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Menopause between 40 and 45

Thinking you're menopause may have come early? Broadly speaking there are two terms for when menopause happens earlier than average - 'premature ovarian insufficiency (POI)' and 'early menopause'. Here we describe what an early menopause is, and what it means for your health.

So, what is early menopause?

Reminder - menopause is one year with no periods. And in the UK, the average age for menopause is 51. When menopause happens between the ages of 40 and 45 it's called an early menopause. If periods stop before you are 40 this is premature ovarian insufficiency (POI)**. We've explained POI in another Alva article.

What are the most common symptoms?

  • Lack of periods
  • Fertility issues (and the anxiety that goes with this)
  • Hot flushes/night sweats
  • Vaginal dryness

What causes someone to have an early menopause?

The cause of early menopause is not always known. If you speak to a doctor with symptoms of early menopause they will take a very detailed medical and family history. This is because genetics play a part - if there's a family history of early menopause you're at increased risk. Certain medical treatments and past infections can also increase the risk of early menopause. Underlying medical conditions can also cause early menopause - including certain autoimmune conditions and enzyme deficiencies.

Why does it matter?

Well, beyond the fertility consequences of early menopause which can be devastating, women with early menopause have some increased health risks. It's important to reduce these risks with lifestyle changes and medical steps as needed. The risks include a higher risk of low bone density and fractures; an increased risk of developing cardiovascular disease; poorer cognitive outcomes; and an overall lower life expectancy.

How will a doctor identify an early menopause?

Alongside taking a full medical and family history a doctor may order some tests to help identify early menopause. These might include:

  • FSH blood tests taken twice over a 6-8 week period - to check your ovarian function [1]
  • Thyroid function blood tests - to check your thyroid isn't messing with your hormones and causing your symptoms
  • Autoantibody blood test - to assess whether there's an underlying autoimmune condition
  • Measurements of bone mineral density - to assess your risk of low bone density and fractures.

If you have symptoms of other conditions, a doctor may also run tests for these at the same time. High FSH levels in both blood tests suggest early menopause.

Medical guidelines say women with early menopause should take hormone replacement therapy (HRT). HRT replaces the hormones that have declined prematurely. The form and dose of these HRT will depend on a person's age, symptoms and medical history. In general, it's recommended that women with an early menopause stay on HRT until at least 51 (the average age for menopause).

Other lifestyle interventions may help women manage symptoms - but these do not have the same impact on reducing long term health risks. Medical practitioners should be able to provide advice on both medical treatment and lifestyle changes. If they don't offer you both - make sure you know to ask.

References:

  1. Nice.org.uk. 2015. Overview | Menopause: Diagnosis And Management | Guidance | NICE. [online]
    Available at: https://www.nice.org.uk/guidance/ng23.

  2. Hillard, T., Abernathy, K., Hamoda, H., Shaw, I., Everett, M., Ayres, J. and Currie, H., 2017. Management Of The Menopause. 6th ed. British Menopause Society.

  3. nhs.uk. 2017. Early Menopause. [online]
    Available at: https://www.nhs.uk/conditions/early-menopause/ [Accessed 13 October 2019].