What Causes Early Menopause
As mentioned previously, menopause before the age of 40 are considered to be in premature, or early, menopause. One medical causes of premature menopause is known as premature ovarian failure. Technically, premature ovarian failure is not the same as premature menopause. In premature ovarian failure, the ovaries stop functioning normally before the age of 40. Women with premature ovarian failure may still occasionally have menstrual periods, but they typically experience infertility. Premature ovarian failure is usually accompanied primary ovarian insufficiency. Premature ovarian failure is usually accompanied by the symptoms of premature menopause.
Premature menopause can also be caused by treatments for cancers or other conditions that involve chemotherapy and/or radiation therapy to the pelvis. These treatments can damage the ovaries and result in ovarian failure.
Surgery to remove the ovaries, either for benign or malignant conditions, results in premature menopause if both ovaries are removed. Surgery to remove the uterus results in menopause only in the sense that menstrual bleeding does not occur. In that case, the ovaries will continue to produce hormones.
Other infrequent causes that may lead to premature menopause include drugs, chronic diseases, pituitary and hypothalamic tumors, psychiatric disorders, and other relatively rare or undefined conditions.
The Signs Of Menopause
There are several signs that most people know and associate with the start of menopause, including missed, irregular, or completely non-existent periods, hot flashes, and night sweats. There are other symptoms, however, that affect your brain and cognitive ability as well as your mood, including:
- Trouble sleeping
- Feeling moody, depressed, or anxious for extended periods of time
- Increased forgetfulness and misplacing things
In general, these are nothing to be concerned about and are perfectly normal as your body is going through quite a significant transition. If the mood swings, insomnia, and brain fog is beginning to have a major impact on you and your ability to function effectively, however, should trigger some alarm bells.
What To Expect After A Diagnosis
If possible, find a supportive and sympathetic doctor to help you adjust to the diagnosis of early menopause. Your doctor will help to counsel you, prescribe appropriate treatments and refer you to relevant specialists when necessary. This is a specialist area and usually, at least initially, an endocrinologist or gynaecologist with expertise in early or premature menopause should assess and advise you.
Your doctor should see you regularly over the years to reassess your health needs, including reviewing your medications and to test routinely for potential risks associated with POI. Often it is necessary to have a team of health professionals monitor you through the years after you have been diagnosed.
You may need to seek out a specialist early-menopause clinic or individual practitioners, such as infertility specialists, endocrinologists , psychologists or psychiatrists for support.
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What Causes The Menopause
The menopause is caused by a change in the balance of the body’s sex hormones, which occurs as you get older.
It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month.
Premature or early menopause can occur at any age, and in many cases there’s no clear cause.
Sometimes it’s caused by a treatment such as surgery to remove the ovaries , some breast cancer treatments, chemotherapy or radiotherapy, or it can be brought on by an underlying condition, such as Down’s syndrome or Addison’s disease.
Page last reviewed: 29 August 2018 Next review due: 29 August 2021
Why Testing Is Important
Perhaps the most important aspect of testing has to do with what you do you with that information.
What I’m referring to is the treatment for menopause.
Knowing you are in menopause is only a small part of the battle.
The next most important step is what you decide to do as a result of that information.
As a woman, you will find that menopause hits certain women harder than others.
Some women can go through their life with a few hot flashes and maybe some minor weight gain while others can be completely incapacitated.
The decision to use treatment largely depends on you and how badly you are suffering from symptoms.
The good news is that there is a VERY effective treatment for menopause known as hormone replacement therapy or HRT.
The goal of HRT is NOT to give you more hormone than you need or to bring back your menstrual cycle or anything like that.
It’s simply to provide your body with the exact replica of youthful hormone that your body has been used to for decades to help reduce your symptoms and improve your quality of life.
HRT has been shown in many studies to completely reverse the symptoms associated with menopause in a matter of days.
Because menopause is the result of the DECLINE in these hormones, so it makes perfect sense that the treatment would be to provide your body back with these hormones.
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Symptoms Of Early Menopause
The main symptom of early menopause is periods becoming infrequent or stopping altogether without any other reason .
Some women may also get other typical menopausal symptoms, including:
Read more about the symptoms of the menopause.
Table : Nice Quality Standard For Menopauselist Of Quality Statements4
Women with premature ovarian insufficiency are offered HRT or a combined hormonal contraceptive.
Women having treatment for menopausal symptoms have a review 3 months after starting each treatment and then at least annually.
Women who are likely to go through menopause as a result of medical or surgical treatment are given information about menopause and fertility before they have their treatment.
FSH=follicle stimulating hormone HRT=hormone replacement therapy
National Institute for Health and Care Excellence. Menopause. Quality Standard 143. NICE, 2017. Available from: www.nice.org.uk/qs143
NICE has not checked the use of its content in this article to confirm that it accurately reflects the NICE publication from which it is taken
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Nice Guidance On Menopause
In November 2015, NICE Guideline 23 on Menopause: diagnosis and management was published, providing recommendations for healthcare professionals who care for women in menopause.1 NICE NG23 also includes a section with information for the public, which provides women with information about what to expect from a healthcare professional if they have menopausal symptoms.
NICE Quality Standard 143,4 published in February 2017, distils the key points from NICE NG23 into measurable statements that can be used to assess the quality of care provided and quantify potential improvements to clinical practice. The five quality statements that make up NICE QS143 are listed in Table 1 and discussed in detail below.
Is It Early Or Premature Menopause
Early menopause is menopause that begins between the ages of 40 and 45.
Premature menopause starts even earlier, before age 40. Many doctors now refer to premature menopause as premature ovarian failure or primary ovarian insufficiency. These terms reduce some of the stigma for younger women going through menopause.
Early menopause is relatively uncommon. Premature menopause is even less common, with only about
- change in diet or exercise
- response to a medication or contraceptive
The low estrogen levels associated with missed periods can lead to bone loss. Early treatment can help prevent bone damage.
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Psychological Wellbeing & Emotions
The diagnosis of a premature or early menopause can bring many changes and challenges: when menopause does not come at the age and stage of life you expected it to, it can have a major impact on your wellbeing. Women who experience premature or early menopause can be at greater risk of depression, anxiety and mood changes.
It can be very upsetting for some women to experience menopause in their 20s or 30s when they expected it to happen in their late 40s or 50s. Often this is a time of feelings of loss, sadness and grief. These feelings are very common, along with the feelings of losing your body image, fertility, femininity and sexuality, and feeling old before your time.
It can take some time to diagnose a premature or early menopause. Not knowing what is wrong, having no control over symptoms and not knowing what the future holds can be frightening. Some women with early menopause talk of ‘loss of womanhood’ and ‘loss of dreams’.
Associated illnesses, such as cancer and chemotherapy or surgery to remove ovaries, may also alter the course of your life. Plans, dreams and expectations must be re-thought and that can be very challenging and distressing.
During this time, women can experience a sense of loss of control, loss of ability to plan and loss of self-image, but often there is no one with whom to share the grief. Girlfriends might not understand because they are not yet experiencing menopause, and, for some, mothers haven’t yet reached menopause either.
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 . 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 , including in vitro fertilization 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.
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Responses To Loss Of Fertility
For some women, early or premature menopause can take away the possibility of becoming a mother. Some women have said, ‘I wasn’t sure if I even wanted children’, or, ‘I didn’t know if I wanted more children’, but when the power to make that decision is taken away, it can seem unfair. Early or premature menopause can mean the longed-for role of motherhood might not happen or, if it happens, it may not be in the way you anticipated. How this feels and the impact it has will depend on your individual circumstances, support networks and coping skills.
Some women with early or premature menopause feel they have to take on a role they did not expect until they were in their 50s that of a menopausal woman. They might even experience menopause before their mother.
Sometimes we have many roles, which we overlook when we focus strongly on wanting to fulfil one particular one. Some women forget they are also partners, daughters, sisters, friends, aunties, granddaughters, workers, neighbours, caregivers. Thinking about these other roles does not necessarily take away all the pain of loss, but it can help to shift the focus.
There are also other constructive ways to think about your role in life. For example, if you think your role is to be a mother, explore the steps you can take to achieve this perhaps donor eggs or adoption are options. It can be helpful to seek counselling to help you with your decision-making.
How Is Premature Menopause Diagnosed
To diagnose premature menopause, your doctor will most likely perform a physical exam and draw blood to rule out other conditions, such as pregnancy and thyroid disease. They may also order a test to measure your estradiol levels. Low levels of estradiol, a form of estrogen, can indicate that your ovaries are starting to fail. When estradiol levels are below 30, it may signal that you are in menopause.
However, the most important test used to diagnose premature menopause is a blood test that measures follicle stimulating hormone . FSH causes your 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, it usually indicates that you are in menopause.
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Tests For Early Or Premature Menopause
If early menopause signs have been detected, there are certain tests that can determine whether or not you are experiencing early menopause. Test for early menopause are generally easy and involve no risk.
Common Tests for Early Menopause
Pregnancy test. Ruling out pregnancy is an important first step, since women going through the menopause process can still become pregnant.
Thyroid disease test. Some of the menopause symptoms are similar to those caused by thyroid disease. That’s why, if they appear before 40, a thyroid disease test should be considered.
Thyroid disease test. Some of the menopause symptoms are similar to those caused by thyroid disease. That’s why, if they appear before 40, a thyroid disease test should be considered.
Estradiol level test. Estradiol is a form of estrogen. If estradiol levels are low, it might indicate that there is some trouble with ovaries. Some conditions related to low estradiol levels are early menopause, ovarian failure, and Turner Syndrome.
FSH test. Follicle stimulating hormone levels rise when there is a very low presence of estrogen in the body. Generally, when FSH levels are higher than estrogen levels, women are considered to be menopausal. However, since FSH levels vary during menstrual cycle, it is important to consider the help of a health practitioner when dealing with this test.
Emotional Impact Of Early Or Premature Menopause
Premature menopause can be emotionally devastating. Some of the common issues women may face include:
- grief at the prospect of not having children
- fear of ‘growing old before their time’
- concern that their partner wont find them sexually attractive anymore
- self-esteem problems.
Psychological counselling and support groups may help women come to terms with their experience of early or premature menopause.
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Information For Women Having Treatment Likely To Cause Menopausestatement 5
Certain medical or surgical treatments, such as cancer treatments and gynaecological surgery, can affect fertility and induce menopause.1,4 It is important that women who require treatment of this kind are provided with information about menopause and fertility before they have their treatment, as they may be younger than women experiencing natural menopause and therefore less likely to be aware of menopausal symptoms.
Left untreated, menopause symptoms can lead to long-term poor health outcomes and potential psychological trauma.6 Promoting awareness of menopausal symptoms increases the likelihood that women will access treatment and services as soon as they need them, and empowers women to make an informed choice about their ongoing hormonal status.
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Treatments To Relieve Signs And Symptoms
There is no treatment that can reverse or prevent premature menopause. However, women who have reached menopause do have treatment options that can help control unpleasant symptoms.
Types of treatments for symptom relief include:
- Hormone therapy: hormone therapy is available in different forms including pills, patches, transdermal sprays, or gels or creams. Localized hormone treatments are also available for intravaginal use. HT/ET is the most effective way to control symptoms like hot flashes and vaginal dryness. Because HT/ET has been associated with certain health risks , experts recommend using the lowest effective dose of hormone therapy for the shortest period of time necessary for symptom control.
- Oral contraceptive pills are a form of HT that is sometimes used to help relieve menopausal symptoms.
- Antidepressant medications: the selective serotonin reuptake inhibitors and related medications have been shown to be effective in controlling the symptoms of hot flashes in up to 60% of women.
- Non-hormonal vaginal gels, creams, and lubricants can help prevent the symptoms of vaginal dryness.
- Assisted reproductive technologies: in selected cases, pregnancy may be achieved using donor eggs in women with premature menopause.
Reviewing Treatments For Menopausal Symptomsstatement 4
Most women find that their menopausal symptoms respond well to treatment however, some women find that their symptoms do not improve or they experience unpleasant side-effects. A review should take place 3 months after starting each treatment, and annually thereafter unless there are clinical indications for an earlier review .1,4 This review mechanism gives the opportunity for referral to a specialist if necessary.1
In the authors opinion, it is important to assess the following factors at review:
- tolerability and treatment compliance
- suitability of the regimen
- change in medical or sexual history
- change in venous thromboembolic risk.
At annual review the importance of keeping up to date with national screening programmes should also be discussed.1
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Home Menopause Testing Kits: Are They Worth It
You may have heard about a kit you can use at home to see if you are in menopause. It tests urine for the presence of FSH, or follicle-stimulating hormone.
Fine, but here’s the first potential trap: Levels of FSH in the blood correlate poorly with menopausal symptoms. So, if a blood test that looks for FSH isn’t a reliable marker, neither is the urine test.
As disappointing and surprising as it may seem, many aspects of the menopause process remain a mystery to medical science. The medical definition of menopause is when menstrual periods stop for 12 months as a consequence of the ovaries shutting down. Menopause is not defined by a blood test, or a urine test, or any lab test for that matter.
Women might want to know if their symptoms are a result of menopause, so would FSH testing meet that need? Well, women can have terrible menopause symptoms and yet their FSH level may remain in the “premenopausal” range. Conversely, women without symptoms such as hot flashes may have an FSH level in the “menopausal range.”
For all of these reasons, FSH testing is not suited as a routine test for every woman around the age of menopause. Encouraging women without any menopausal symptoms to check their FSH levels is not doing them any service.