Early Menopause: Symptoms, Diagnosis, and Treatment Options

Early menopause is menopause (undergoing 12 months without a period) that occurs between the ages of 40 and 50. It differs from natural menopause in that natural menopause usually occurs post the age of 50. Premature menopause (premature ovarian insufficiency) is menopause occurring before the age of 40.

Symptoms of early menopause are the same as natural menopause, including: irregular or stopped periods, hot flushes and night sweats, sleep problems, mood changes, joint aches and some urogenital issues. In both cases (early and normal), periods often become irregular before stopping completely.

Diagnosis of normal menopause is usually done based on symptoms alone, early menopause is diagnosed using a combination of blood tests and symptom-based assessments, and premature menopause diagnosis usually requires blood hormone level checking for a definitively

Treatment options of early menopause include lifestyle changes, hormone replacement therapy in its different forms (tablets, gels, patches or intrauterine systems) or non-hormonal drugs to address symptoms.

In this article, we try to give you a broad overview of early menopause, what to look out for, and when to consider seeing a doctor and some medications that may be useful.

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What Is Early and Premature Menopause?

This article covers the answer to questions such as “what age is premature menopause ?” and “when does early menopause occur ?”

Menopause is when a woman stops having her periods permanently. It is usually diagnosed after a period of 12 months without a period, and it marks the end of the natural fertile cycle. In the UK, the average age of menopause is 51. Early menopause is when menopause occurs before the average age (occurring at age 45). Premature menopause is when menopause occurs below the age of 40.

During premature menopause, the ovaries stop working earlier than expected and oestrogen levels drop earlier than expected. Periods can stop and become irregular.

Reasons for early menopause (Figure 2) or premature menopause include:

• Smoking
• Family history of premature menopause
• Exposure to certain medical treatments, such as chemotherapy or radiotherapy
• Surgery to remove the uterus/ovaries
• Some autoimmune conditions.

Figure 2: Reasons for early menopause

What Age Is Considered Premature Menopause?

Menopause before the age of 45 is identified and defined as early menopause. Menopause before the age of 40 is defined as premature menopause.

If you are under the age of 40-45, especially if you are younger (below 40) and having symptoms of menopause such as:

• Hot flushes and night sweats
• Vaginal dryness
• Difficulty sleeping
• Low mood or anxiety
• Low sex drive
• Problems with memory or concentration

Then this may be a sign that you are undergoing premature or early menopause, and it may be time to consult your GP

Signs and Symptoms of Early Menopause

During menopause, the ovaries and reproductive organs in the body stop responding to reproductive-stimulating hormones released by the brain. This leads to reduced ovarian function, low oestrogen levels and the stopping of ovulation.

The decrease in oestrogen levels and consequent dysregulation by the brain (hypothalamus) leads to symptoms and signs of early menopause such as:

• Hot flushes
• Night sweats
• Vaginal dryness
• Low mood and anxiety
• Difficulty sleeping
• Low libido

The signs of premature menopause are very similar and identical to the symptoms of actual menopause. However, there are slight but noticeable differences. Some of these include:

• Periods becoming irregular (At earlier ages – symptoms of early menopause at 30)
• Cycles may become shorter or longer
• Heavier or lighter periods
• Skipped bleeding

Due to the early decline in oestrogen levels, there are also more likely to experience physical changes and muscle/joint-related issues. These physical changes include:

• Joint aches and stiffness
• Bone thinning

What Causes Early Menopause?

There are several known causes of early menopause (Figure 1), these include:

• Genetic factors (such as a family history):
  • If you have a family history of early menopause, this can make it more likley that you may experience it.
  • Sometimes genetic function such as certain chromosomal conditions can affect and cause decline in ovarian function
• Certain medical treatments
  • Medical treatments such as chemotherapy and radiotherapy can damage the ovaries
  • Surgical procedures such as oopherectomy (ovary removal) or hysterectomy (uterus removal).
• Auto-immune conditions
  • Sometimes auto-immune conditions such as addison’s disease, rheumatoid arthirtis, type 1 diabetes or thyroid disease can cause premature menopause. These conditions are more likely to cause premature menopause (under 40) rather than early menopause (40-50).
• Smoking
  • Women who smoke are likely to increase menopause 1-2 years earlier than women who don’t, this can contribute to early menopause.

Image 1: What causes early menopause

 How Early and Premature Menopause Is Diagnosed

Early and premature menopause is diagnosed depending on age, symptoms and hormone blood tests. The approach is slighly different for early menopause and premature menopause.

The first step in diagnosing early or premature menopause is your doctor taking a clinical history. Your doctor may ask questions regarding changes to your periods, hot flushes or night sweats, vaginal dryness, mood changes, sleep disturbances or family history of early menopause. People who are over 45 with typical symptoms are often diagnosed following a clinical history without any tests.

Blood tests for hormone levels are usually recommended for people under 45. The key hormones checked in early and premature menopause include:

• Follicle stimulating hormone (FSH) levels – High FSH levels can indicate ovaries not responding normally
• Oestradiol (oestrogen) levels – low oestrogen levels can also indicate menopause and ovarian dysfunction

For Premature menopause (earlier than 40), the doctor would ask for two FSH levels within a span of a few weeks to look for a definitive diagnosis.

If premature menopause is suspected, doctors may also sometimes ask for a pelvic ultrasound to look at the ovaries, their sizes and their follicle activity.

Treatment Options for Early Menopause

Early menopause is treated slightly differently from the main menopause. Because it happens earlier, treatment is not just recommended for symptoms but also to protect long-term health.

Hormone Therapy and Other Medical Treatments

For most women undergoing early menopause, hormone-related therapy (HRT) is strongly recommended. This is because oestrogen levels drop earlier than expected in early menopause and this increases the risk of osteoporosis, Cardiovascular disease and cognitive decline. For women experiencing premature menopause, doctors usually advise continuing HRT till the natural menopause age of 50-51.

There are different types of hormone replacement therapy options. If you still have a uterus (have not had a hysterectomy), then you will be recommended to use both an oestrogen and progesterone-containing component. If you’ve had a hysterectomy, then you may use an oestrogen-only option.

HRT therapy, whether based on a singular hormone or two hormones, is available as tablets, skin patches,  gels/sprays or intrauterine (hormone-releasing devices).

For medical but non-hormonal options, other drugs may be used to treat early menopause symptoms. Sometimes these include: antidepressants, which can reduce hot flushes, and gabapentin (used for night sweats), as well as vaginal oestrogen for dryness.

Vaginal pessaries or tablets can be used for the genitourinary symptoms of menopause, such as vaginal dryness or painful urination. These can be used long-term without risks.

Lifestyle and Long-Term Health Considerations

Because early menopause can cause long-term health risks, it is important to think about lifestyle changes, prevention and non-medical options for sustaining health.

Bone health can be preserved with the following measures:

• Adequate calcium intake
• Weight-bearing exercises such as walking or resistance training
• Vitamin D supplementation (in the UK)
• Bone density factors

Good cardiovascular health can be maintained by:

• Maintain a healthy weight
• Stop smoking
• Regular aerobic exercise
• Manage blood pressure and cholesterol.

Mental health promotion can be done through psychological support, CBT for mood and anxiety, good sleep hygiene and social support networks.

A nutritious diet rich in leafy greens, oily fish, whole grain and proteins can also help prevent any long term consequences.

When to See a Doctor About Early Menopause

Early menopause (occurring between age 40 and 50) should not be treated lightly, as it can have long-term impacts on the heart and bone health. The following is an overview of when you should see your doctor about it.

Your periods should stop or become irregular before the age of 45:

You should see a doctor if your periods become irregular for several months, your periods skip unexpectedly or stop completely, or the bleeding becomes unusually heavy or very light.

You have persistent menopausal symptoms such as:

• Frequent hot flushes or night sweats
• Severe sleep disturbances
• Mood changes affecting daily life
• Vaginal dryness causes a great deal of discomfort
• Reduced libido

You are concerned about fertility:

Early menopause can reduce fertility earlier than expected. See a doctor if you are trying to conceive without success, your periods have become irregular, and pregnancy is desired, you are under 40 and suspect conditions relating to ovarian insufficiency.

You are under 40 years old and have menopause symptoms.

Menopause below the age of 40 indicates premature menopause and premature ovarian insufficiency. This usually requires blood tests (hormone levels), investigations for any autoimmune causes or long-term hormone replacement unless contraindicated. Specific signs of this include irregular and much longer period patterns at first (early signs of menopause in 20s and 30s) before other associated symptoms start as above.

You should seek urgent review from your doctor if:

• You have unexplained vaginal bleeding
• Bleeding occurs after 12 months of no periods
• You have severe pelvic pain
• Symptoms develop very suddenly after any pelvic surgery or treatment

Key Takeaways on Early Menopause

Early menopause occurs between the ages of 40 and 50. The average age of menopause in the UK is 51. Premature menopause is menopause that occurs before the age of 40. Premature menopause is called Premature Ovarian Insufficiency and hence requires further investigation.

The first few signs of early menopause are period changes, such as:

• Irregular cycles,
• Skipped periods
• Lighter or heavier bleedings
• Periods are stopping completely.

A diagnosis of premature/early menopause is made after 12 months of not having a period.

According to the National Health Service of the UK, the signs of early menopause nhs are the same as those of normal menopause. These symptoms include:

• Hot flushes and night sweats
• Sleep changes
• Mood problems or anxiety
• Brain fog
• Vaginal dryness
• Reduced libdio
• Joint aches

Causes of Early menopause can include a family history of such conditions, smoking, surgeries to remove the ovaries, medications like chemotherapy or radiotherapy and autoimmune conditions.

Diagnosis of Early menopause/Menopause depends on age:

If women are older than 45, the diagnosis of menopause is usually based on symptoms.

If women are below 45, blood tests (checking hormone levels) are usually required.

If women are below 40, two raised FSH (hormone blood) tests that are 4-6 weeks apart would be required.
Please see your doctor if you have concerns regarding premature menopause, premature menopause symptoms, itd diagnosis or any fertility concerns.