Signs and Symptoms of Premature Menopause
Menopause is a time of many health changes, both within the female reproductive tract and throughout the body. It typically occurs when you are middle-aged, but it sometimes comes on earlier due to natural causes or external factors like surgery.
If you transition into menopause earlier than expected, it is a good idea to talk to your doctor, as it may be a sign of an underlying medical condition. Additionally, while many people find menopause uncomfortable, treatments are available that may help ease symptoms. Knowing what to expect and how to manage your menopause may help improve your well-being as you enter a new stage of life.
What Is Menopause?
Menopause occurs when menstrual periods permanently stop and you can no longer become pregnant. Doctors say that you have reached menopause 12 months after your last period.
Your periods are controlled by several different hormones, including estrogen and progesterone. During menopause, your body makes much lower amounts of these hormones, and your ovaries stop releasing egg cells. Drops in hormone levels are what cause the symptoms of menopause.
Menopause doesn’t often happen right away. Instead, your periods may start becoming more irregular or lighter, or you may start missing periods. You may also experience other health changes. This period of time in which you’re transitioning into menopause, called perimenopause, lasts an average of seven years. However, perimenopause can often start in a woman’s thirties and extend into her fifties. After you reach menopause, you are said to be postmenopausal.
When Does Menopause Occur?
Menopause that occurs between the ages of 40 and 45 is known as early menopause. This occurs in about 5% of women, or 1 out of 20.
When menopause occurs before age 40, it is called premature menopause. About 1% of women go through premature menopause.
Why Might Menopause Occur Early?
There are several different factors that might trigger early or premature menopause. In some cases, doctors can’t detect any obvious reason for the condition. In other cases, menopause is expected due to surgery or other treatments.
Certain Medical Treatments
If you haven’t already gone into menopause, having surgery to remove the ovaries will trigger the condition. This procedure, called an oophorectomy, may be performed for various reasons, such as to treat ovarian cancer or other ovarian diseases or to reduce the risk of ovarian cancer. After an oophorectomy, your estrogen levels will immediately drop, leading to menopause.
The ovaries are also sometimes taken out during a hysterectomy (removal of the uterus), which will trigger menopause. If the ovaries are left in, they will usually continue to make hormones, but you may later go through menopause slightly earlier than average.
If you need to have certain cancer treatments at a younger age, you may also go into early menopause. Chemotherapy or radiation treatments to the pelvis can damage the ovaries and shut them off, preventing them from making any more hormones. Sometimes, the ovaries will start working again later, but other times they will remain non-functional. Hormone therapy drugs used to treat breast cancer may also cause menopause.
Autoimmune diseases — conditions that cause the immune system to become overactive and attack the body’s healthy tissues — can trigger early menopause. Autoimmune diseases include thyroid disease, rheumatoid arthritis, and Addison’s disease. Between 30% and 60% of those with premature menopause have an autoimmune disease.
Chronic fatigue syndrome, also known as myalgic encephalomyelitis/chronic fatigue syndrome or ME/CFS, may lead to early menopause. Other signs of this disease include extreme fatigue or weakness, body pains, headaches, and memory loss.
Some genetic disorders can increase your chances of experiencing early menopause, including:
- Turner’s syndrome
- 17 alpha-hydroxylase deficiency
- Myotonic dystrophy
- Ataxia telangiectasia
- Di George syndrome
- Other conditions that lead to too many or too few chromosomes (pieces of DNA) within your cells
If you have a parent or sibling who has been diagnosed with early menopause, you may also be more likely to start the menopause transition at an early age. In my practice, I often find that the average age of menopause, as well as the typical menopausal symptoms women experience, tend to run in families.
Smoking is an early menopause risk factor. The more you smoke, the more likely you are to go through menopause in your 40s or earlier. Additionally, smoking puts you at risk of having more severe menopause symptoms.
Having poor overall health and eating a diet that doesn’t provide enough nutrition are also premature menopause risk factors. Additionally, the more children you have, the higher your chances of developing this condition.
Symptoms of Premature Menopause
Menopause symptoms are generally the same regardless of when or why they occur. If you are going through menopause, you may notice:
- Hot flashes — These feelings of heat in your upper body are often the worst during the first one to two years of menopause but may continue for many years. Your face, neck, chest, back, or arms may also become flushed (red). You may also sweat during a hot flash, or feel a cold chill afterward. About three out of four women experience hot flashes.
- Night sweats — You may experience frequent sweating, especially at night. Night sweats can sometimes be so intense that your sleepwear or bedding becomes drenched.
- Irregular periods — Your periods may come on earlier or later, last for more or fewer days, or be lighter or heavier than usual. Eventually, your periods will stop completely.
- Insomnia — You may have trouble falling asleep or staying asleep.
- Changes in heart rate — Your heart may start suddenly beating more quickly or feel like it is pounding within your chest. You may also sometimes feel like it skips a beat (heart palpitation).
- Pain — Menopause may trigger headaches or joint pain.
- Hair changes — The hair on your head may thin out, while the hair on your face may grow darker or thicker.
- Mood swings — Your emotions may change suddenly or unexpectedly. You may feel increasingly irritable, anxious, or depressed.
- Thinking problems — Memory problems can occur or worsen during menopause. You may also have trouble concentrating. Nearly half of women going through menopause experience psychological problems, including mood changes, mental health conditions, or focus problems.
- Urinary problems — You may sometimes notice urine leaking out when you laugh, sneeze, or cough, or when you can’t make it to the bathroom in time (called urinary incontinence). You may also need to go to the bathroom more often, especially at night, or feel sudden, strong urges to urinate.
- Vaginal dryness — Your vagina may not be as naturally lubricated as it once was. This can sometimes lead to pain or discomfort during sex, as well as itching or burning feelings.
- Other changes in sexual health — You may have a lower sex drive after menopause, although there is also a chance you may feel more sexual. Sex may also feel different than it once did because of vaginal changes. You may also develop vaginal infections. About three out of five women have changes in urinary, vaginal, or sexual health during menopause.
These symptoms can all be caused by other conditions as well. Your doctor may be able to help you figure out whether you are going through menopause or if something else is causing your health changes.
How Do You Know Whether You’re Going Through Menopause?
If you’re not already tracking your periods, you may want to start noting when they occur so that you can determine if they’re happening less often. You can use various apps or websites to track your period, or you can write down your period start date, end date, and related symptoms in a calendar or planner.
Talk to your healthcare team to get more information. If your doctor thinks that you may be going through menopause, they can use blood tests to measure your hormone levels. Low levels of estrogen or human chorionic gonadotropin (hCG) or high levels of follicle-stimulating hormone (FSH) be signs of menopause. Your doctor may recommend repeating these tests since hormone levels rise and fall over the course of your menstrual cycle.
Your physician may also suggest other tests or exams to look for additional health problems that may be linked to early menopause. You may need tests to look at your genes, blood sugar, calcium levels, bone strength, and thyroid health. These tests may help explain early menopause, or they may help rule out other health problems.
Treatments for Early or Premature Menopause
The treatments that work best for you depend on which symptoms you experience and how severe they are. You may also use different treatment options based on other health conditions you have or your own preferences.
Some treatments can directly help ease menopause symptoms. Other remedies prevent additional health problems. For example, going through menopause at an earlier-than-usual age raises your risk of experiencing osteoporosis (weak bones) or heart disease in the future.
Menopausal hormone therapy may help relieve many of the most common menopause symptoms. It involves taking medication containing estrogen, progesterone, or both. These medications may come in the form of a pill, cream, gel, skin patch, or vaginal ring.
Hormone therapy isn’t right for everyone. Experts recommend that anyone thinking about this treatment talk about the pros and cons with their doctor. These medications may help relieve menopause symptoms and complications. While they can sometimes increase your chances of developing blood clots, strokes, heart attacks, or breast cancer, these risks are less likely for those undergoing early menopause.
Experts usually recommend hormone therapy for those dealing with premature or early menopause because the benefits are more likely to outweigh the risks. This treatment can reduce your risk of developing future health problems including osteoporosis, heart disease, and dementia.
Other Medications and Treatments
Your doctor may also recommend other medications to treat specific menopause symptoms, such as:
- Antidepressants like Effexor (venlafaxine), Wellbutrin (bupropion), or Prozac (fluoxetine), which can treat hot flashes
- Gralise (gabapentin), an anti-seizure medication that can help prevent hot flashes
- Kapvay (clonidine), a drug normally used for high blood pressure that can also be a treatment for hot flashes
- Osphena (ospemifene), which can reduce pain during sex
- Intrarosa (prasterone), a hormone-containing drug that also helps treat painful sex
- Water-based vaginal lubricants, which can increase comfort during sex for women dealing with vaginal dryness
Depression is also a common symptom. However, menopause-related depression is harder to treat with anti-depressant medications. These treatments may be more likely to work when they are combined with hormonal therapy. Counseling with a therapist or psychologist may also be a good option.
Some people who go through menopause sooner than expected experience mental health problems not only because of hormone changes but also due to the inability to get pregnant. If you are interested in having children, you may also be able to explore other options such as adoption or using donated eggs.
Natural Remedies and Lifestyle Changes
Diet changes may help ease menopause symptoms. Many people find it helpful to eat more soy products such as tofu, edamame, soy-based meat alternatives, or soy milk. Staying away from spicy foods and limiting the amount of caffeine and alcohol you drink may also be a good idea. To reduce your risk of weakened bones, take calcium and vitamin D supplements, or eat more foods rich in these nutrients.
Getting more physical activity can go a long way in reducing multiple menopause symptoms. Exercise can help keep hot flashes under control, help you sleep better, increase your energy levels, sharpen your mind, and boost your mood.
Some people going through menopause swear by certain natural or herbal supplements. Make sure to talk to your doctor before using these supplements, because they can sometimes interfere with other medications, including hormonal therapy. You may want to try products that contain black cohosh or red clover.
Reducing your stress levels and taking time to relax is also a good idea during menopause. Starting a yoga or meditation practice or trying acupuncture may improve your well-being. Additionally, when you feel a hot flash coming on, deep breathing may help reduce its intensity. Try breathing in for five seconds while feeling your stomach expand, and then exhaling for five seconds while your stomach pushes the air out.
Keeping Up With Your Health
Ask your doctor about which health screenings or tests are needed in your post-menopause years. You will likely want to discuss:
- Annual exams to measure your height, blood pressure, and cholesterol as well as basic blood or urine tests to detect chronic health problems
- Pap smears every three years or co-testing every five years until the age of 65 (but this time frame strongly depends on your individual risk factors and is to be discussed with your physician as the guidelines are as different as we all are unique)
- Annual mammograms on schedule as discussed and agreed upon between you and your physician
- Regular vaccinations you might need, as discussed between you and your physician
The Bottom Line
When menopause strikes early, it is important to work with your doctor to determine potential causes. You may end up discovering that you have another underlying condition that requires treatment. Your doctor can also prescribe hormonal treatments that can relieve menopause symptoms and help you avoid developing other health problems in the future.