What is premature menopause and who does it affect?

Generally, menopause happens to most women between the ages of 45 and 55. When periods stop before the age of 40, this is commonly referred to as premature menopause or premature ovarian, but in fact, a more accurate term is premature ovarian insufficiency (POI) because often the ovaries have not completely failed, and periods may sometimes restart. When periods stop between the ages of 40 and 45, this is referred to as early menopause.

POI can occur for a number of reasons, both natural and as a side effect of treatments like chemotherapy. It can be a stressful and scary time if women don’t understand what is happening to their bodies.

Fortunately, lots of support and information are available. This guide will take you through how to recognise the signs of POI, its associated risks, and your treatment options.

Signs of POI

Many women often don’t associate their symptoms with menopause and can go through a lengthy, and sometimes stressful process of diagnosis.

One of the first signs of POI is that periods become irregular, and occur less frequently. They may also become longer or shorter.

Symptoms of POI

The symptoms of POI are the same as those of typical menopause, and along with irregular menstrual cycles, include:

What causes POI?

The cause of POI is often unknown, however, anything that stops estrogen production or that causes damage to the ovaries can cause POI.

• Autoimmune diseases such as thyroid disorders, type 1 diabetes or Addison’s disease 
• Genetic conditions – abnormalities in the chromosomes or other genes. Genetic causes are more common where there is a family history of POI
• Surgery to remove the ovaries
• Treatments that damage the ovaries such as chemotherapy or radiotherapy
•  Infections such as mumps

Risks of POI

There are health risks associated with POI, as is the case with typical menopause. Estrogen plays a vital role in the functioning of body systems and estrogen receptors are found in almost all cells, including the brain, cardiovascular system, bones, joints and skin.

Low estrogen levels are associated with long-term health consequences including:

POI puts women at risk of the above earlier in life than typical menopause, so it’s important to recognise it when it occurs and to seek medical help.

Diagnosing POI

A diagnosis of POI  will usually require the following:

• A thorough medical history including details of  your menstrual cycles and family history
• A physical examination
• A blood test to assess hormone levels
• Tests for other medical conditions such as thyroid disease

Treatment of POI

Hormone Replacement Therapy (HRT) is an important treatment for POI as it replaces the hormones no longer being produced. Clinical studies show that when estrogen is given as HRT to women under the age of 60, or within 10 years of menopause onset, the risks of cardiovascular disease (heart attacks and strokes) and osteoporosis are reduced, but this is especially crucial for women with POI as loss of ovarian function in this age group has profound effects on long term health, including a significant increase in the risk of cardiovascular disease and osteoporosis.

In addition to HRT, it’s also important to address lifestyle choices, including stopping smoking, reducing alcohol intake, and paying attention to mental health, diet and exercise.  

Can POI be reversed?

In POI, ovarian function may fluctuate, meaning that very rarely ovulation may occur or periods return temporarily and pregnancy may occur in 5-10% of women. However, POI is generally irreversible. In some women, HRT may stimulate ovulation because of its beneficial effects on the reproductive system.

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