The diagnosis of premature menopause (also known as Premature Ovarian Failure POF) and Early Menopause can be devastating especially for a woman who has not started or completed her family. On average your ovaries supply you with eggs until the age of 51/52, the average age of natural menopause, however, 1% of women worldwide go through a much earlier menopause than expected, occurring before the age of 40, whether natural or induced.
If your ovaries fail, they don’t produce normal amounts of estrogen or release eggs regularly, commonly resulting in infertility.
The cause of premature menopause is usually idiopathic, meaning that the cause cannot be found. It can also be due to genetics (primary), illness or medical procedures (secondary).
When no specific reason has been identified for a diagnosis of POF, the ovaries can begin to work again, an egg can be released and pregnancy is possible. Any women who does not wish to become pregnant should be advised to take contraception.
What is Premature Ovarian Failure (Primary)?
This is when periods never start due to the absence of ovaries, non functioning or poorly developed ovaries:- Chromosomal and/or genetic conditions such as Tuner Syndrome, Swyer Syndrome and Androgen Insensitivity Syndrome. Enzyme Defects: related to Galactosemia, Thalasemia and Hemos Cromatosis enzyme.
Abnormal Gonad (FSH and LH) secretion. Autoimmune Diseases: Hypothyroidism, Graves Disease, Lupus
What is Premature Ovarian Failure (Secondary)?
This is when ovary function has occurred but then stops due to medical procedures including:- Chemotherapy or pelvic radiation treatments for cancer. The younger a woman is, the lower the chances that she will experience menopause. (In treatments such as chemotherapy the ovaries can sometimes start working again, depending on many factors including the woman’s age, types of drugs administered and dosage.)(Chemotherapy for breast cancer in perimenopausal women may also lead to early menopause). Surgery to remove the ovaries. Surgical removal of both ovaries (bilateral oophorectomy) causes immediate menopause. A woman’s periods will stop after this surgery and her hormones drop quickly. (In the case of chemotherapy or removal of ovaries, symptoms can be particularly severe due to the sudden drop in estrogen levels.) Some women who have a hysterectomy to remove the uterus are able to keep their ovaries. They will not enter menopause immediately because their ovaries will continue to produce hormones. However, they will no longer have periods and cannot get pregnant.They may have hot flashes due to the surgery affecting the blood supply to the ovaries and may experience natural menopause a year or two earlier than expected. Tubal ligation (sterilization) may increase the chances of entering menopause at an earlier stage.
Infections – Tuberculosis and mumps
Stress – although stress can’t cause early menopause, it does play a large role in the severity and frequency of symptoms.
What is Primary Ovarian Insufficiency?
Primary Ovarian Insufficiency is the term used for women who may still conceive. Some women have ovaries that still make hormones from time to time and their menstrual periods return. Some women can even become pregnant after the diagnosis.
What is Early Menopause?
Menopause between 41 and 45 years is called early menopause.
Women who smoke have a higher rate of early menopause. Smoking and alcohol intake triggers hormonal imbalances in the body leading to early menopause.
What are the Symptoms of Premature and Early Menopause?
- The symptoms are the same as those experienced by women going through natural menopause
- Irregular or missed periods
- Periods that are heavier, lighter, longer, shorter
- Hot flushes
- Vaginal Dryness
- Bladder issues
For a comprehensive list and information about the 34 symptoms of menopause, see the symptom checker.
How is Premature Menopause Diagnosed?
Consult your healthcare professional if you have unsuccessfully tried to become pregnant for more than a year or if your mother or sister experienced premature menopause.
Your healthcare professional will most probably take a full medical history, discuss any symptoms you may be experiencing, perform a physical examination and carry out a blood test to rule out other conditions such as pregnancy or thyroid disease.
A test to measure your estradiol (a form of estrogen) levels may be taken. Low levels of estradiol is an indication that your ovaries are beginning to fail. When estradiol levels are below 30 it may indicate that you are in menopause.
The most widely used test used to make a diagnosis is a blood test which measures follicle stimulating hormone (FSH). FSH causes ovaries to produce estrogen. When your ovaries slow down their production of estrogen your levels of FSH increase. When your FSH levels rise above 40 mIU/ml, this usually indicates that you are in menopause.
Hormone Replacement Therapy
Women with premature menopause have a long postmenopausal life, therefore, restoring estrogen levels helps to prevent the early onset of health complications such as osteoporosis and cardiovascular disease.
Women with POF are commonly advised to take HRT until the average age of menopause, whether or not they are experiencing menopausal symptoms. Concerns about the risk of HRT should not pertain to women with POF since they are replacing hormones which would normally be produced at this stage of their lives.
If premature ovarian failure has happened to you and you wish to become pregnant your healthcare professional will be able to refer you to a specialist unit for advice, support and consideration of fertility treatment involving egg donation.
The risk of infertility and other health complications combined with fear of growing old before their time and self esteem issues may cause depression or anxiety in some women.
Recommended Lifestyle Changes
Manage your stress – self relaxation techniques such as yoga, meditation, visualisation, aromatherapy may help.
Maintain an open dialogue with partner, family and friends.
Speak to women with similar experiences.
Calcium intake is recommended to support bone health.
Increase vitamin B intake.
Eat a balanced diet rich in vitamins. Take a high quality multivitamin to support this.
Exercise regularly and maintain a healthy body weight.
Reduce alcohol and smoking intake as these are symptom triggers.
You can find more information, help and support at the Daisy Network Premature Menopause Support Group.
Premature Menopause. Retrieved from http://www.thebms.org.uk/factdetail.php?id=1
What is Premature Menopause? Retrieved from http://www.daisynetwork.org.uk/what-is-premature-menopause.htm
Premature Ovarian Failure. Retrieved from http://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/basics/definition/con-20028351