What Is Premature/ Early Menopause?

The terms premature menopause and early menopause seem to be interchangeable when you’re looking for information about it. I tried to find a clear distinction between the two but the lines remained a little blurred.

The general thinking seems to be:

• Premature menopause – when menopause happens before the age of 40 years old.
• Early menopause – when menopause happens between 40 – 45 years old.

It’s worth pointing out though that if menopause is a consequence or side effect of surgery or medical treatment then it’s considered as premature, no matter what your age is. 

As the terminology seems to overlap, and to make this article easier to read, I will use ‘premature/early menopause’ as the general term for the information that follows. 

What Causes Premature/ Early Menopause?

Natural causes can be passed on through the genes you inherit. For example, premature ovarian failure, also known as primary ovarian insufficiency, can run in families. This means that the ovaries stop making certain hormones, oestrogen in particular, at an earlier age. If you have any relatives that experienced menopause when they were between 20 years old and their early 30’s then hereditary factors could be the cause.

While the cause of premature ovarian failure is not always clear for each woman there are other things that may be possible causes. Some examples are:

• Chromosome abnormalities can cause premature/early menopause. Turner Syndrome for example, is a genetic disorder that only affects girls. The ovaries of girls with Turner Syndrome may not fully develop. This can lead to lack of periods and also infertility.
• Autoimmune diseases – where the immune system mistakes body tissue for an invader and starts attacking it. If the ovaries are in the line of fire they will be attacked, affecting or stopping their ability to function. This is more common for women who have thyroid problems or those with rheumatoid arthritis.
• Some medications can trigger premature/early menopause. Some antidepressants for example, and other similar medications can have this side effect
• Lifestyle factors can also play a part in premature ovarian failure. Poor diet, obesity and smoking are believed to be possible causes.

Cancer treatments such as Radiotherapy and Chemotherapy can cause premature ovarian failure. Sometimes this is only temporary but it can also be a permanent effect.

The risk associated with premature/early menopause will depend on your age and the type of treatment you are given.

Older women and young women past the age of puberty are more likely to be affected than prepubescent girls whose bodies can tolerate stronger treatment. 

There are different types of Chemotherapy and they may affect the ovaries in different ways. This can sometimes lead to permanent premature ovarian failure and, therefore, premature/early menopause.

The risk from Radiotherapy to the ovaries can depend upon where on your body the treatment is focused. If the Radiotherapy is around your pelvic area or around your brain the risk of premature ovarian failure and premature/early menopause will be higher.

Hysterectomy

Hysterectomy is a surgical procedure that can cause premature/early menopause. Although it does depend on exactly what is removed during the surgery. 

Sub-total or incomplete hysterectomy means that the womb is removed but one or both of the ovaries are left in place. The ovaries will continue to produce hormones but as the womb is no longer present there won’t be a monthly bleed. Even though the ovaries continue hormone production it’s possible that they will stop doing so after a few years. Depending on your age this could mean that you experience a premature/early menopause. As there is no monthly bleed it could be harder to tell that this is happening.

Total or complete hysterectomy involves the removal of the womb and both ovaries all at the same time. Women who have a total hysterectomy will enter menopause straight away or within a day or so of the surgery. Again, depending on your age it could mean your menopause is premature/early. 

Surgical causes for premature/early menopause can cause menopausal symptoms to start abruptly. They are likely to be more severe than those experienced by women going through a natural menopause. 

Causes That May Be Temporary

Cessation of periods accompanied by other menopausal symptoms can have other causes which may be only temporary. High levels of stress over a long period of time is one example. Stress can interrupt the monthly cycle. It can lead to missed or the cessation of periods and other symptoms associated with the menopause, such as sleep and memory problems and mood swings. 

Also women who stop taking the contraceptive pill after using it for many years may find their periods stop. It can take some time for the ovaries to resume their normal ovulation cycle while the body’s hormones are rebalancing.

There could be other reasons for temporary loss of periods Some medical conditions and medicines can have this side effect. See your doctor though if you are concerned about disruption to your monthly cycle or any accompanying symptoms. Your doctor will be able to give you help and advice and to find out the cause.
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What Are The Symptoms of Premature/ Early Menopause?

The symptoms of premature/early menopause can be the same or very similar to natural aging menopause symptoms. The important difference being the age at which you experience them. 

The main symptom will be the disruption to your monthly period. Your periods may become irregular, light, heavy or prolonged and you may also have spotting. It’s possible they might stop altogether without any reason.

Apart from disruption to your monthly bleed you may experience some of the more common perimenopause/menopause symptoms such as:

• Hot flushes
• Night sweats
• Concentration /memory problems
• Reduced sex drive (libido)
• Vaginal dryness/discomfort during sex
• Sleep problems
• Anxiety/low mood
• Feeling depressed about body changes and fertility issues

Take a look at my other articles (click the links above) for more information about perimenopause/menopause and it’s symptoms. There’s a lot of Tips and Tricks that I hope you will find helpful.
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How Is Premature/Early Menopause Diagnosed?

The symptoms of premature/early menopause can also be similar to other health problems and the effect of some medications and lifestyle issues. So it’s important to get a professional diagnosis from your doctor. Your doctor will be able to rule out or treat other causes.

If premature/early menopause is considered the most likely cause for your symptoms your doctor will be able to carry out further investigation. Your family history and blood tests to check your hormone levels are likely to be used in the diagnosis. There are other checks that can be carried out and your doctor may refer you to a specialist.

It’s important to get yourself checked whatever the cause of your symptoms. Women who have premature/early menopause are more likely to suffer from an increased risk of osteoporosis and cardiovascular disease. A diagnosis of premature/early menopause means you will be in a position to take steps to guard against related health issues.

What Are The Treatments For Premature/Early Menopause?

As far as I can tell from looking into this, the main treatments are the combined oral contraceptive pill and HRT (hormone replacement therapy). Both of these make up for the hormones that are missing. If you are prescribed either of these you are likely to be advised to take them for the long-term. Past the age of natural menopause. This should give you a lasting protection.

If you’ve had certain types of cancer the combined oral contraceptive pill and HRT may not be suitable for you. Hormonal treatment for women who’ve had certain types of breast cancer, for example, will not be prescribed hormonal treatments.

Your doctor or specialist will explain any other treatment options that will be beneficial for you. You will also be given information about any lifestyle changes that you can make to guard against premature/early menopause related health issues. This advice will help to keep you fit and healthy throughout your life.

Fertility

Fertility has to be the most sensitive issue when it comes to premature/early menopause. For women who planned to have a family, and find that it may no longer be possible by natural means, it can be extremely distressing to say the least.

If you decide you want a family there are options that can be considered. Adoption and surrogacy for example, and also IVF. Decisions such as these are a personal matter. However, professional advice and guidance is important, so is the love and emotional support of family and close friends.

In the UK there are several support groups out there. A lot of which are charities whose purpose is to give information, guidance and support to women and their partners. Ask your doctor or specialist for a recommendation. Have a look online, do a little research. I’m sure there must be similar organisations in other countries too that have the same aim. Wherever you live it’s worth taking a look.