Signs that you may be approaching early or premature menopause
Regardless of age, the transition into natural menopause can be challenging for anyone with ovaries. Defined as a woman’s final menstrual period, menopause is a natural process that marks the end of a woman’s reproductive age.
Most women reach menopause between 45 and 55 years of age, however many women reach menopause symptoms earlier than expected. This is called early menopause or premature menopause, and it affects up to 8% of women in Australia.
Because early or premature menopause affects only a small portion of the population, it’s not commonly discussed, making it even more challenging for those living through it. Yet, learning the symptoms of early menopause can provide benefit in knowing how to recognise the onset of this women’s health condition and seek treatment early if it ever happens to you.
What is early menopause and premature menopause?
Menopause is a natural occurrence that causes a woman’s ovaries to stop producing estrogen, leading to the cessation of fertility and menstruation. The average age of menopausal symptoms is 51 years, however for many women, menopause occurs a lot sooner. This is referred to as premature or early menopause.
When a woman’s final menstrual period occurs before she is 40 years of age, this is called premature menopause.
When a woman’s final menstrual period occurs between the age of 40 and 45 years, this is called early menopause.
Causes of early menopause and premature menopause
There are a number of known causes of premature or early menopause, but for up to 60% of women experiencing premature or early menopause, the cause unfortunately cannot be determined.
Primary ovarian insufficiency (POI)
Primary ovarian insufficiency, also referred to as premature ovarian failure (POF), is a condition that causes periods to stop spontaneously due to the ovaries stopping their normal function of releasing eggs and producing normal levels of certain hormones, specifically oestrogen.
Primary ovarian insufficiency affects up to 1% of women.
Menopause can be medically induced for specific reasons, such as cancer surgery. The early onset of menopause can also be triggered by common cancer treatments – chemotherapy and radiotherapy treatment – that cause the ovaries to stop working, ending menstruation and bringing on induced menopause.
Surgical removal of the ovaries can lead to the early onset of menopause symptoms.
Approximately 10-30% of women affected by early or premature menopause have an autoimmune disease, such as hypothyroidism, Crohn’s disease, systemic lupus erythematosus, or rheumatoid arthritis.
Up to 30% of affected women have a female relative who experienced early or premature menopause, which suggests a genetic link to premature or early menopause. Genetic health conditions that can lead to the early onset of menopause include:
Galactosaemia – a condition where the body cannot convert the carbohydrate galactose into glucose. It is thought that the unconverted galactose could be toxic to the ovaries.
Turner’s syndrome – a chromosomal abnormality
Fragile X premutation
Conditions characterised by enzyme problems, such as congenital adrenal hyperplasia.
Symptoms of early menopause and premature menopause
The symptoms of early menopause are the same as perimenopause. Women may have sporadic menstrual periods or irregular periods for a few years before menopause occurs, followed by typical menopause symptoms. This is also the case for early or premature menopause not induced by surgery or cancer treatment.
In 2005, during a state-of-the-science conference on menopausal symptoms, a worldwide panel of expert evaluators determined three symptoms of premature menopause based on a high level of evidence: vasomotor symptoms, vaginal dryness, and difficulty sleeping or insomnia. Following the conference, a fourth symptom of depression was added to the list of menopause symptoms.
Vasomotor symptoms are those that relate to the constriction or dilation of blood vessels. Vasomotor symptoms affect most women during the menopausal transition, with up to 85% of menopausal women experiencing hot flashes. The average duration of hot flashes is estimated to be about 5.2 years, however symptoms of a lesser severity may present for a longer timeframe.
The cause of hot flashes has not yet been determined, however the most reasonable theory suggests there to be a resetting and narrowing of the thermoregulatory system in association with fluctuations or loss of estrogen production. Another theory suggests hot flushes to result from changes in both oestradiol and follicle stimulating hormone (FHS) levels.
Sleep disturbances and insomnia
It’s common for sleep quality to deteriorate with ageing, and unfortunately premature menopause can add an additional layer of severity to this gradual process with many women reporting more trouble sleeping as they transition through menopause.
Disrupted sleeping patterns associated with early menopause are likely due to changing hormone levels.
Depression and anxiety
It’s common for women experiencing early menopause to feel a sudden feeling of mild depression, or even severe depression in some cases. Despite the likelihood of depression typically affecting women from a younger age, the onset of early menopause represents another period of vulnerability for women to fall into bouts of depression, anxiety, and mood swings.
Risk factors for the development of depression during early menopause include poor sleeping habits, negative life events, stress, employment issues, higher body mass index (BMI), younger age, and race. There is also evidence to suggest that hormonal changes during the menopausal transition also play a key role in the onset of depression, This is likely due to fluctuations in oestradiol levels, increasing FSH levels, hot flashes, surgical menopause, and a history of premenstrual syndrome (PMS).
There are many other symptoms reported by menopausal women, including mood swings, joint and muscle aches, changes in body contour, and increased skin wrinkling.
The emotional impact of early or premature menopause
During the menopausal transition, many women develop symptoms of depression and cognitive difficulties, which are linked to changes in hormone levels. Depression and cognitive decline can compound the burden of menopause.
Many younger women also find premature or early menopause distressing due to the impact it has on their fertility and quality of life.
Always consult with a fertility specialist at an early age if you are concerned about long term fertility and health risks associated with the early onset of menopause.
Other causes for premature and early menopause
Common health factors that may also cause premature and early menopause include:
Time of first menstrual bleed
A women who experiences her first menstrual cycle at a young age of 11 years old or younger is more likely to experience menopause earlier than expected.
Having a family history of early or premature menopause
Having a family history of premature or early menopause can increase the risk of premature and early menopause up to 12 times.
Women who smoke cigarettes are more likely to experience early menopause than non-smokers.
Women with the seizure disorder, epilepsy, are more likely to experience premature ovarian insufficiency, which can lead to early or premature menopause.
Having previous surgery on the ovaries (e.g. for endometriosis) can trigger early or premature menopause.
Through direct toxic effects on ovarian follicles, chemotherapy can cause the early onset of menopause. The suppression of ovarian function may be beneficial for the treatment of some cancers, such as breast cancer, however it carries an increased risk of causing adverse effects of fertility loss, osteoporosis, cardiovascular disease and menopause symptoms.
Diagnosis of premature or early menopause
There aren’t specific diagnostic tests to detect early menopause as the condition can normally be self-diagnosed based on symptoms, specifically the absence of menstrual bleeding for 12 months or more.
Blood tests aren’t a useful predictive tool, however a health practitioner may request hormone tests to determine whether any symptoms you’re showing are due to early menopause or another condition. The most common hormones to check include anti-Mullerian hormone (AMH), estrogen, follicle stimulating hormone (FSH), and thyroid stimulating hormone (TSH).
Always seek medical advice if you are worried about irregular periods, heavy bleeding, or menstrual symptoms that interfere with your daily life.
Treatment of early or premature menopause
Early and premature menopause don’t normally require treatment, however there are ways to manage symptoms and reduce severe symptoms of menopause. These include:
Hormone replacement therapy (HRT)
Menopausal hormone therapy (MHT) is a form of menopause treatment that replaces the hormones, oestrogen and progesterone (and sometimes testosterone) with the aim of relieving symptoms of early menopause.
It’s best to start on the lowest effective dose and adjust as needed under consultation from your doctor. Alternatively, your doctor may prescribe the oral contraceptive pill to reduce the symptoms and long-term health risks, such as cardiovascular disease.
If for whatever reason you are unable to take oral contraceptives or hormone treatment, your doctor may prescribe other medications, such as antidepressants, pain medication, or blood pressure medication for symptom management.
Other non-hormonal methods of managing symptoms of menopause include herbal remedies, plant-based oestrogens (e.g. found in soy products), hypnotherapy, cognitive behavioural treatment (CBT), mindfulness techniques, and acupuncture.
Over-the-counter lubricants and moisturisers
Moisturising products available from the pharmacy may be effective in relieving mild symptoms of vaginal dryness.
Whatever form of treatment is preferred, always seek advice from your trusted medical professional prior to commencement.
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Santoro, Nanette et al. “Menopausal Symptoms and Their Management.” Endocrinology and metabolism clinics of North America vol. 44,3 (2015): 497-515. doi:10.1016/j.ecl.2015.05.001
Freeman, Ellen W et al. “Symptoms associated with menopausal transition and reproductive hormones in midlife women.” Obstetrics and gynecology vol. 110,2 Pt 1 (2007): 230-40. doi:10.1097/01.AOG.0000270153.59102.40
“ACOG Practice Bulletin No. 141: management of menopausal symptoms.” Obstetrics and gynecology vol. 123,1 (2014): 202-216. doi:10.1097/01.AOG.0000441353.20693.78
Santoro, Nanette, and Janne Komi. “Prevalence and impact of vaginal symptoms among postmenopausal women.” The journal of sexual medicine vol. 6,8 (2009): 2133-42. doi:10.1111/j.1743-6109.2009.01335.x
Pastore, Lisa M et al. “Self-reported urogenital symptoms in postmenopausal women: Women’s Health Initiative.” Maturitas vol. 49,4 (2004): 292-303. doi:10.1016/j.maturitas.2004.06.019
Faubion, S S et al. “Long-term health consequences of premature or early menopause and considerations for management.” Climacteric : the journal of the International Menopause Society vol. 18,4 (2015): 483-91. doi:10.3109/13697137.2015.1020484
Hayatbakhsh, Mohammad R et al. “Cigarette smoking and age of menopause: a large prospective study.” Maturitas vol. 72,4 (2012): 346-52. doi:10.1016/j.maturitas.2012.05.004
Shuster, Lynne T et al. “Premature menopause or early menopause: long-term health consequences.” Maturitas vol. 65,2 (2010): 161-6. doi:10.1016/j.maturitas.2009.08.003
Oktem, Ozgur, and Kutluk Oktay. “Quantitative assessment of the impact of chemotherapy on ovarian follicle reserve and stromal function.” Cancer vol. 110,10 (2007): 2222-9. doi:10.1002/cncr.23071