Early menopause is defined as when you go through menopause earlier than is typical.
It is something that can happen naturally or as a side effect of medical treatment but going through it earlier than your contemporaries can, potentially, be really difficult both physically and emotionally, and it can seem like the feelings of younger women experiencing it have been largely overlooked.
Understanding why you’ve entered menopause early, what you can do about it and how you can access the support you need should help you to feel more in control and reassured that you are not the only one it is happening to.
What is considered early menopause?
If your menopause starts between the ages of 40-45 it is classified as early menopause.[1]
If you start yours before the age of 40 this is typically known as Primary Ovarian Insufficiency (POI) – POI accounts that approximately 3.5% of women will go through menopause under the age of 40.[2]
The physiological changes involved in an early menopause can start up to seven years before your periods actually stop so be mindful that these can kick in for women who go through early menopause.
What causes menopause to start early?
In up to 90% of cases no known cause can be found[3] – although it has been shown that hereditary factors can influence menopausal age. That means if your mum experienced a natural early menopause your chances of experiencing the same will be higher. to be hereditary, so runs in families. That means if your mum experienced a natural early menopause your chances of experiencing the same will be higher.
Dr Rebeccah Tomlinson, a GP, with a special interest in menopause, points to other known causes including:
- Surgical menopause which happens after having your ovaries or womb or uterus surgically removed. The effects of surgical menopause are similar to those of natural menopause but they can potentially be more acute as they happen abruptly rather than building up gradually over several years.
- Some cancer treatments, including chemotherapy and radiotherapy, can affect the way the ovaries work causing an early menopause for some women.
- Autoimmune disease. These types of conditions are characterised by your immune system attacking itself. Examples include type 1 diabetes and thyroid conditions.
- Ethnicity. Early and premature menopause tend to be more common in non-Caucasian women – up to 8% of women from an Indian background will present with POI.
What are the symptoms of early menopause?
Symptoms will typically be the same as for any woman going through menopause including:
- Sleep problems – these are often linked to night sweats which can make women anxious about falling asleep and can cause you to awaken unexpectedly making it difficult to fall back to sleep. Research suggests that often women wake just before a flush occurs triggered by a rush of adrenaline.[4] Anecdotally, many women also describe having bad nightmares and ultra-vivid or disturbing dreams as they transition into menopause.
- Weight gain – it is estimated that women put on around 5lbs during the time of the menopause.[5] There is no conclusive proof that menopause in itself causes this (and it is often put down to ageing and lifestyle factors). But we do know that the hormonal changes at this time can lead to fat being distributed differently around the body with many women starting to put it on around their belly.
- Low energy – often the result of having your sleep disrupted by night sweats which can leave you feeling physically and mentally drained but also compounded by the psychological symptoms of menopause including low mood, anxiety and fearfulness.
- Hot flushes and night sweats – these sensations of extreme heat spreading throughout the body are often accompanied by sweating that can be so severe you might have to change your clothes or bedding. Hot flushes and night sweats can also be accompanied by palpitations which, although generally harmless, can be frightening.
- Joint aches and pains – the hormone oestrogen is known to help regulate inflammation in the body and also keep your joints lubricated. When levels of it start to diminish during menopause this can commonly lead to joint aches and pains.[6]
- Brain fog – this is an umbrella term for a range of cognitive symptoms that can occur during menopause including forgetfulness, feeling mentally confused. the inability to concentrate and a feeling like your brain is like ‘cotton wool’. Disrupted sleep only exacerbates these symptoms.
- Stress and anxiety – feelings of anxiety, tension, fearfulness and possibly depression are common during menopause triggered by fluctuations in the hormones oestrogen and progesterone.[7]
- Low mood – levels of the ‘feel-good’ hormone serotonin can be affected by declining levels of oestrogen during menopause. Add to this, regularly having your sleep disrupted, and this can lead to feelings of ‘flatness’ and an inability to enjoy things you used to.
- Loss of libido – decreased hormone levels can cause vaginal dryness, making sex painful. Experiencing symptoms like weight gain, fatigue, stress and hot flushes can also, and understandably, reduce your interest in sex.
- Irregular periods that then stop – these are characteristic symptoms of perimenopause when your periods can become increasingly heavier and more frequent, lighter and more far apart or a combination of these.
Is there a test for early menopause?
If you are under 45 and seem to be experiencing menopausal symptoms, your GP is likely to suggest a blood test to measure the level of follicle stimulating hormone (FSH) in the blood.
This hormone generally increases as you approach menopause and by measuring your blood levels of it your doctor can ascertain whether your symptoms are most likely menopause-related or not. This test is generally repeated four to six weeks later. Dr Tomlinson adds, ‘There may also be other tests needed such as genetic testing, routine blood tests and scans to determine the actual underlying cause for the change in your menstrual cycles.’
Can you treat early menopause?
‘You cannot “delay” or reverse an early menopause’, explains Dr Tomlinson, ‘you can just manage the symptoms that come along with it. The only caveat would be if you are still wishing to add to your family and if that is the case you would need to be referred to a specialist to help aid conception.’
Treatment is usually straightforward she says: “prescribing the combined contraceptive pill for younger women or HRT to ensure there is enough oestrogen to replace what is being lost physiologically during menopause.
HRT may also be set at much higher levels for women going through early menopause and testosterone is often also recommended if HRT or combination contraception does not alleviate all their symptoms. It is then recommended that you stay on your prescribed treatment until the age of 55, although many more women stay on HRT for much longer.”
The health risks of early menopause.
Early and premature menopause increases your risk of:
- Osteoporosis (brittle and thinning bones): This is because oestrogen helps protect your bones and stops bone density from falling – putting you at an increased risk of the condition. For this reason, your GP might refer you for a DEXA scan, which measures bone density (basically, the strength of your bones).
- Heart disease: Oestrogen has been shown to play a supportive role in blood pressure, cholesterol levels and reducing build-up of cholesterol plaques which form when cholesterol lodges in the coronary arteries.
- Fertility problems: Permanent or fluctuating ovary cessation can have a real impact on fertility, and this can be devastating if you want a baby or wish to add to your family. In these cases, you may be referred to a specialist who can provide treatment options. It might still be possible for you to conceive using IVF and donated eggs (or your own if you have had them stored).
- Breast cancer: Many women are concerned that going through menopause early, and taking HRT to alleviate symptoms, can lead to an increased risk of breast cancer. However, research appears to show the risk is actually reduced for women going through an earlier menopause. Those risks appear to be slashed even more if you maintain a healthy weight.[8]
How to cope with early menopause
The emotional fallout after being diagnosed with early menopause can be traumatic and devastating for some, especially if you haven’t started a family or completed it. It can leave you with feelings of loss, grief, and overwhelming sadness.
Research shows women who go through menopause before the age of 40 report higher levels of depression and stress and lower levels of self-esteem and life satisfaction than women who go through menopause in their early 50s.[9],[10]
Plus, when typical symptoms of menopause include mood swings, anxiety, increased stress and issues with self-esteem this can lead to a double whammy of despair.
This is why it is so important to get the care and support you need and ideally create a network of friends, family and health professionals to help you through it.
Psychologist Dr Deborah Lancastle provides general advice on coping with your emotions during menopause but it can also help to get in touch with a specialist organisations like the charity The Daisy Network[11] which provides specific help for women going through early menopause.
Reading about other women’s experiences of it can be a comfort. It is also hugely important to make time to generally look after yourself by eating well, getting enough sleep, exercising regularly and finding ways to manage stress and anxiety as this will help you manage your mood and symptoms generally.
Lifestyle habits to help with symptoms
- Get enough vitamin D – As early menopause puts you at an increased risk of osteoporosis it is important to get enough of this vitamin to support calcium absorption and healthy bone density.[12] There is also research linking low levels of vitamin D with an increased risk of depression and low mood making it a crucial nutrient on many levels. Vitamin D is produced naturally on exposure to UV light but us sun-starved Brits are probably not making enough of it for around six months of the year (which is why the government guidance is that we should all be taking a 10mg supplement from October to March).[13] There are some food sources including oily fish like salmon and mackerel, egg yolks, liver and fortified foods but you might not be able to get enough from food alone, so taking a supplement can help with any shortfall and when sunshine is in short supply.
- Exercise – Regular weight-bearing exercise like walking, weight training, dancing, aerobics and swimming will not only help to keep your weight in check it will also help to strengthen your muscles and bones, relieve joint pain and reduce your risk of bone fractures. Regular exercise is also a well-documented way to help reduce stress, anxiety and depression[14] and should go some way towards reducing your risk of cardiovascular disease. (You can find more advice on the best exercise for menopause here).
- A menopause-friendly diet and lifestyle – To generally help improve your health and minimise your risk of heart disease and bone and joint problems eat a healthy balanced diet (for practical advice on how read How to eat for a happier, healthier menopause), keep physically active, limit how much alcohol you drink, if you smoke cut down or ideally stop and get your blood pressure checked regularly. Doing all this should help to mitigate against some of the potential risk factors posed by going through an early menopause.
Sources & resources
[1] https://www.nhs.uk/conditions/early-menopause/
[2] https://www.nhs.uk/conditions/early-menopause/
[3] https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/early-and-premature-menopause
[4] https://www.sleephealthfoundation.org.au/pdfs/Menopause.pdf
[5] https://joinzoe.com/learn/menopause-weight-gain
[6] https://patient.info/news-and-features/how-to-ease-joint-pain-during-the-menopause
[7] https://health.clevelandclinic.org/is-menopause-causing-your-mood-swings-depression-or-anxiety/
[8] https://pubmed.ncbi.nlm.nih.gov/10517172/
[9] https://pubmed.ncbi.nlm.nih.gov/11076338/
[10] https://www.kjfp.or.kr/journal/view.html?uid=689&vmd=Full
[11] https://www.daisynetwork.org/
[12] https://theros.org.uk/information-and-support/bone-health/vitamin-d-for-bones/
[13] https://www.gov.uk/government/publications/vitamin-d-for-vulnerable-groups/vitamin-d-and-clinically-extremely-vulnerable-cev-guidance
[14] https://adaa.org/living-with-anxiety/managing-anxiety/exercise-stress-and-anxiety
Further resources
The Daisy Network (daisynetwork.org) is a charity that offers support to women facing an early menopause.
Healthtalk.org is an organisation which provides health information including about early menopause and features women talking about how it has affected them and experts talking about the condition.
Fertility friends is a support network for women with fertility problems.
