Premature and Early Menopause
What are premature menopause, early menopause and primary ovarian insufficiency?
Premature menopause and early menopause are conditions where a woman goes through menopause at an earlier age than is typically expected. Both conditions can result in women being unable to become pregnant. If there is no obvious medical or surgical cause for the premature menopause, this is called primary ovarian insufficiency (POI). Primary ovarian insufficiency is also referred to as premature ovarian insufficiency.
The name premature ovarian failure (POF) is no longer used because women who are told they have early menopause can have intermittent ovulation, menstrual bleeding or even pregnancy after being told they have ovarian “failure.”
What is menopause?
Menopause is a stage in a woman’s life when menstruation (periods) ends. Natural menopause typically happens when a woman is in her early 50s. This is a normal part of the aging process and means that a woman can no longer become pregnant. There are three stages to natural menopause:
- Perimenopause: This is a transition phase where the ovaries start to make less hormones, causing fluctuating levels of estrogen and progesterone, as well as less testosterone. This stage stops when menopause begins. Menopausal symptoms tend to begin during this time and can often be the worst.
- Menopause: In this stage, a woman’s period stops. The ovaries no longer release eggs and estrogen levels become very low. Once a woman has not had periods for 12 straight months, she has gone through menopause. However, it is important to ensure that the lack of periods is not due to another reason (like abnormal thyroid function or the use of birth control pills).
- Postmenopause: This is the time after a woman has gone through menopause. The symptoms that happen during menopause, such as hot flashes, may start to fade away but could continue for a decade or longer in many women.
What age does a woman typically go through menopause?
Women typically go through natural menopause in their early 50s. The average age is between 51 to 52.
What is the difference between premature menopause and early menopause?
The difference between premature menopause and early menopause is when it happens. Premature menopause occurs before a woman is 40. Early menopause is when a woman undergoes menopause before age 45.
Many of the causes of premature menopause can also be causes of early menopause. The two types of menopause also share many of the same symptoms.
How common is premature menopause, early menopause and primary ovarian insufficiency?
Premature menopause happens to about 1% of women under age 40. Early menopause, occurring in women under age 45, is seen in about 5% of women.
Symptoms and Causes
What causes premature menopause?
Premature menopause can be caused by a medical condition or treatment or it may have no known cause (spontaneous). Possible factors that could cause premature menopause include:
- Having a surgery that removes the ovaries.
- Being a smoker.
- Having surgery to remove the uterus (hysterectomy).
- A side effect of chemotherapy or radiation.
- Having a family history of menopause at an early age.
- Having certain medical conditions, including:
- Having certain infections, including:
What are the symptoms of premature menopause, early menopause and premature ovarian insufficiency?
Women may start having irregular menstrual cycles for a few years prior to the last menstrual period. If your cycles are irregular, you should speak with your doctor to look into possible causes. The symptoms of premature and early menopause include many of the typical menopause symptoms. These can include:
- Hot flashes (sudden warmth that spreads over the body).
- Night sweats and/or cold flashes.
- Vaginal dryness; discomfort during sex.
- Urinary urgency (a pressing need to urinate more frequently).
- More urinary tract infections (or symptoms without an infection).
- Difficulty sleeping (insomnia).
- Emotional changes (irritability, mood swings, mild depression, worsening anxiety).
- Dry skin, dry eyes or dry mouth.
- Breast tenderness.
- Racing heart.
- Joint and muscle aches and pains.
- Changes in libido (sex drive).
- Difficulty concentrating, memory lapses (often temporary).
- Weight gain.
- Hair loss or thinning.
What are the risks of premature menopause and primary ovarian insufficiency?
Loss of estrogen at a younger age is associated with increased risks of various medical problems. These risks include:
Diagnosis and Tests
How is premature menopause, early menopause and primary ovarian insufficiency diagnosed?
If you begin to have symptoms of menopause before the age of 40, your healthcare provider will do several tests and ask questions to help diagnose premature or early menopause. These tests can include:
- Asking about the regularity of your menstrual periods.
- Discussing your family history of menopause at an early age.
- Testing your hormone levels (estrogen and gonadotrophin).
- Looking for other medical conditions that may be contributing to your symptoms.
Women who have not had a menstrual period for 12 straight months, and are not on any medication that could stop menstruation, may have gone through menopause.
Management and Treatment
How is premature menopause and primary ovarian insufficiency treated?
Management of the condition can vary depending on why menopause started earlier than normal. Given the health risks associated with early menopause, hormone replacement therapy (HRT) is routinely recommended to all women with premature menopause or primary ovarian insufficiency, unless there is a compelling reason it can’t be used. There is a lot of confusion about the safety of hormone therapies. Many of the risks of hormone therapy used after natural menopause are not thought to apply to women who have premature menopause. It is important to discuss the pros and cons of hormone therapy with your doctor. Some healthcare providers have additional certification in the management of menopause, and these providers will be a valuable resource when receiving conflicting information about the safety of hormone therapy.
Outlook / Prognosis
Can I still get pregnant after being diagnosed with premature menopause, early menopause or primary/premature ovarian insufficiency?
Unless the ovaries have been surgically removed, it can be difficult to diagnose a woman younger than age 45 with “menopause” as opposed to primary ovarian insufficiency (POI). Women with POI can have intermittent ovulation, which may or may not be accompanied by a menstrual bleed. Other women may be able to get pregnant through in vitro fertilization with egg donation. It is important to work with a fertility specialist to explore options.
Options available to you will vary depending on whether you have interest in having children in the future. In some cases, fertility may be restored and pregnancy could be possible. Assisted reproductive technology (ART), including in vitro fertilization (IVF) might be considered.
If you do not want to get pregnant while on hormone-replacement therapy, your doctor will talk to you about contraceptive options.
Talk to your healthcare provider about possible causes of premature or early menopause and your questions regarding fertility.