Dr. Joy'El Ballard / Menopause 101

Most simply put, premature menopause is the loss of ovarian function before the age of 40 (the average age of natural menopause is 52). Premature menopause is rare and occurs in just about one percent of people who menstruate in the U.S. The symptoms of premature menopause are similar to the symptoms many experience during perimenopause and natural menopause, which can include irregular periods or no periods, hot flashes, mood changes, anxiety or depression, sleep disturbances, sexual dysfunction and vaginal dryness. Premature menopause can be spontaneous or medically induced. It can be medically induced by surgical removal of both ovaries, chemotherapy, or radiation in the pelvic region. If it is medically induced, people typically skip perimenopause and go straight into menopause.

Spontaneous causes of premature menopause are most often genetic (i.e. chromosomal defects like Turner syndrome), metabolic (i.e. diabetes), autoimmune (i.e. thyroiditis), smoking, or, in some cases, unknown.

If there is no obvious cause, premature menopause is referred to as Premature Ovarian Insufficiency (POI), formerly known as premature ovarian failure. The term “failure” was changed to “insufficiency” because researchers found that some people have transient function of ovaries and may sporadically ovulate. It is a condition that occurs in younger folks, sometimes as young as their teens, characterized by skipping many periods in a row or having no periods at all. POI is most often diagnosed when a healthcare provider observes a patient with infrequent or no periods and the presence of menopausal symptoms. A blood test that measures Follicle-Stimulating Hormone (FSH) may confirm. FSH is the hormone that controls the menstrual cycle and stimulates the growth of eggs in the ovaries. FSH becomes persistently elevated in menopause. When the FSH level is elevated on two occasions, at least one month apart, this confirms POI.

Premature menopause or POI affects everyone differently, though it is common to have higher incidence of mental health issues like anxiety or depression along with a greater degree of sexual dysfunction compared to those who undergo natural menopause. One study on premature menopause found mood disorders and sexual problems were the most distressing among patients with this diagnosis.

If you are younger than 40, have skipped at least three periods in a row (and are not using contraception), your healthcare provider can evaluate your condition — once there is confirmation that you are not pregnant. Your physician will need to know if you have any preexisting medical conditions and if there is family history of premature menopause. A number of blood tests can determine if you have POI, premature menopause, or other conditions that can cause similar symptoms, for example, a thyroid disorder.

If you are younger than 40 and anticipate medical treatment that involves chemotherapy or radiation to the pelvis for cancer or surgical removal of both ovaries, make sure to discuss with your doctor the expectations of premature menopause, in addition to your fertility options.

Infertility. Since there is loss of ovarian function, spontaneous pregnancy is rare. About five percent of people with POI can get pregnant on their own. If you’re experiencing premature menopause and also interested in childbirth — or just want the option open — it’s important to have a conversation with your gynecologist or a fertility specialist to explore options of ovulation induction, in vitro fertilization (IVF) and egg donation to achieve pregnancy. Due to the lack of ovarian function, many people with premature menopause who wish to carry a pregnancy use donor eggs.

Osteoporosis. Those of us with premature menopause are at risk of early low-bone density or bone loss. Therefore, they are at risk for fractures.

Before considering treatment, your healthcare provider should identify the cause of premature menopause. In addition to treating the underlying cause, hormone therapy (HT) may be recommended. This includes a combination of estrogen and progesterone if a patient still has a uterus (estrogen alone may be prescribed for people without a uterus). HT is usually recommended until age 50–51, which is around the age that menopause would begin naturally. Remember that hormone therapy has both pros and cons, which should be discussed with your physician to determine the best option for you.

In addition to treatment, lifestyle changes are also important during premature menopause to protect the health of your heart, bones, and brain. Eating a balanced diet, exercising, avoiding smoking, and limiting alcohol are all beneficial in decreasing health risks associated with premature menopause. Calcium and Vitamin D supplementation may also be prescribed to protect your bones.

Also important: Tending to your mental health. The diagnosis of premature menopause can take an emotional toll and it’s important to have access to support groups and therapy, in addition to the support of your healthcare team, to help you manage your feelings — and to know you’re not alone.