Premature menopause occurs when a woman’s periods stop before the age of 40. Early menopause occurs when a woman’s periods stop before the age of 45. Either can be caused by certain surgeries and medical treatments, as well as by early changes in ovarian function that are not yet well understood.
In women who have not yet reached menopause, surgical removal of the ovaries (oophorectomy) will lead to an abrupt drop in hormone levels. This results in the same changes as those in natural menopause (except that testosterone levels are lower after oophorectomy), but the abruptness can make the transition more difficult.
Removal of the uterus (hysterectomy) with the ovaries left in place does not bring premature menopause, although menstrual bleeding stops and fertility ends and the hormonal changes of perimenopause may occur at a younger-than-average age.
Premature menopause can occur as the result of chemotherapy, pelvic or whole-body radiation therapy, or other drug therapies used for cancer treatment. Some women who have undergone cancer treatments experience a temporary alteration of ovarian function; for others, the impact is permanent.
Premature ovarian insufficiency (POI)
Approximately 1 percent of women under the age of 40 will experience the unexpected onset of night sweats, hot flashes, sleep disturbances, and other perimenopausal symptoms. Periods may dwindle or stop. Once known as premature ovarian failure, this condition is now referred to by many as premature ovarian insufficiency (POI), because the ovaries rarely “fail” entirely. Instead, ovary function becomes insufficient to maintain a regular menstrual cycle.
Causes of POI include genetic factors (chromosomal irregularities, particularly fragile X syndrome and Turner syndrome) or an autoimmune process. Viral infection may also play a role. Some women with POI also suffer from other autoimmune disorders, such as Addison’s disease (adrenal problems), or experience other endocrine disruptions, such as thyroid disease.
Diabetes, lupus, rheumatoid arthritis, and inflammatory bowel syndrome are also thought to be connected to POI, as are environmental toxins. Still, more often than not, researchers are unable to determine an exact cause for premature menopause. Genetics appear to play a role, as some women come from families where it is common.
If you are under the age of 40 and begin to experience irregular menstrual cycles and/or other symptoms of perimenopause (such as hot flashes, insomnia, headaches, or vaginal dryness), consider tracking your experiences, cycles and ovulation with a daily perimenopause diary. This can help both you and your health care provider see patterns.
Another reason to visit your health care provider to rule out other possibilities for your symptoms, including pregnancy, an eating disorder, thyroid disease, endocrine tumors, or other hormone disturbances.
Since most primary care providers do not see a large number of women with POI, they may not have enough experience to diagnose, answer questions about, or provide the best evaluation. In fact, most women report having visited several health care providers before receiving the diagnosis of POI. This means that it’s very important for you to understand your body, note any changes or concerns, and seek a specialist if needed.
It is a mistake to assume that POI is the same as normal menopause except that it occurs earlier. There is a distinctive set of physical and emotional concerns when a woman’s ovaries become insufficient at a young age. This includes a higher risk of cardiovascular disease and osteoporosis. Fertility is affected, and this is a major concern for many women with POI.
Because young women with diminished ovarian function may see a return of ovulation periodically, approximately 5 to 10 percent of women with POI who have unprotected intercourse do become pregnant spontaneously. Others who want to become mothers or add to their families may turn to adoption or assisted reproductive technologies such as egg donation, embryo donation or surrogacy.
Though there is no cure for diminished ovarian function, many good treatment options are available that can alleviate symptoms and minimize complications. Most clinicians recommend that women with premature menopause, if they have no contraindications such as cancer, go on hormone therapy — one example is transdermal estradiol and oral progesterone — until they reach the age of 50, the average age at menopause. More research is needed on the benefits and risks of hormone therapy for premature menopause.
Coping with premature menopause
Most women who experience early or premature menopause describe it as a shock. They suddenly feel “out of step” with other women their age; they never expected to have to face these types of challenges and decisions at this point in their lives. It’s important to allow yourself to grieve and to have your emotions acknowledged and validated. A good support network can help you successfully manage the long-term impacts throughout your life.