Published on 23 June 2022
Premature ovarian insufficiency (POI) - also known as premature menopause - is defined as being menopause that happens before the age of 40. POI is estimated to affect 1% of women under the age of 40 years.
Early menopause is defined as menopause between the ages of 40 and 44.
What is premature or early menopause?
POI happens when ovaries stop making hormones and periods stop at a younger age than usual. This can happen naturally or for a medical reason, such as when both ovaries are removed in a hysterectomy. Early menopause can have the same causes.
Natural pregnancy becomes very unlikely, but is still possible in some cases. You may want to discuss your fertility options with a specialist.
What causes premature or early menopause?
Premature or early menopause can happen on its own for no clear reason, or it can happen because of certain surgeries, medicines, or health conditions.
Family history
Women with a family history of early menopause are more likely to experience it themselves.
Smoking
Women who smoke may reach menopause as much as two years before non-smokers. They may also get more severe early or premature menopause symptoms.
Chemotherapy or pelvic radiation treatments for cancer
These treatments can damage your ovaries and cause your periods to stop forever or just for a while. You also may have trouble getting pregnant or not be able to get pregnant again.
Not all women who have chemotherapy or radiation will go through menopause. Recovery from temporary ovarian failure can occur after some chemotherapy, especially at younger ages.
Surgery to remove the ovaries
Surgical removal of both ovaries, called a bilateral oophorectomy may cause menopausal symptoms right away. Your periods will stop after this surgery, and your hormone levels will drop quickly. You may have strong menopause symptoms, like hot flashes and issues with your sexual wellbeing.
Surgery to remove the uterus
Some women who have a hysterectomy, which removes the uterus, can keep their ovaries. If this happens, your periods will stop immediately but you won't enter menopause. However research suggests that natural menopause can occur one to five years earlier on average.
Certain health conditions
Autoimmune diseases, such as thyroid disease and rheumatoid arthritis
Although rare, the body’s immune system, which normally fights off diseases, may mistakenly attack the ovaries and keep them from making hormones.
HIV and AIDS
Women with HIV, whose infection is not well controlled with medicine, may experience early menopause - but this will depend on overall health and treatment status.
Missing chromosomes
Women born with missing chromosomes, or problems with chromosomes, can go through menopause early. For example, women with the condition called Turner’s syndrome are born without all or part of one X chromosome, so their ovaries do not form normally at birth and their menstrual cycles, including the time around menopause, may not be normal.
The Fragile X permutation (FMR1 carrier status) is also a recognised cause of POI.
Chronic fatigue syndrome
Women with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have extreme tiredness, weakness, muscle and joint pain, memory loss, headache, unrefreshing sleep, and other symptoms. Research has found that women with ME/CFS are more likely to have early or premature menopause
What are the signs of premature or early menopause?
You know you have gone through menopause when you have not had your period for 12 months in a row. If you think you may be reaching menopause early, talk to your doctor.
Your doctor will talk to you about the signs of early or premature menopause such as hot flashes, irregular periods, sleep problems, and vaginal dryness. They may give you a blood test to confirm. These tests measure oestrogen and related hormones, like follicle-stimulating hormone (FSH).
You may choose to get tested if you want to know whether you can still get pregnant. Your doctor will test your hormone levels in the first few days of your menstrual cycle (when bleeding begins).
What are the effects of early or premature menopause?
Women who go through early or premature menopause may have symptoms or health problems similar to those of regular menopause. But some women may also have:
Higher risk of serious health problems
Serious health issues, such as heart disease and osteoporosis, may be more likely since women will live longer without the health benefits of higher oestrogen levels.
Talk to your doctor or nurse about steps to lower your risk for these health problems.
Severe symptoms
Talk to your doctor about treatments to help with menopause symptoms if they affect your daily life.
Sadness or depression
You may feel sad at the early loss of fertility or the change in your body. Talk to your doctor if you have symptoms of depression, including less energy or a lack of interest in things you once enjoyed that lasts longer than a few weeks. Your doctor can recommend specialists who can help you deal with your feelings.
Your doctor can also discuss options, such as adoption or donor egg programs, if you want to have children.
Supporting your health at Benenden Hospital
It’s important not to suffer in silence during the menopause. We’re experts at treating women’s health concerns and offer a range of private gynaecology services, in a comfortable, discreet and reassuring environment in the heart of the Wealden countryside.
You can also book an Advanced female health assessment with Dr Fiona Warner, which includes comprehensive pathology biomarkers and is suitable for women that may be concerned with various stages of menopause and/or are 50 years old and over.
Contact our Private Patient team in confidence today via Livechat, by completing our online form or by calling 01580 363158.