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Early Menopause and premature menopause

Menopause is when a woman stops having her periods. Menopause usually happens between the ages of 45 and 55 (the average age being 51). For a small number of women, menopause occurs earlier.

What's in a number?

If menopause happens before 40, it’s called premature menopause (or premature ovarian insufficiency). These terms may be used interchangeably, which can be confusing. To clarify - early menopause is used to describe menopause before the age of 45 and premature menopause, when it occurs below the age of 40. However, premature menopause can occur at any age - even in late teenagers.

What is early/premature menopause?

To put it simply, ovaries stop producing the hormones, years or even decades before they should. It can present as an absence of periods The ovaries produce hormones called oestrogen and progesterone in response to other hormones (follicle stimulating hormone (FSH), and luteinising hormone (LH)). All these hormones interact as part of the monthly menstrual cycle, which results in the development of an egg in one of the ovaries. In premature menopause, the ovaries stop producing normal levels of oestrogen and eggs may not develop and mature.

The causes of premature menopause are described as primary or secondary. In the great majority of cases it's not possible to explain why premature menopause happens but some of the causes of primary premature menopause may include:

  • Chromosome abnormalities, such as women with Down's syndrome.
  • Enzyme deficiencies, where enzymes in the body affect the ovaries by damaging the eggs and preventing the production of oestrogen.
  • Autoimmune diseases, where the body's natural defence mechanisms start producing antibodies that destroy its own tissues.

Secondary causes can be due to cancer treatments such as radiotherapy or chemotherapy. The risk will depend on the type of treatment and the patient's age. Other secondary causes include surgical menopause (an operation to remove both ovaries) or having a hysterectomy.

What are the signs and symptoms of premature/early menopause?

Periods may become infrequent or stop. There may be other symptoms such as:

  • Hot flushes (also known as hot flashes)
  • Night sweats
  • Palpitations
  • Decreased or low energy levels
  • Lack of concentration
  • Poor sleep
  • Lack of interest in sex
  • Vaginal dryness
  • Painful intercourse

What are the risks associated with premature/early menopause?

Women, who have an early or premature menopause, have an increased risk of osteoporosis, cardiovascular disease, dementia, cognitive decline and Parkinson's, and all cause mortality due to reduced oestrogen levels. Infertility is also an issue. Women who experience menopause before they've been able to have children may find this emotionally very hard to deal with.

What treatments are recommended?

Women with early/premature menopause are usually advised to have hormonal treatment with either HRT or a combined hormonal contraceptive until the average age of the natural menopause (which is about 51).

There is no evidence to suggest that HRT increases the risk of breast cancer and cardiovascular disease over and above that of women with a normally timed menopause.

The diagnosis of premature menopause can be a shock and upsetting, especially in women who haven't yet had children. Counselling or support may be helpful if you have or are experiencing premature menopause.

The Daisy Network is a large support group for women suffering with Premature Ovarian Insufficiency (POI).
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