What is an early or premature menopause?

What causes early or premature menopause?

The menopause is the stage in your life when you stop having periods. 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

You might have increased risk of early or premature menopause if you’re underweight, smoke, if you started your period at an early age and if you’ve never given birth. But doctors often can’t find an exact cause.

Is there an early or premature menopause test?

If you think you’re experiencing an early or premature menopause, for example you notice your periods have stopped, see a GP.

Your GP should be able to diagnose you from your symptoms, family history and medical history. But you may also need to have some blood tests. Your doctor will 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)

If there is uncertainty around diagnosis, your GP 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. Hot flushes and night sweats are the most common symptoms. Around 80 percent of menopausal people have these symptoms, but they aren’t necessarily the most troublesome.

Other menopausal symptoms include:

• changes in your mood
• aches and pains in your muscles and joints
• headaches
• bladder leakage (incontinence) and urinary tract infections
• poor sleep
• problems with your memory or trouble concentrating
• vaginal dryness or soreness
• losing interest in sex

If you have premature ovarian insufficiency, you may still ovulate occasionally. So this 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.

What treatment is there for early or premature menopause?

It’s important to get treatment for early or premature menopause. This is to protect your future health. For example, you’re more likely to get heart disease and have thinning bones (leading to osteoporosis) later in life.

After you receive a diagnosis, 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 may be better than the combined contraceptive pill at protecting your bone health and preventing 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 use contraception such as condoms if you don’t want to become pregnant.

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. You may need a higher dose for relief of symptoms with premature menopause than if you had menopause at a later age.

If you take HRT, you’ll need stay on it until you at least reach the natural age of menopause (51 years old in the UK). 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 want to stay on HRT.

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).

Managing early and premature symptoms

You might not be able to have hormonal treatments if you’ve had certain types of cancer. 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 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 avoiding it completely
• limiting alcohol
• giving up smoking if you smoke 

Your GP will also discuss how to protect your general health after the menopause. You’ll need to make sure to get enough calcium and vitamin D for good bone health as well getting enough exercise.

Getting support

Going through the menopause at any age can make you feel very down. Even more so if it happens earlier than you expected. It’s important to have the right emotional support in place.

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. There is also a charity called the Daisy Network. This is a support network for women diagnosed with premature ovarian insufficiency.