Early menopause

Menopause usually starts between the age of 45 and 55.

Early menopause happens when your periods stop before the age of 45. It can happen by itself or as a side effect of some treatments.

Talk to your GP if you're under 45 and your periods are infrequent or have stopped.

Symptoms of early menopause

The main symptom of early menopause is infrequent periods or periods stopping altogether, that are not caused by other reasons such as pregnancy.

Other symptoms can include:

• hot flushes
• night sweats
• difficulty sleeping
• low mood or anxiety
• problems with memory or concentration
• vaginal dryness and pain, itching or discomfort
• reduced sex drive (libido)
• discomfort during sex
• fatigue
• headaches
• heart palpitations (a fast-beating, fluttering or pounding heart)
• recurring UTIs
• lack of energy
• loss of muscle
• weight gain
• joint aches and pains

Early menopause causes an increased risk of osteoporosis and cardiovascular disease. This is because of low oestrogen hormone levels.

Causes of early menopause

The ovaries stop working

Early menopause can happen if your ovaries stop making enough hormones, particularly oestrogen.

If periods stop completely before the age of 40, this is called 'premature ovarian failure' or 'primary ovarian insufficiency'.

The cause is often unknown, but can include:

• chromosome abnormalities, such as Turner syndrome
• autoimmune diseases, where the immune system starts attacking body tissues
• certain infections, such as tuberculosis, malaria and mumps in rare cases

Premature ovarian failure can sometimes run in families. This may be the case if a relative went through menopause in their 20s or 30s.

Cancer treatments

Radiotherapy and chemotherapy can cause premature ovarian failure. This may be permanent or temporary.

Your risk of having early menopause depends on:

• your age – before puberty you can tolerate stronger treatment than when you're older
• the treatment – different types of chemotherapy have different effects on the ovaries
• the area treated – the risk is higher if you have radiotherapy around your brain or pelvis

Surgery to remove the ovaries

Removing both ovaries causes premature or early menopause.

If you have a hysterectomy, your surgeon may need to remove your ovaries. A hysterectomy is an operation to remove the womb. But most hysterectomies do not involve the removal of the ovaries.

Diagnosing early menopause

Your GP can diagnose early menopause based on your symptoms, family history and blood tests. The blood tests check your hormones such as follicle-stimulating hormone (FSH).

Your GP may refer you to a specialist.

Treating early menopause

Treatment for early menopause is often to replace the missing hormones. This is usually the combined contraceptive pill or hormone replacement therapy (HRT).

Your GP may recommend you take this treatment until at least the age of natural menopause - around age 51. This is to reduce your risk of developing osteoporosis and other conditions such as cardiovascular disease.

You may not be able to have hormonal treatment if you've had certain types of cancer, such as breast cancer. This is because of the increased risk of cancer coming back.

Your GP will tell you about other treatment options and lifestyle changes to help protect your health.

If you still get symptoms, your GP can refer you to a specialist.

Getting support for early menopause

Early menopause affects your ability to have children.

If you want to have children following early menopause, there are a number of different options available.

Some women use donated eggs. Surrogacy and adoption may also be options for you.

Counselling and support groups may be helpful:

• The Daisy Network – a support group for premature ovarian failure
• Cancer.ie – provides information about menopausal symptoms after cancer treatment