What is early menopause and how can it affect fertility?

What is early menopause?

The word menopause means the final period, and you have been through the menopause when you haven’t had a period for twelve months. Females are born with all the eggs they are ever going to have in their ovaries (in an immature state) and essentially, when you run out of eggs, the menstrual cycle and therefore the periods stopped.

The average age for the menopause is often quoted as 51, but this is the average age in Caucasian women. Research has shown that African American and Hispanic women go through the menopause approximately 9 months earlier, and globally the average age is even younger.

An early menopause is defined as a menopause under the age of 45, and occurs in approximately 1 in 20 people. A premature menopause, premature ovarian insufficiency is one under the age of 40, which affects 1 in 100 people. It can and does occur at younger ages, though becomes less common the younger you are, affecting 1 in 1000 people under the age of 30 and 1 in 10,000 people under the age of 20.

What is the difference between early menopause and perimenopause?

An early or premature menopause is one where the last period occurs before a certain age. The perimenopause is a period of years in the lead up to the final period, where you may have regular or irregular periods, and may have symptoms due to fluctuating and decreasing levels of hormones during this time. Importantly, you can have treatment for your symptoms, whether or not you are still having periods!

What are the main symptoms of early menopause?

The symptoms of the perimenopause and menopause do not differ depending on the age at which they happen. The symptoms are due to changing levels in hormones oestrogen, progesterone and testosterone which affect all areas of the body. However, symptoms can be more severe if you have a premature menopause, particularly if you have a surgical menopause, where the ovaries are removed during surgery (perhaps due to cancer). The symptoms can be more severe in this case and start very suddenly, as essentially the day before the surgery your ovaries may be working and producing hormones and the next day not, so instead of a gradual decline in levels of oestrogen the hormone levels suddenly plummet.

Physical symptoms include hot flushes and sweats, changes to your periods, headaches, joint aches and pains and more, while psychological symptoms include worsening PMS, irritability, anxiety, low mood and depression. Some symptoms can be both physical and psychological including insomnia, fatigue and loss of libido. There can also be other changes such as weight gain and changes to your skin and hair.

Not all people will have symptoms related to the perimenopause and menopause. Approximately 1 in 4 or 5 women will not have, or have very few symptoms, while approximately half will have moderate symptoms and about a quarter will have severe symptoms.

Why do some women experience a premature menopause?

The cause of premature menopause, or premature ovarian insufficiency (POI) is often not known. In fact, somewhere between 70-90% of cases do not have a known cause. It is thought that there is likely to be a genetic component to POI as about 3 in 10 women with POI have a family history of the condition. It is also associated with autoimmune conditions, which are conditions where the body’s immune system incorrectly attacks itself, for example type 1 diabetes and thyroid disease, and it may be that the immune system incorrectly focuses on the ovaries. Some infections such as TB and mumps are associated with POI, as are some health conditions such as epilepsy.

Medical interventions can also cause POI, for example surgery to remove the ovaries, perhaps due to severe endometriosis or cancer. Treatments such as radiotherapy can also cause POI as can medications such as chemotherapy.

Is there anything lifestyle-related you can do to delay menopause?

It is important to remember that the cause of POI is often not known, however there are some lifestyle factors which may affect the timing of the menopause in general.

Smoking is associated with a slightly earlier menopause, about 18 months earlier than average, though this depends on how much you smoke. Smoking affects the blood vessels of the body, contributing to the fatty plaques that can build up in them affecting blood supply, including blood supply to the arteries.

It may also be that diet plays a part, though lots more research is required into this area. There is some evidence that eating oily fish and legumes is associated with a slightly later menopause (about three years later) and eating white rice and pasta a slightly earlier one – but this study did not show that one caused the other, merely that they are associated. Even if it doesn’t affect the timing of the menopause, eating a healthy diet has lots of known health benefits!

How does premature menopause affect fertility?

POI can lead to infertility and if you have been diagnosed as having POI and are trying to conceive you should ask to be referred to a specialist. If there are no more immature follicles then no more eggs can be produced. It may be that there are follicles but the ovaries have stopped working, and this may not always be permanent. It is known that pregnancy occurs in about 1 in 10-20 women after being diagnosed with POI, and often in the first year of the diagnosis. For example, if you have been diagnosed with POI due to chemotherapy, it may be that the ovaries recover and start working again after a period of time.

It is complicated and can add to the mental health burden of being diagnosed with POI. On the one hand you are told you have been through a premature menopause and there may be fertility issues, but on the other you are still often told that the ovaries may start working again sporadically (if they haven’t been removed) so there is a risk of pregnancy unless you use contraception.

If you are concerned that you may be in perimenopause and are trying to conceive then please discuss with your doctor, whatever your age.

Are there any ways to find out if you’re likely to experience early menopause?

Although POI does run in families, it doesn’t always mean that it will happen to you and currently there isn’t a test to predict when the menopause will happen to you. What your family history does is give you information, so that if you start to develop symptoms of the perimenopause, perhaps in your 30s, that you are able to tell your doctor that POI runs in your family.

If your periods stop for over six months after they had started (and you aren’t pregnant), please see your doctor. Although blood tests aren’t used to diagnose perimenopause and menopause in women over the age of 45, blood tests are important in POI. Here two separate blood tests are taken six weeks apart to check the levels of follicle stimulating hormone (FSH) from the brain, which would be high in POI. Other blood tests are also taken to rule out other causes for your symptoms.

What are the treatments for POI?

If you are able to take it, then HRT is recommended for people with POI and early menopause until at least the age of the average menopause. HRT here replaces the hormones which would otherwise naturally be there in the body at that age, protecting against heart disease and osteoporosis. Or you may be offered the combined oral contraceptive pill/patch/ring, which are then given without a pill free break. Both of these options protect the heart and bones as well as controlling your symptoms.

If you can’t take HRT, perhaps if you have had breast cancer, or the combined oral contraceptive pill is not suitable then there are other non hormonal prescribable options to help control your symptoms. These don’t have the same heart and bone protective effects, so you may be offered a bone density scan to assess your bone health.

What support is there on the NHS for women experiencing premature menopause?

There is medical support and advice, not just to diagnose POI but also to treat it on the NHS. The Daisy Network is the UK POI charity which offers support, information and advice.

Pics: Getty Images

About our expert GP Philippa Kaye

Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. 

Dr Philippa has also written a number of books, including The Science of Menopause: Understand Your Body, Make the Right Choices. She is a mum of 3.