What is early menopause?

When we talk about early menopause, we're referring to a woman's menstrual cycle coming to an end between the ages of 40 and 45. If this happens before the age of 40, it falls under the category of primary ovarian insufficiency (POI). The latter condition is not as rare as one might think, affecting about 3.5% of the female population. Whatever the case, it's important to note that the physiological changes associated with menopause can begin several years before menstruation stops entirely, so it's beneficial for women to be vigilant about the early signs. 

Exploring the causes of early menopause

The causes of early menopause can be multifaceted. In a significant number of cases, up to 90%, the exact cause may not be determined. However, there's a clear genetic link; if your mother or sister went through early menopause, the chances are higher that you might, too. Other causes include:

• Surgical menopause which is induced by the removal of the ovaries or uterus. Its effects can be more pronounced as they occur suddenly rather than gradually over several years.
• Treatments for cancer, such as chemotherapy and radiation therapy, which can affect ovarian function and cause early menopause. 
• Autoimmune diseases, where the body's immune system mistakenly attacks itself, impacting reproductive organs. 
• Ethnic background, with some studies indicating that early menopause is more prevalent among women of colour, particularly those of Asian descent.

Recognising the symptoms of early menopause

The symptoms of early menopause are mainly consistent with those experienced during natural menopause and can include: 

• Disruptions in sleep patterns, often due to night sweats. 
• An increase in weight, particularly around the midsection, which is a common complaint. 
• A general sense of fatigue, which can be a direct result of poor sleep quality. 
• Hot flushes and night sweats, which are sudden and intense feelings of heat that can be uncomfortable and disruptive. 
• Joint discomfort, as the hormone oestrogen, which plays a role in reducing inflammation and maintaining joint lubrication, declines. 
• Cognitive difficulties, often referred to as "brain fog," which encompass a range of symptoms from forgetfulness to trouble concentrating. 
• Emotional fluctuations, including increased stress, anxiety, and feelings of depression. 
• A reduction in sexual desire, which can be attributed to hormonal changes and the physical symptoms of menopause. 
• Changes in menstrual patterns, which are often the first noticeable sign of the transition into menopause. 

Diagnosis

If you're below 45 and experiencing menopausal symptoms, your GP may suggest blood tests to measure the level of follicle-stimulating hormone (FSH), which tends to increase as menopause approaches. By assessing your FSH levels, your GP can determine whether your symptoms are likely related to menopause. This test is usually repeated after four to six weeks and may be followed by other tests to determine whether your symptoms are probably related to menopause.  

Can early menopause be treated?

While early menopause cannot be reversed, its symptoms can be managed, the exception being if you wish to expand your family, in which case a specialist's assistance may be required.

Treatment often involves hormone replacement therapy (HRT) or the use of contraceptive pills to balance hormones and alleviate symptoms. These treatments also serve to reduce the risk of long-term health issues associated with early menopause, such as osteoporosis and cardiovascular disease. 

The health risks of early menopause

Early or premature menopause is more than just an earlier end to menstruation. It can, in fact, have significant implications for your long-term health:

Osteoporosis:  a condition characterised by brittle and thinning bones, which makes them more susceptible to fractures. Oestrogen plays a critical role in maintaining bone density, and its reduced levels during early menopause can lead to an increased risk of osteoporosis. For this reason, your GP may refer you to a DEXA scan to measure the strength of your bones and assess the risk of fractures.

Heart disease: oestrogen also contributes to cardiovascular health by regulating blood pressure and cholesterol levels and by preventing the accumulation of arterial plaques. With the onset of early menopause, the decrease in oestrogen can increase the risk of heart disease.

Fertility problems: early menopause can impact fertility, presenting challenges for those who wish to conceive. Fertility specialists can offer guidance and treatment options, such as in vitro fertilisation (IVF). For those who have planned ahead, the use of stored eggs may be a viable option.

Breast cancer risk: concerns about the relationship between early menopause, hormone replacement therapy (HRT), and breast cancer are quite common. However, research indicates that early menopause may be associated with a lower risk of breast cancer, and this risk may decrease further by maintaining a healthy weight.

Living with early menopause

The psychological impact of early menopause should not be underestimated. It can be particularly distressing for women who have not had the opportunity to have children or who have different plans for their reproductive years. 

Studies have shown that women who enter menopause before the age of 40 often experience heightened levels of depression and stress, along with a decrease in self-esteem and overall life satisfaction, compared to those who transition into menopause in their early 50s. These emotional challenges are compounded by the common symptoms of menopause, which include mood fluctuations, anxiety, and stress, potentially exacerbating feelings of distress.

Given these challenges, getting the appropriate care and support is critical. Building a supportive network that includes friends, family, and health care professionals can help during this period.

In addition, reading about other women's experiences of early menopause can provide comfort and a sense of community. Beyond emotional support, it's important to prioritise self-care. A balanced diet, adequate sleep, regular physical activity, and effective stress management techniques can all contribute to better mood regulation and symptom management during this time.

Lifestyle habits for managing symptoms