Early Menopause

Early menopause (premature ovarian insufficiency or POI) occurs when the ovaries stop functioning normally before age 40, leading to irregular or absent periods and reduced fertility. It affects 1 in 100 women under 40 and 1 in 1,000 under 30.

Common Symptoms

• Hot flashes/night sweats.
• Irregular or missed periods (for 4+ months).
• Sleep disturbances, fatigue, or mood swings.
• Vaginal dryness or pain during sex.
• Brain fog or difficulty concentrating.
• Emotional distress (grief, anxiety about fertility).

Possible Causes

• Genetic conditions (e.g., Turner syndrome, Fragile X premutation).
• Autoimmune diseases (e.g., thyroiditis, lupus).
• Medical treatments: Chemotherapy, radiation, or ovarian surgery.
• Infections (rare, e.g., mumps).
• Idiopathic: No identifiable cause (most cases).

Diagnosis

1. Check hormone levels:
   1. High FSH (follicle-stimulating hormone) and low estrogen.
   1. AMH test (measures ovarian reserve).
2. Rule out causes: Genetic testing, autoimmune screening, or pelvic ultrasound.

Health Risks

Early menopause increases long-term risks of:

• Osteoporosis (weakened bones).
• Heart disease.
• Cognitive decline/dementia (if untreated).
• Depression or anxiety.

Treatment & Management

1. Hormone Replacement Therapy (HRT)

• Benefits: Relieves symptoms, protects bones/heart, and improves quality of life.
• Options: Oestrogen patches/gels + progesterone (if uterus intact).
• Duration: Usually recommended until at least age 51 (natural menopause age).

2. Fertility Support

• Egg freezing (if diagnosed early).
• IVF with donor eggs (most common route for pregnancy).

3. Lifestyle Adjustments

• Weight-bearing exercise (protects bones).
• Calcium & vitamin D (1,200 mg/day calcium, 800–1,000 IU vitamin D).
• Avoid smoking (worsens bone/heart health).

4. Emotional Well-Being

• Counselling therapy to cope with grief, identity, or relationship changes.
• Support groups (e.g., The Daisy Network).

Frequently Asked Questions

Q: Can early menopause be reversed?
A: No, but HRT can manage symptoms and reduce health risks.

Q: Will I age faster?
A: No, but untreated low oestrogen increases certain health risks. HRT helps mitigate these.

Q: Can I still get pregnant?
A: Spontaneous pregnancy is rare (5–10% chance), but options like donor eggs exist.

Q: Is HRT safe?
A: Yes, for most women under 50, benefits outweigh risks. Discuss family history (e.g., blood clots) with your doctor.

Q: Will I go through menopause again at 50?
A: No—HRT is adjusted around age 50 to match natural menopause timing.

eGynaecologist Advice:

• HRT is strongly recommended to protect bones, heart, and brain, and consulting a gynaecologist is essential for protecting long-term health.
• You must consult your gynaecologist if you miss periods for 3+ months under age 40.
• Concerns about fertility must be discussed at early opportunity with your gynaecologist.