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What is an early or premature menopause?
People who experience the menopause usually reach it between the ages of 45 and 55. But if your periods stop before you turn 45, it’s known as early menopause. If they stop before you turn 40, this is known as premature menopause (also called premature ovarian insufficiency or premature ovarian failure). It might happen naturally or because of medical or surgical treatments.
An early or premature menopause can be upsetting, especially if it’s sudden, so it’s important to get the help you need. Here I’ll talk about what can cause an early or premature menopause, how to spot the signs and the treatment available.
What causes early or premature menopause?
The menopause is the stage in your life when you stop having periods and your levels of the hormone oestrogen fall.
You may be more likely to have an early or premature menopause because of:
- your family history – if a close relative had a very early menopause, you may have one too
- a genetic disorder, such as Turner’s syndrome
- an autoimmune condition (when your immune system overreacts and attacks your normal cells) such as type 1 diabetes or a thyroid problem
- infections, such as tuberculosis, malaria and mumps – although sometimes, your ovaries may start working properly again after a while
You may also have an early or premature menopause if you’ve had:
- radiotherapy
- chemotherapy
- surgery to remove your ovaries
But doctors often can’t find an exact cause.
How do you know if you’re going through early or premature menopause?
The menopause affects everyone differently, and many people experience an early or premature menopause without realising at first. You may only discover this when your periods get less regular or stop altogether. Some people also experience other common symptoms of the menopause, like hot flushes and night sweats.
Diagnosis of early or premature menopause
If you think you’re experiencing an early or premature menopause, it’s important to see your GP.
Your GP should be able to diagnose an early or premature menopause from your symptoms, family history and medical history. But you may also need to have some blood tests to check your levels of a hormone called follicle stimulating hormone (FSH). You’ll need to have two blood tests, four to six weeks apart. If your FSH levels are high, this means your ovaries aren’t working properly.
You may also have other tests to check your:
- chromosomes (part of your DNA)
- bone density (to check for thinning bones)
- thyroid hormones (because a problem with your thyroid gland can cause similar symptoms)
- blood sugar (because diabetes can cause similar symptoms)
If your GP isn’t completely sure the menopause is causing your symptoms, they may refer you to a specialist doctor or menopause clinic.
What are the symptoms of an early or premature menopause?
Having low oestrogen levels can affect your physical and mental health in lots of different ways. Hot flushes and night sweats are the most common symptoms, affecting around three iout of four menopausal people. These symptoms can last for several years.
Other menopausal symptoms include:
- changes in your mood
- aches and pains in your muscles and joints
- bladder leakage (incontinence) and urinary tract infections
- not sleeping properly
- problems with your memory or trouble concentrating
- vaginal soreness or dryness
- pain during sex
- losing interest in sex
If you have premature ovarian insufficiency, you may still ovulate occasionally, which means there’s still a chance you could get pregnant. But a premature menopause can affect your ability to have children naturally. You may still be able to have fertility treatments, so discuss this with your doctor.
Treatment for early or premature menopause
It’s important to get treatment for early or premature, because it can sometimes affect your future health too. For example, you’re more likely to get heart disease and thinning bones (leading to osteoporosis) later in life.
If you’re diagnosed with premature menopause, your GP will talk to you about your treatment options and how to ease any symptoms. You’ll be offered either the combined contraceptive pill or hormone replacement therapy (HRT) to replace your missing oestrogen.
Taking HRT
Taking HRT is better than the combined contraceptive pill at protecting your bones and reducing your risk of getting osteoporosis or heart disease. It’s also better for your blood pressure. Unlike the combined contraceptive pill, HRT isn’t a form of contraception. This means you’ll need to take other precautions, such as using condoms, if you’re having sex but don’t want to become pregnant.
If you’ve lost interest in sex, you may be prescribed the hormone testosterone. This is because if your ovaries aren’t working properly, or you’ve had surgery to remove them, you may not have enough testosterone in your body. This can affect your sex drive (libido).
Your GP will discuss all of the pros and cons of taking HRT and will make sure the dose and type is right for you. If you have premature menopause (especially after surgery), your symptoms may be worse than if you had a menopause at a later age. This means you may need to take higher doses of oestrogen to ease any hot flushes and night sweats. Taking HRT doesn’t seem to increase the risk of breast cancer in women under 50.
If you take HRT, you’ll need stay on it for several years, at least until you’re 51 (the average age of menopause). This is to protect your long-term health, reducing your risk of osteoporosis and heart disease. After this, you and your GP will discuss whether you still need to stay on HRT.
Managing your symptoms
If you’ve had certain types of cancer (e.g. hormone-sensitive breast cancer), you may not be able to have hormonal treatments for early or premature menopause. But your GP will be able to suggest other ways to ease your symptoms, such as:
- non-hormonal medications for hot flushes
- vaginal moisturisers or lubricants for any vaginal dryness
- cognitive behavioural therapy (CBT) for changes to your mood
If you get hot flushes, there are lots of self-help measures you can try to ease your symptoms. These include:
- wearing layers of light clothing that you can remove easily
- avoiding spicy foods
- cutting down on caffeine – or cutting it out completely
- cutting down on alcohol
- giving up smoking if you smoke
Your GP will also discuss how to protect your general health after the menopause. For example:
- getting plenty of calcium (1000 mg per day) and vitamin D (800 iu or 20 mcg per day) for healthy bones
- losing weight if you need to
- doing regular exercise, especially weight-bearing exercise such as walking, which strengthens your bones
- getting plenty of sleep
- doing relaxation exercises to reduce stress
Getting support
Experiencing the menopause at any age can impact your mental health, but even more so if it happens earlier than you expected. It’s important to have the right support in place, to help you deal with your emotions and come to terms with your diagnosis.
You may be able to speak to your family and friends about what you’re going through, or you may prefer to speak to someone you don’t know. Your GP can put you in touch with a suitable counsellor. You can also contact the Daisy Network which is a support network for women diagnosed with premature ovarian insufficiency.
Bupa offers digital GP services through different routes to suit you. If you have Bupa health insurance you have unlimited access to Digital GP appointments through the Digital GP app (in partnership with Babylon) and if you don't have health insurance, our remote private GP service is available to anyone who wishes to book a self-pay video appointment with a private GP via Bupa Health Clinics.
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