Whilst many women begin the menopause around the age of 50, some women experience the menopause much earlier. Although it is less common, many women begin to experience the symptoms of the menopause from the age of 40. This is known as premature menopause. There can be various reasons why you may experience premature menopause, but understanding the signs is the best way to help you manage it, so we have broken it down for you here. 

What’s the difference between early and premature menopause?

There are two definitions for the menopause starting earlier than usual, and it’s based on the age of onset. Early menopause is considered to be when a woman stops ovulating before the age of 45, whilst premature menopause is considered to be when you stop before the age of 40. Around 1 in 100 women in the UK experience the menopause before the age of 40. (1) 

It’s important to note that symptoms of premature or early menopause can be similar to primary ovarian insufficiency (POI), but they are different things. POI is where your ovaries stop working properly — your body won’t produce as much oestrogen, and you may have irregular periods but you can still get pregnant. (2) 

What causes premature menopause?

While premature menopause can sometimes occur for no apparent reason, like the menopause, there are various factors which can affect the age at which you reach it. 

If the women in your family, especially your mother or her mother and siblings, experienced premature menopause, it is more likely that you would too. Smoking is another factor that may speed up the onset of the menopause. (3) 

If you have undergone medical treatments, such as chemotherapy or pelvic radiation, or surgical procedures such as a hysterectomy (removal of the uterus) or an oophorectomy (removal of an ovary), this can speed up the onset of the menopause. Some procedures, such as a bilateral oophorectomy (removal of both ovaries) will result in an immediate onset. Conditions such as thyroid disease, rheumatoid arthritis, Turner's syndrome, and HIV can also cause early or premature menopause. (4), (5)

What are the signs of premature menopause?

The signs of early or premature menopause are much the same as those of the menopause, but they will occur earlier. Understanding your symptoms and getting the necessary medical investigations is essential to ruling out the possibility of other underlying conditions and managing your health and wellbeing.

Irregular menstrual cycles

The definitive symptom of the menopause is the irregularity of your period. If you’re experiencing the menopause, prematurely or otherwise, you’ll notice that you menstruate less frequently than you used to, a sign that your ovarian function is declining. 

If, however, you are also experiencing significant weight changes or stress, or you are doing endurance exercise such as marathon running, this may be the reason for your irregularity. Other conditions that can result in irregular or absent periods include polycystic ovarian syndrome (PCOS), thyroid disorders, cervical or uterine cancers, endometriosis, and pelvic inflammatory disease, all of which your doctor can help you rule out with the appropriate investigations. (6)

Hot flushes

Fluctuating or declining levels of oestrogen can often bring on hot flushes (also called hot flashes), due to the role oestrogen plays in your body's temperature regulation. They can come on fast, leaving you sweaty and flushed, and you may even experience palpitations. 

Hot flushes can also be triggered by extreme stress, high caffeine or alcohol levels, smoking, illness, certain medications, and other conditions, including hyperthyroidism and diabetes. (7) If your symptoms persist, it would be best to see a doctor to rule out these possibilities. Meanwhile, you can manage hot flushes with a few lifestyle changes and natural remedies that can help you fight the heat.

Night sweats and poor sleep

Night sweats are a typical sign of the menopause, regardless of when you reach it. They could, however, also be due to medication, hypoglycaemia (low blood sugar levels), or even the result of a high intake of alcohol. (8) (9) 

The menopause can also impact on your sleep, and you may experience general poor sleep. Sleep can also be disrupted by underlying mental health concerns — like anxiety and depression — or conditions such as obstructive sleep apnoea (OSA). To better understand your symptoms, keep track of your sleep and your night sweats, and consult your GP to get to the bottom of it.

Vaginal dryness

Vaginal dryness is not uncommon, and most women will experience it at some stage of their lives. If you are going through early or premature menopause, your declining oestrogen levels can cause your vaginal tissue to lose lubrication and elasticity, leaving you feeling dry, itchy or sore. You can also experience vaginal dryness due to other factors such as medications, UTIs, or the overuse of perfumed soaps, washes, or vaginal douching products; surgical procedures and treatments such as hysterectomies and chemotherapy can also cause dryness. (10)

Anxiety, low moods, and brain fog

Anxiety and mood swings during premature menopause due to the fluctuating levels of hormones in your system can leave you feeling fatigued and unable to concentrate. If your anxiety is resulting in physical symptoms such as exhaustion, an increased heart rate, headaches, or nausea, you should consult your GP to help rule out any possible underlying conditions that may be causing these. In rare cases, poor memory may also be a symptom of early-onset Alzheimer's disease, which may occur in your forties, so if you are experiencing significant lapses in memory, it’s advisable to consult your doctor.

Diagnosing early or premature menopause

Diagnosing early or premature menopause starts with consulting your GP, who will assess your symptoms and family history, and carry out a series of blood tests to check your hormone levels. If they suspect that you are indeed going through premature menopause, they may refer you to a specialist who can help you manage your menopause.

While this may all seem very daunting, the key is to not jump to conclusions that may do nothing more than cause you unnecessary anxiety. Premature menopause is a manageable condition, and with the correct diagnosis and treatment, your life can remain as great as ever. To discover more advice on managing the symptoms of the menopause, visit our Menopause Guide.

References

1. nhs.uk. (2018). Menopause. [online] Available at: https://www.nhs.uk/conditions/menopause/ [Accessed 9 Dec. 2019].
2. Mayo Clinic. (2019). Primary ovarian insufficiency - Symptoms and causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/syc-20354683 [Accessed 9 Dec. 2019].
3. Women.smokefree.gov. (n.d.). Smoking’s Impact on Women’s Health | Smokefree Women. [online] Available at: https://women.smokefree.gov/quit-smoking-women/what-women-should-know/smokings-impact-on-women [Accessed 10 Dec. 2019].
4. womenshealth.gov. (2018). Early or premature menopause | Womenshealth.gov. [online] Available at: https://www.womenshealth.gov/menopause/early-or-premature-menopause [Accessed 10 Dec. 2019].
5. Imai, K., Sutton, M.Y., Mdodo, R., del Rio, C. (2013). HIV and menopause: A systematic review of the effects of HIV infection on age at menopause and the effects of menopause on response to antiretroviral therapy. Obstetrics and Gynecology International, 2013:340309.
6. Medical News Today. (n.d.). Irregular periods: Symptoms, causes, home remedies, and treatment. [online] Available at: https://www.medicalnewstoday.com/articles/178635.php [Accessed 10 Dec. 2019].
7. nhs.uk. (2018). Menopause - Hot flushes. [online] Available at: https://www.nhs.uk/conditions/menopause/hot-flushes/ [Accessed 10 Dec. 2019].
8. Kalra, S., Mukherjee, J., Ramachandran, A., Saboo, B., Shaikh, S., Venkataraman, S., Bantwal, G. and Das, A. (2013). Hypoglycemia: The neglected complication. Indian Journal of Endocrinology and Metabolism, 17(5), p.819.
9. Yoda, T., Crawshaw, L., Nakamura, M., Saito, K., Konishi, A., Nagashima, K., Uchida, S. and Kanosue, K. (2005). Effects of alcohol on thermoregulation during mild heat exposure in humans. Alcohol, 36(3), pp.195-200.
10. nhs.uk. (2018). Vaginal dryness. [online] Available at: https://www.nhs.uk/conditions/vaginal-dryness/ [Accessed 10 Dec. 2019].