Your Burning Questions About Early and Premature Menopause Answered
If you're in your 20s or 30s, the thought of going through menopause at your age may be unfathomable. But for a small percentage of people, "the change" comes much earlier than expected. We talked to two experts about why early and premature menopause occur, the health risks these conditions pose and how to cope if you're affected.
What is early and premature menopause?
Menopause occurs once a person has gone 12 months without a period, indicating the reproductive stage has ended.
The average age of menopause onset in the United States is 51. Early menopause, between ages 40 and 45, affects about 5 percent of people with ovaries. Premature menopause occurs before age 40 and affects about 1 percent of people.
Early and premature menopause, sometimes referred to as primary ovarian insufficiency (POI), is not to be confused with perimenopause, or menopausal transition, which can begin 8 to 10 years before menopause.
"Perimenopause literally means 'around menopause,' and refers to the time before the menopause—when hormone levels begin to transition toward the menopause and periods may become irregular, but haven't stopped completely," said César Díaz-García, M.D, Ph.D., associate professor, fertility specialist and medical director of IVI London.
In perimenopause, the menstrual cycle may lengthen or shorten. So, if your cycle was once 25 days, it might now be 32. You may also have periods without ovulation. Menopause-like symptoms, including hot flashes, mood swings, weight gain and insomnia, might also start to occur.
What causes menopause to come early?
Every person with ovaries is born with a fixed number of eggs or follicles (sacs housing the eggs within the ovaries) that develop by the time they're a 20-week fetus. Typically, there are about 6 million.
Over time, the follicle count depletes. When it drops to 50,000, perimenopause sets in, followed by menopause at a count of 1,000.
"Women who have menopause earlier than age 45 are outliers in that their age at menopause is more than two standard deviations below the norm," explained Nanette Santoro, M.D., an OB-GYN at the University of Colorado Hospital. "The early follicle loss has two basic causes: fewer follicles were present from the start—this can happen due to in utero infections that attack the egg supply or possible toxic exposures that prevent all the eggs from ever getting to the ovary in fetal life—or the existing follicles are destroyed or die off at a more rapid pace than normal."
Ovary removal (oophorectomy), pelvic chemotherapy and radiotherapy are examples of toxic exposures, in which follicles are destroyed or damaged by an external factor.
Individuals can also experience POI because of genetic conditions like Turner's syndrome, Fragile X, galactosemia or congenital adrenal hyperplasia; autoimmune disorders such as Crohn's, HIV/AIDS, hypothyroidism or systemic lupus erythematosus; or viral infections like mumps, tuberculosis, malaria or cytomegalovirus. For still others, the cause is not known. Díaz-García noted smoking, even infrequently, can increase the risk as well.
Although menopause is permanent, in some cases, primary ovarian insufficiency is temporary.
"For about 25 percent of women, they will have at least one more menstrual bleed in their life, and some women who have this condition will go months and months without cycling and then have several menstrual periods in a row," said Santoro.
Ovarian failure caused by a secondary factor like chemotherapy sometimes resumes once chemo is completed.
What are the symptoms and health effects?
Early and premature menopause symptoms generally mimic those of normal menopause, but the condition can present additional symptoms as well.
"In a study I was involved in a number of years ago, women with premature menopause had some additional symptoms that differed from naturally menopausal women: more 'brain fog' type complaints and more issues with fatigue and low energy, and their symptoms seemed to last longer, up to 20 years," said Santoro.
Because of the decrease in estrogen, early or premature menopause can also increase the risk of certain severe or chronic conditions, including glaucoma, heart disease, stroke, dementia, depression, Parkinson's and osteoporosis. It can also affect fertility and sexual function.
There is a silver lining in that decreased estrogen correlates to a reduced risk of breast cancer.
How is POI treated?
Unfortunately, it isn't possible to medically restore ovarian function.
However, it is possible to reduce the risk of long-term health effects via hormone therapy. Typically, treatment continues until the person reaches average menopause age, at which point it's mostly about managing symptoms, with the potential for continued therapy.
Hormone treatment might consist of a combined estrogen and progestin pill or menopausal hormone therapy (MHT).
Early and premature menopause symptoms generally mimic those of normal menopause, but the condition can present additional symptoms as well.
"If you are a woman under 45 who has noticed their menstrual cycle changing in any way—becoming infrequent, irregular or stopping completely—you should contact your doctor," said Díaz-García.
Early intervention is particularly crucial for those hoping to have children. In the early stages of POI, it might still be possible to successfully freeze the remaining eggs to undergo IVF in the future.
Additionally, Santoro encourages people to undergo screening for genetic conditions their children might inherit. This can inform decisions about reproduction and provide a clearer picture of a person's overall health and that of their family.
"Going through menopause unexpectedly can be very traumatic and can often provoke feelings of grief," said Díaz-García. "I would suggest reaching out to support groups in your area and think about talking to a specialist fertility counselor, especially if the diagnosis has affected your family planning."
