Early menopause and premature ovarian insufficiency

Early menopause means your periods stop before 45. Premature menopause, or premature ovarian insufficiency (premature ovarian insufficiency), means before 40. It can come as a shock, and it can bring grief about fertility, identity and the future. Those feelings are completely valid. It is also very treatable, and you are not alone.

Why it happens

• Often no cause is found
• It runs in some families
• You are more likely to have it if you started your periods early, smoke or are underweight, says the NHS
• Cancer treatment such as chemotherapy or radiotherapy, some hormone medicines, or surgery to remove the ovaries
• Some health conditions. NICE notes that some people from ethnic minority backgrounds, or with some lifelong conditions, may reach menopause at a younger age.

Signs

The main one is periods that become irregular or stop before 45. Others are hot flushes, night sweats, vaginal dryness, poor sleep, low mood or anxiety, lower sex drive and problems with memory or focus. Many are the same as in later menopause.

How it is checked

NICE says that under 40, premature ovarian insufficiency is diagnosed from symptoms (including no or very few periods) plus a raised FSH level on two blood tests taken 4 to 6 weeks apart. It should not be diagnosed from a single test. Between 40 and 45, a doctor may use an FSH test to help confirm. Over 45, tests are not needed.

Why treatment matters

Having low oestrogen for many years raises the chance of osteoporosis and cardiovascular disease. The NHS says it is especially important to replace the missing hormones, with either HRT or the combined pill, unless there is a reason not to (for example, certain hormone-sensitive cancers). You are usually advised to continue until at least around 51, the average age of natural menopause. For people under 40, NICE says the baseline risks of breast cancer and heart disease are very low, and that HRT is not a contraceptive.

• NICE says psychological support should be offered if early menopause (40 to 44) or POI is distressing. You can also refer yourself to NHS talking therapies in England.
• Bone, heart and mental health checks matter.
• If you are facing treatment that will cause menopause, NICE says you should be able to talk about fertility and menopause before and after it.
• If HRT is not suitable, a specialist can advise on bone health, heart health and symptoms.

Fertility

Early menopause or POI can make it harder to get pregnant. The NHS says some people have children through IVF using their own frozen eggs or donor eggs, and others consider surrogacy or adoption. Occasionally the ovaries still work for a while, so if you do not want to get pregnant, ask about contraception. A fertility specialist can talk through your options and timings.