Early and premature menopause

Menopause arrives on average at around 51. If periods stop before 45 it is called early menopause, and before 40, premature ovarian insufficiency. This is not simply a natural event arriving sooner: with the ovaries stopping early, the body spends decades without oestrogen, and that affects bones, blood vessels and the brain. The approach is therefore different from menopause at the usual age, and the essential point is not to leave the situation untreated.

Symptoms

• periods have become irregular or stopped;
• hot flushes and night sweats;
• disturbed sleep;
• mood swings, anxiety, low mood, irritability;
• vaginal dryness, discomfort during sex, reduced sex drive;
• needing to pass urine often, recurrent urinary infections;
• poorer concentration and memory;
• dry skin, thinning hair;
• joint pain;
• difficulty conceiving — often the reason a woman first attends.

Causes

In about half of women no cause is found. Known causes are:

• cancer treatment — chemotherapy, radiotherapy to the pelvis;
• surgery — removal of the ovaries and sometimes other operations on the uterus and ovaries;
• genetic causes — Turner syndrome, FMR1 premutation and others; this is why genetic testing is recommended in premature ovarian insufficiency;
• autoimmune conditions, often alongside thyroid or adrenal disease or type 1 diabetes;
• infections — rarely;
• smoking — brings menopause forward by one to two years;
• family history — if a mother or sister had early menopause.

When to see a doctor

• you are under 45 and your periods have become irregular or stopped for three months or more;
• you have developed hot flushes, night sweats or insomnia at a young age;
• you are unable to conceive;
• you have had ovarian surgery or cancer treatment;
• there is a family history of early menopause;
• you have vaginal dryness and discomfort;
• your mood has dropped — a common and underestimated part of this picture.

How it is diagnosed

The basis is blood FSH, measured twice 4–6 weeks apart, because a single value can mislead. Oestradiol, prolactin and thyroid function are also checked, and AMH where relevant. Pregnancy is always excluded.

Once premature ovarian insufficiency is confirmed, further tests follow: genetic testing (karyotype and FMR1 premutation), adrenal and thyroid antibodies, bone density scanning, lipid profile and blood pressure.

Why treatment is essential

This is the key difference from menopause at the usual age. Many years without oestrogen increase the risk of:

• osteoporosis and fractures;
• cardiovascular disease;
• decline in cognitive function;
• persistent mood disturbance;
• urogenital problems.

For this reason, in early and premature menopause hormone replacement therapy is not prescribed "if you would like it" but as standard, at least until the age of natural menopause, around 51. At this age the benefit clearly outweighs the risks, and the concerns discussed in relation to older women do not apply here in the same way.

Treatment

• hormone replacement therapy — oestrogen, with a progestogen mandatory if you still have a uterus, to protect the endometrium;
• combined oral contraceptives — an alternative for some women, particularly if contraception is also needed;
• local oestrogen for vaginal dryness and urinary symptoms; it acts locally and can be combined with systemic treatment;
• testosterone for persistently reduced sex drive, prescribed by a specialist;
• calcium and vitamin D and weight-bearing exercise;
• non-hormonal options for hot flushes where hormones are contraindicated;
• psychological support — a diagnosis like this at a young age is often hard to absorb, particularly where plans for children are affected;
• follow-up of blood pressure, lipids, bone density and thyroid function.

The question of pregnancy

Premature ovarian insufficiency does not always mean the complete absence of any chance: in some women ovarian function returns intermittently and spontaneous pregnancy is possible, though unlikely. If pregnancy is not wanted, contraception is therefore needed. If it is wanted, the main route is treatment with donor eggs, and it is worth discussing this with a fertility specialist early. Women facing cancer treatment should raise egg or ovarian tissue preservation beforehand.

What you can do

• do not smoke — it affects both bone and blood vessels;
• exercise regularly, including strength and impact work for bone;
• enough dietary calcium and vitamin D;
• limit alcohol;
• keep an eye on blood pressure, weight and lipids;
• use vaginal moisturisers and lubricants for dryness;
• sort out your sleep and have a plan for flushes — layered clothing and a cool bedroom;
• seek support: groups of women with the same experience genuinely help.

Common questions

Can it be reversed? Ovarian function cannot be restored. But the hormones can — and should — be replaced and the consequences prevented.

Aren't hormones risky? At a young age you are replacing what your body should be producing itself. That is a fundamentally different situation from prescribing hormones after 60.

How long should I take them? At least until 51; after that, a decision made with your doctor.

Can I get pregnant? Rarely, but it is possible. That is why contraception is needed if pregnancy is not wanted.

Online consultation

In an online consultation the doctor explains which tests are needed and why FSH is measured twice, interprets the results, discusses the replacement regimen and its duration, sets up monitoring of bone and cardiovascular health, and advises when it makes sense to see a fertility specialist.

This material is for information only and does not replace a medical consultation.