Early menopause: causes, signs, symptoms and treatment

early menopause
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The NHS describes early menopause as when periods stop before the age of 45, but for many women that’s just the tip of the iceberg, as they face a difficult, if not devastating, transition that can negatively affect their health and fertility.

Most women start the menopause between 45-55; their periods become less frequent and their ovaries stop releasing eggs, but early menopause does happen to others.

In the lead-up to this many women experience the perimenopause, when the ovaries start to produce less oestrogen and they begin to experience symptoms (opens in new tab). When a women has reached 12 months without periods, she has reached menopause. In the UK, the average age for this is 51 but some face theirs years, if not decades, earlier.

Even in our enlightened times, menopause and the accompanying symptoms are regarded as embarrassing and even taboo subjects. For women undergoing early menopause it can be even harder to find support and understanding.

Debra Waters spoke to two experts about what to expect from early menopause: Aly Dilks, Clinical Director at The Women's Health Clinic (opens in new tab); and Claire Hardy, a lecturer in Organisational Health and Wellbeing at the Faculty of Health and Medical at Lancaster University, and a spokeswoman for the medical research charity Wellbeing of Women (opens in new tab).

The difference between premature and early menopause

The NHS describes early menopause as one that occurs before the age of 45. This is the most common term used, although medically speaking if a woman is under 40 her menopause is described as premature, and if she’s between 40-45 it’s described as early.

‘Premature menopause – also called premature ovarian insufficiency (POI) or premature ovarian failure – is when the ovaries stop functioning in women younger than 40. It’s not common and estimated to affect only 1 per cent of women under that age,’ explains Aly Dilks.

Causes of early menopause

‘The most common genetic causes of premature ovarian insufficiency (POI) are X-chromosome abnormalities such as Turner syndrome or Down syndrome,’ says Dilks. If this doesn’t apply to you look to your mum, ‘Women whose mothers had an early menopause can be more susceptible.’

Read about three women’s experience of early menopause (opens in new tab)

‘It can also happen due to surgery, such as having your ovaries removed, or a hysterectomy. This may be referred to as surgical menopause,’ says Claire Hardy. ‘An early menopause can also occur because of cancer treatment that affects hormone levels – this is sometimes called chemically-induced menopause.’

Certain illnesses, such as epilepsy and autoimmune disease, can also trigger the process.

Symptoms of early menopause

Regardless of age, around eight out of 10 women experience menopausal symptoms. These include irregular – and other changes to – periods; hot flushes; night sweats; trouble sleeping; and mood swings. Vaginal dryness, painful sex and loss of desire are also symptoms and these, along with mood changes and depression, can cause relationship problems.

Jo Behari (opens in new tab), a DIY Professional and Writer, whose menopause began at 37, found that ‘the first sign was I started sweating at the gym when I worked out – I never sweat. I also had the craziest rages and emotions, one second crying uncontrollably and the next flying into fits of rage over nothing.’

How it's diagnosed

In terms of self-diagnosis, look out for ‘early signs that you’re moving into a menopausal transition, such as irregular periods, hot flushes and night sweats,’ advises Hardy. If you’re suffering from these, see your doctor.

‘NICE guidelines don’t recommend blood tests to diagnose menopause unless early menopause is suggested,’ says Dilks. So, if you’re under 45 your GP will ask you about your symptoms and family history then offer ‘blood tests to measure FSH (follicle stimulating hormone). Two tests, taken six weeks apart, are required to confirm diagnosis of early menopause.’

Your oestrogen levels and thyroid-stimulating hormone (TSH) may also be checked.

early menopause

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How early menopause is treated

‘Hormone Replacement Therapy (HRT) is recommended to reduce the risk of osteoporosis, for example. It's believed the risk of this increase if a woman goes through her menopausal transition early,’ says Hardy.

HRT is not always necessary for women experiencing their menopause within the usual age range. However, it’s usually required for younger women ‘who have different hormonal needs so higher doses of oestrogen are often required,’ says Dilks.

Although uncomfortable about taking HRT Behari was advised by her doctor that 'so long without oestrogen would be far worse than any side effects of HRT.’

Concerned about certain cancers, Charity Worker Maggie Magennis (opens in new tab), whose menopause began at 39, regrets saying no to HRT. ‘I now know that I should have had 10 years of HRT to give my body the 10 years of hormones it lacked because of my menopause. It’s a real shame as I now have osteopenia.' Osteopenia is loss of bone density that can lead to osteoporosis.

Going through the menopause can be difficult at the best of times but is especially problematic for younger women. They not only face potential issues with their fertility but also their health and looks.

Lisa Bain (opens in new tab), a Global HR Director who was diagnosed at 34, worries about ‘thinning skin and shifting weight – I lost my waist in my 30s, not my 50s, and sometimes I feel resentful that I have the body of an older person. I know it sounds vain but it’s part of who you are.’

‘Women require psychological support especially during diagnosis,’ says Dilks. Hardy agrees, suggesting that one way to manage it is with counselling or Cognitive Behavioural Therapy (CBT).

early menopause

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What women can expect

While associated with a decreased risk of breast cancer, unfortunately it’s also associated with ‘lower bone density so an increased risk of osteoporosis, an increased risk of cardiovascular [heart] disease, an increased risk of dementia and decreased life expectancy,’ explains Dilks, which is why ‘HRT is important until the natural age of the menopause (around 51) to protect against those risk factors.'

Many women believe that their days of conceiving are over but this isn’t always the case. It very much depends on the individual and their reasons.

Premature ovarian failure can be misleading because women with ovarian insufficiency don’t always stop menstruating. And the ovaries don’t always fail so pregnancy is still possible,’ says Dilks. Women should also be aware that HRT 'doesn’t provide contraception and pregnancy is still possible.’

Special advice and support for women going through early menopause

‘NICE suggests women who become menopausal at a young age should be referred to a menopause specialist,’ says Dilks. If your fertility has been affected they will be able to talk you through your options. These include IVF and egg donation, surrogacy and adoption.

There are many excellent support groups and charities to help women facing early menopause:

  • Earlymenopause.com (opens in new tab) is an online community providing a wealth of information
  • Healthtalk.org (opens in new tab) has a forum sharing people’s experiences and advice
  • For women with premature ovarian insufficiency (POI) the Daisy Network (opens in new tab) is a nationwide charity that offers support and guidance
  • My Menopause Doctor (opens in new tab) is a useful site full of relevant information
  • Hot Flush (opens in new tab), an online magazine that brings 'colour and positivity to the menopause', has articles on early menopause
  • On Facebook try the Early Menopause and Perimenopause Support (opens in new tab) group.

If you’ve been diagnosed and would like to get away from it all there are tailored wellbeing retreats available. The next menoheaven retreat (opens in new tab) – which incorporates nutrition, yoga, massage, herbalism and naturopathic medicine – is from 2-4 October in Sussex, while &breathe (opens in new tab) offers its first menopause retreat in September 2019.

Founder Clio Wood advises these are for ‘women looking for specific health and fitness advice. Plus help and guidance for this life transition, which can throw a hormonal spanner in the works.’

Debra Waters
Freelance Lifestyle Writer

Debra Waters is an experienced online editor and lifestyle writer with a focus on health, wellbeing, beauty, food and parenting. She currently writes for Goodto and Woman&Home, and print publications Woman, Woman’s Own and Woman’s Weekly. Previously, Debra was digital food editor at delicious magazine and MSN. She’s written for M&S Food, Great British Chefs, loveFOOD, What to Expect, Everyday Health and Time Out, and has had articles published in The Telegraph and The Big Issue.