination. Your doctor may do different tests to look for a cause. For example:

• a pregnancy test
• hormone tests (e.g. oestrogen, prolactin, follicle stimulating hormone (FSH))
• a vaginal or internal ultrasound to check if your ovaries are working.

POI is one of many reasons periods stop early. If you are diagnosed with POI, your doctor may also refer you to a specialist to check for other possible causes.

Cancer treatment

Cancer treatments, such as chemotherapy and radiotherapy, can cause your ovaries to stop working. But not all cancer treatments will cause menopause.

Surgery

Surgical removal of the ovaries can cause menopause. Surgery can be with or without a hysterectomy (removal of the uterus).

Other causes

Other causes of premature or early menopause include:

• genetic abnormalities, such as Turner syndrome or Fragile X syndrome
• metabolic disorders
• infection (e.g. mumps).

You are more likely to have premature or early menopause if you smoke, have epilepsy or have a family history of premature or early menopause.

Treatment and management

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

If you cannot take the Pill or MHT (e.g. if you have a history of breast cancer) your doctor will discuss your situation and recommend the best treatment.

Fertility

It can be devastating to reach menopause earlier than expected, particularly if you had hoped to start a family or have more children. If you are diagnosed with POI and find it hard to fall pregnant, you can explore different ways of having children. For example, IVF or surrogacy with a donor egg, foster care or adoption.

Emotional wellbeing and support

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

If you reach menopause in your 20s or 30s, it’s normal to feel a sense of loss, sadness and grief. You can get help from a counsellor or psychologist if you need it.

People close to you might not understand the impact of going through menopause early. If you have a partner, you can ask them to read information about menopause for partners.

When to see your doctor

See your doctor if:

• you have stopped having periods and are under 45
• you are worried about your periods
• your symptoms (physical and emotional) stop you from doing things you normally do.

Depending on your symptoms, your doctor may refer you to a specialist (e.g. a gynaecologist, psychologist, endocrinologist or dietitian).

For more information, resources and references, visit the Jean Hailes menopause web page.