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Premature and early menopause

Early menopause happens when a woman’s periods stop before the age of 45. However it is termed premature menopause if the periods stop before the age of 40. Premature menopause is now more commonly referred to as premature ovarian insufficiency (POI). It can happen naturally, or as result of some medical treatments. Around 1 in 100 women experience menopause before they reach the age of 40.

There are extra risks to those women who experience premature or early or menopause, partly because they have oestrogen deficiency for longer. These include decreased bone density and increased risk of fractures, early progression of cardiovascular disease and psychological impact that may include depression, anxiety. It also may include early decline in cognition, and dry eye syndrome. So, most authorities recommend hormone treatment for women with premature or early menopause unless there are medical reasons why you can’t be prescribed it.

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If you’re under 45 and have noticed your periods becoming infrequent or stopping altogether, you should speak to a GP.

Diagnosis

Premature or early menopause is diagnosed using your age and symptoms, as well as information about your family history and medical history: for example, whether you have had medical treatment that is known to trigger menopause. You should be offered blood tests to measure your levels of FSH (follicle-stimulating hormone). There are 2 tests that should be done at least 4–6 weeks apart, because your FSH levels change at different times during your menstrual cycle. These tests may be difficult to interpret if you are taking oral contraceptives.

If it is not clear whether you are in premature or early menopause, you should be referred to a menopause specialist.

Treating premature and early menopause

Premature or early menopause is usually treated with HRT or a combined hormonal contraceptive. Your GP will be able to explain any risks and discuss what’s best for you. If you are offered this kind of treatment, it’s important to continue it until at least the age of natural menopause, to give you some protection from osteoporosis and other conditions that can develop after menopause. Remember HRT is not a contraceptive!

However, hormonal treatment is not suitable for some women, for example if you have a history of breast cancer or another type of cancer stimulated by the hormone oestrogen. Your GP should discuss other possible treatments with you.

You may also be referred to other healthcare professionals who have the right training and experience to help you to manage different aspects of your condition.

Other sources of advice and support

Premature or early menopause can mean big changes for women before, during and afterwards. Don’t be afraid to ask for help. Our articles might help.

Understanding the menopause

Menopause treatment and support

A guide to HRT

Life after menopause

There are also lots of other support groups and information available too. The list below might help.

Menopause Support UK
The Daisy Network
Menopause matters
The Menopause exchange
Fertility friends
Women’s health concern

You can also go to NHS Choices for more information.

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Not got the app yet? Download the Evergreen Life app and look out for a notification about your Menopause questionnaire*. Start taking more control of your health and wellbeing.

* Must be 30 or over and female to receive the Menopause Check. If you haven’t told us your age and sex, please first take the GP Check in your Records section.

Reviewed by:

Dr Brian Fisher MBBCh MBE MSc FRSA Medical Expert

Dr James Harmsworth King MBBS MPhil PhD Biotechnology & Medical Expert

Menopause

Overview | Menopause: diagnosis and management | Guidance | NICE

RCN guide to Menopause

Picture of Mr Michael Savvas FRCOG

Mr Michael Savvas FRCOG

Michael Savvas is a Consultant Gynaecologist at King’s College Hospital, and our Women’s Health Expert at Evergreen Life. He has a special interest in the menopause and HRT and has undertaken many research projects and published a number of papers on the use of different forms of HRT in the treatment of symptoms of the menopause including depression.

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