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Menopause under 40

Or Premature Ovarian Insufficiency (POI). If you're under 40 and getting menopausal symptoms this is the one for you. Heard about POI and wondered what it is? Here we explain what an early menopause is and what to do if this is relevant to you.

What is premature ovarian insufficiency (POI) or 'premature menopause'?

POI is when periods stop for one year before the age of 40. Sometimes this is a true 'early menopause' - when the ovaries stop working - but not always.

It's important to realise that if your periods have stopped for a year and you are under 40 it may not be the end of your reproductive life. If you are taking any form of hormonal contraception this can impact your periods. So can other things going on in your life - such as stress. It is important to seek help from a medical professional to understand what is going on.

POI is not uncommon - it's estimated to affect 1% of women under 40. It can happen at any age after puberty. [1]

Is POI the same as an early menopause?

No they are slightly different. An early menopause is when periods stop for one year between the ages of 40 and 45. POI is when your periods stop before the age of 40. Although slightly different, however, they do share similar symptoms.

What is the cause of POI?

Not all causes of POI are yet know. The most common known causes are genetic.

In some cases autoimmune diseases can lead to POI. Our immune system affects our sex hormones - including oestrogen, progesterone and testosterone. If something goes wrong with our immune system our sex hormones can get out of whack! Autoimmune thyroid problems are one of the more common causes of POI.

Chemotherapy and radiotherapy treatments for cancer can also cause periods to stop. This likelihood of this happening will depend on the drug, dose and duration of treatment.

Induced/Surgical menopause (surgical removal of your ovaries), or a hysterectomy, can also cause this. Some enzyme deficiencies and infections have also been shown to cause POI.

What should I do if I think I have POI?

Go to your GP for further investigation. They may refer you to a specialist, depending on the other symptoms you are presenting with. Often they will run a blood test to check the hormone levels of FSH. FSH will be high if you are perimenopausal. This test needs to be repeated, so you have two consistent high readings over a 6-8 week period. They'll also check in on your thyroid function too.

What happens if it is POI?

There's some important long term health risks with going through menopause early - so it's important to know what's going on. There are increased risks of:

  • low bone density (so higher chance of breaking bones - risk of developing Osteoporosis)
  • Cardiovascular disease
  • Poor cognitive outcomes (brain function)

The good news is that the chances of getting breast cancer are a bit lower! Most of these risks were identified from women who had a surgically induced premature menopause. More research is needed into the risks associated with a natural early menopause.

If you do have POI the medical guidelines state that you should be offered counselling as a form of support. Also hormone replacement therapy should be offered to reduce some of the health risks. Your doctor may also suggest lifestyle changes to help you stay healthy. These may include eating calcium and taking a vitamin D supplement; maintaining a healthy weight; and keeping active.

It can be a scary diagnosis - but the health system should be there to help you. Treatment and support may need to last some years - and that is OK. Make sure you get the help you need.

References:

  1. 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.

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