Early menopause

What is early menopause?

Early menopause is when a woman’s last monthly period occurs between the ages of 40 and 45 years. Up to 1 in 12 women have their last period by the time they are 45 years. When menopause occurs before the age of 40, it is considered to be ‘premature menopause’. Most Australian women experience normal menopause between the ages of 45 and 60 years.

What are the symptoms of early menopause?

Symptoms of early menopause are similar to those of normal menopause:

• Changes to your menstrual cycle — monthly periods become less frequent and stop.
• Hot flushes or night sweats – a sudden feeling of heat in the neck and chest with changes to your heart rate.
• Problems sleeping (insomnia) and/or lower energy levels and tiredness.
• Pain in your muscles or joints.
• Vaginal and urinary symptoms — as the vaginal lining becomes thinner and dryer, you may experience discomfort during sex and/or need to urinate more often.
• Mood changes — you may feel anxious, upset, sad or angry in more situations.

What causes early menopause?

Early or premature menopause can occur due to:

• certain treatments that stop the ovaries from functioning, such as chemotherapy or radiotherapy for cancer
• surgery to remove a woman’s ovaries (oophorectomy)
• primary ovarian insufficiency (POI), when periods stop spontaneously due to certain genetic, autoimmune or metabolic conditions
• someunknown cause — in 6 in 10 women with early menopause, the cause is unknown

How is early menopause diagnosed?

While there isn’t a specific diagnostic test, menopause is confirmed if it has been 12 months since your last period. Blood tests are unlikely to be accurate or helpful in predicting menopause.

If spontaneous menopause happens early (that is, it has been 3 months since your last period and you are younger than 45), your doctor may suspect POI. You will be asked to have 2 blood tests at least a month apart to check your levels of follicle-stimulating hormone (FSH).

Seek medical advice if you are concerned about irregular cycles, heavy or abnormal bleeding, or symptoms that interfere with your daily life.

How is early menopause managed?

If you are affected by early menopause, it’s important to get medical support to help you manage not just your menopause symptoms, but also reduce your risk of developing other conditions. These may occur due to a lack of oestrogen and include:

Hormone therapy

Menopausal hormone therapy (MHT) involves replacing your hormones (oestogren and progesterone, and sometimes testosterone) to relieve menopause symptoms. If you opt to start MHT, take the lowest effective dose for only as long as you need to, and review with your doctor regularly whether to continue treatment.

Alternatively, your doctor may prescribe ‘the pill’ (combined oral contraceptive pill). While its main purpose is to prevent pregnancy, the pill is also recommended to reduce severe symptoms and long-term health risks such as osteoporosis and early onset cardiovascular disease.

Non-hormonal therapy

If for some reason you can’t take ‘the pill’ or MHT (for example, if you have had breast or uterine cancer),1 your doctor may suggest other prescription medicines such as certain antidepressants, gabapentin (a type of pain medicine), or clonidine (a blood pressure medicine).

Other non-hormonal options for managing menopause symptoms include:

• herbal remedies such as black cohosh and red clover
• plant-based oestrogens (phytoestrogens) — for example, in soy
• hypnotherapy
• cognitive behaviour treatment
• mindfulness therapy
• acupuncture and traditional Chinese medicine

Before trying any of these options, get advice from your GP.

Can early menopause be delayed?

There is no clear evidence that changing behaviour can delay menopause. However, some factors increase your risk of early or premature menopause:

• if your period started at 11 years old or earlier
• a family history of early menopause (this increases your risk by up to 12 times)
• smoking
• epilepsy
• previous ovarian surgery

Can I still get pregnant?

In some women who experience early menopause (for example, due to POI), there is a small chance that the ovaries will spontaneously start functioning again. In these women, there is a 1 in 10 chance that a natural pregnancy is possible.

Should I continue to get cervical screening?

Changes to your vagina after menopause can make important tests such as cervical screening uncomfortable. However, you should still have a Cervical Screening Test every 5 years until you’re 74 years of age. Talk with your doctor about the available options.