Early menopause: what causes it and can I still conceive?
What age can you have a premature menopause? What are the signs – and can it prevent you from conceiving? Dr Philippa Kaye, family GP and author of The M Word: Everything You Need To Know About The Menopause, explains all
Premature / early menopause, also known as premature ovarian insufficiency, occurs when your periods stop completely before the age of 40. The average age to reach menopause (in the UK) is 51 but, although it's uncommon, it's not that rare to reach it earlier: research suggests 1 in 100 of us will have our last period before the age of 40 (and 5 in 100 before the age of 45).
So, why does it happen early for some of us? What causes it and what are the signs and symptoms? Are there any special treatments or medicines you need to take? And does going though premature menopause mean you can no longer have a baby? We've all the answers here...
What causes premature menopause?
We don’t always know why premature menopause occurs but it's often triggered by another condition.
Early menopause is associated, for example, with autoimmune conditions, such as type 1 diabetes or thyroid disease, where the body’s immune system attacks itself – here, it attacks the ovaries.
Did you know?Premature menopause is, strictly (and medically) speaking, 'secondary premature menopause' because there is something called 'primary menopause' – which is when your periods never start. This might happen if, for example, your ovaries don't develop properly, as is common in certain in genetic disorders, such as Turner’s syndrome.
Infections such as mumps and tuberculosis can also affect the ovaries and cause an early menopause. And certain medications can bring on the menopause.
Surgery that removes your ovaries – perhaps done as part of treatment for cancer – will automatically and immediately bring on the menopause. And having a hysterectomy – where your womb is removed but not your ovaries – is associated with having an earlier menopause.
What are the symptoms of premature menopause?
As well as infrequent or stopped periods, women affected by early menopause may also experience the same symptoms as women going through menopause later in life. These symptoms include:
- hot flushes
- night sweats
- difficulty sleeping
- reduced sex drive
- problems with memory and concentration
- vaginal dryness
- anxiety or low mood
- heart palpitations
- joint stiffness
- frequent urinary tract infections
Hot and bothered?
Hot flushes and sweaty nights are some of the most bothersome symptoms of menopause. The good news is there are cooling sprays that can help. Try Promensil Cooling Spray to help hot flushes, night sweats and redness.
How is premature menopause diagnosed?
If your periods stop for 6 months or more – or any of the symptoms listed above are causing you concern – you should see your GP. Doctors don't usually 'test' for the menopause but, if you are much younger than the average age for menopause, you should be offered blood tests to measure your hormones levels.
If you are under of 45, you will be offered diagnostic tests. Other tests will also be requested to rule out other causes of the loss of your periods, such as a thyroid hormone test
The blood test will measure your levels of follicle stimulating hormones (FSH) and luteinising hormone (LH), the hormones in your brain that trigger the menstrual cycle. They'll bee checked approximately 4 to 6 weeks apart. If they are consistently raised, you may be diagnosed with premature menopause.
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What about getting pregnant? Can I still conceive if I have premature menopause?
A common concern about premature menopause is whether or not you will be able to conceive and become pregnant. The answer for you will depend on the cause of your early menopause.
If your ovaries have been removed surgically, then no, you will not be able to conceive.
However, if you still have your ovaries, whether or not you can get pregnant will depend on what eggs – if any – you have left. If you have no eggs left, you cannot ovulate and so cannot get pregnant but, if you have eggs and your ovaries have stopped working, they can sporadically start working again and ovulate – meaning pregnancy is possible.
One in 10 women with premature menopause will actually become pregnant as the ovaries intermittently work. This means that, if you don’t want to become pregnant, you will need to use contraception.
If you are trying to conceive, your GP should be able to refer you to the local gynaecology fertility clinic for investigations and treatment.
What is the treatment for premature menopause?
Having an early menopause means that you will spend longer time in an oestrogen-deficient state than the average menopausal woman, which increases your risk of osteoporosis and heart disease.
In order to prevent osteoporosis and heart disease and maintain your cardiovascular and bone health, it is recommended to start on hormone replacement therapy (HRT)
There is no increased risk of any conditions in using HRT if you have a premature menopause until about age 50, as you are simply replacing the hormones which would otherwise be present if you had not had an early menopause.
You can, of course, use HRT for longer than that if the benefits for you outweigh any potential risks: your GP should be able to advise you on this.
An alternative to going on HRT until the age of 50 would be to take the combined oral contraceptive pill, which contains both oestrogen and progesterone and would work both as HRT and contraception.
Want to know more about the menopause?Dr Philippa has written a book all about the menopause. The M Word: Everything You Need to Know About The Menopause (Summersdale) includes loads of really helpful information, written in Philippa's super-friendly and reassuring way, on the symptoms of menopause, and how to treat it.
About our expert GP Philippa Kaye
Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. Dr Philippa has also written a number of books, including The M Word - Everything You Need To Know About The Menopause. She is a mum of 3.
1. Premature Menopause TC Okeke et al. Ann Med Sci Res 2013; 3(1):90–95. DOI: 10.4103/2141-9248.109458
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