Our ovaries make less estrogen and progesterone as we age, and so we stop having periods. Sometimes this happens suddenly, while for others it takes years. Typically, people who menstruate experience menopause in their late forties to mid-fifties but for a small proportion of people (around 4%), it happens before the age of 40. This is known as early or premature menopause.
What causes premature menopause?
It can be the result of cancer treatment – either radiotherapy targeted at the pelvis or chemotherapy. In other cases, it kicks in after having one or both ovaries removed (perhaps due to benign or cancerous cysts, endometriosis, an infection of the fallopian tube(s), or as a preventive measure for people with the BRCA gene who have an increased risk of hormonal cancers).
One of the most common causes is premature ovarian failure, where the ovaries stop working normally. This has been linked to autoimmune disorders, viruses, and genetics, but there isn’t always an obvious explanation.
What are the signs of a premature menopause?
You can’t be considered menopausal until you’ve gone 12 months without a period. Whatever your age, the symptoms are the same, and are likely to include some or all of the following:
- Mood swings
- Vaginal dryness
- Problems with concentration and memory
- Hot flashes
- Low sex drive
- Night sweats
How is it diagnosed?
See your doctor if you suspect you’re going through an early menopause. They will want to rule out pregnancy and an underactive thyroid, and may run some hormonal tests, too. If those show low estradiol (the most powerful type of estrogen during your menstruating years) and high follicle-stimulating hormone (FSH), this indicates that your body’s reproductive system is shutting down.
What are the health consequences?
Obviously, without periods, you won’t be able to conceive a baby. Your risk of osteoporosis will go up, meaning your bones could become more brittle and likely to break, because estrogen is needed to keep them healthy. It also helps protect your heart, so you’re more likely to experience heart disease. Urinary incontinence and increased UTIs are also a side-effect for some people.
How to deal
There’s no way to stop or reverse the menopause, but there are interventions to make it more bearable. The main one is hormone replacement therapy (HRT), which comes in the form of patches or creams, so it can be easily absorbed, and the dose can be fine-tuned. Estrogen creams designed to be applied to the vagina may relieve dryness and help with incontinence. Some people find a low dose of a selective serotonin reuptake inhibitor (SSRI) antidepressant like Prozac reduces hot flashes.
Vitamin D and calcium might be useful to keep bones strong, but check with your doctor before taking anything new.
Dietary changes could be helpful, too: cutting down on caffeine and alcohol should improve sleep quality, and reducing spicy foods and hot drinks might relieve hot flashes. Eating more vegetables, wholegrains, and fruit (and fewer saturated fats and sugary foods) is always a good idea.
Exercising regularly is important too, especially strength training, as it improves bone and muscle health. This doesn’t have to be in the gym – you can use dumbbells at home. It can also be a good way to relieve stress, as can CBT or counselling if you’re struggling with all the physical and emotional changes.
Whether you experience the menopause sooner or later, and even if it does take you a while to adjust, remember that it will end. Then you’ll feel cooler, calmer, and never have to ask a stranger in the bathroom for a tampon ever again.