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When your ovaries check out early: Early menopause

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If you’re in your 30s, you probably think of menopause — the end of women’s reproductive lives — as something that awaits you in the distant future.

It’s true that typically, the natural age of menopause begins after 45 years and occurs in most women between ages 50 and 55. But for some women, this life change starts much earlier.

In Mayo Clinic’s menopause-focused women’s health practice, we often see women who are younger than 45 when their bodies enter this transition. In fact:

  • Approximately 5% of women enter menopause between ages 40 and 45. This is known as early menopause.
  • Approximately 1% of women’s ovaries stop functioning in typical ways before age 40. This is a type of early menopause known as primary ovarian insufficiency (POI).

Early menopause and POI often come as a surprise. And they can be tough for women to deal with physically and emotionally. Even if an early ending to periods sounds great, it’s important to know about the health risks that come with this change.

 

Naming the problem

Spontaneous menopause before age 45 can be challenging for both patients and health care providers. The diagnosis can be delayed because periods may become irregular but not stop altogether. Recognizing spontaneous POI in particular in young women is often confusing because the symptoms — irritability, sweating, changes in libido — overlap with those of other conditions.

When providers suspect that symptoms are related to early menopause or POI, they may use the following diagnostic tools:

  • A careful medical history, including gynecological and sexual histories
  • A physical exam, which will likely include a pelvic exam
  • A pregnancy test even if you’ve done one at home
  • Lab tests evaluating hormones such as follicle stimulating hormone (FSH) and estradiol
  • Imaging, most likely an ultrasound of the pelvis

It is important to try to discover the underlying cause of POI if chemotherapy or radiation — both known to cause POI — are not a factor. For example, some women may have accompanying weight loss, fatigue and vague abdominal pain. These symptoms indicate that the adrenal glands are not functioning, a disorder known as adrenal insufficiency. Other women may have a personal or family history of an autoimmune disease associated with POI, especially thyroid disease. There also could be an underlying genetic or chromosomal condition causing POI. A full evaluation with a knowledgeable and experienced clinician is key.

In addition to naturally occurring menopause, surgical menopause occurs when both ovaries are removed (oophorectomy) with or without removing the uterus (hysterectomy) before going through natural menopause. Ovaries may be removed for several reasons, including to treat ovarian cancer or endometriosis or to reduce the risk of ovarian or breast cancer in individuals at increased risk.

In surgical menopause, there is an abrupt loss of ovarian hormones including estrogen, progesterone and testosterone. Many women feel this hormone loss through severe and bothersome symptoms such as hot flashes, night sweats, sleep and mood disturbance, and sexual health concerns. Care providers can prepare women undergoing oophorectomy for these possible symptoms, but the precipitous drop in hormone levels still can be jarring.

 

Emotional and long-term health concerns

Regardless of the cause, going through early menopause can be difficult emotionally, mentally and physically.

Importantly, women with early menopause and POI have higher rates of early cardiovascular disease, bone loss (osteoporosis) and memory issues (cognitive decline and dementia). Sexual health concerns including diminished libido, vaginal dryness and painful intercourse are common. Women may or may not experience typical symptoms of natural menopause with hot flashes and night sweats, but they often experience mood swings and irritability.

Associated emotional issues can be especially challenging for those who were planning on having children in the future. Some women feel devastated by the news that they are going through menopause, as they associate the condition with being older. Mood issues with depression and anxiety, especially in women with abrupt menopause from surgery or cancer treatment, may occur despite no prior history of mental health concerns.

 

Treatment

No matter the underlying cause of POI or early menopause, hormone therapy must be considered as a treatment option to prevent concerning long-term health outcomes. Although there are no randomized, controlled studies that demonstrate the benefit of hormone therapy in women with early menopause, many studies have observed women over time. These studies have shown that hormone therapy is beneficial in preventing the adverse outcomes associated with early loss of ovarian function, including the effects on bones, heart health and cognition.

Hormone therapy usually includes a form of estrogen along with progesterone if you still have your uterus (no hysterectomy). Treatment until at least the natural age of menopause (around 52 years) is typically recommended. Your medical provider can review the risks and benefits of hormone therapy that are specific to you. If you’re still unsure, you can seek the opinion of a certified menopause consultant.

There are also many ways you can help take care of yourself to decrease the risk of cardiovascular disease, bone loss and cognitive decline. Work to maximize a healthy lifestyle — including exercise and maintaining a healthy weight — and monitor and control blood pressure, cholesterol and blood sugar. Moderate exercise supports good cardiovascular health, while weight-bearing exercise and adequate calcium and vitamin D contribute to bone health. Limit or eliminate alcohol use.

Make sure to care for your mental and emotional health as well. Seek support from your medical providers, friends and intimate partners. If you’re having trouble coping with your early transition to menopause, you may benefit from talking to a therapist or counselor. You may also find it helpful to practice stress management techniques such as deep breathing or meditation. The nature of your sexual relationships may change with your physical symptoms, making open communication with your sexual partners critical.

Understanding the impact of POI and early menopause on your health and well-being and creating a medical, social and psychological support network will likely be imperative as you navigate the challenges of menopause at an early age.

Carol Kuhle, D.O., M.P.H.

Dr. Carol Kuhle is a Consultant and Assistant Professor of Medicine in the Division of General Internal Medicine with a second appointment in the Division of Preventive, Occupational and Aerospace Medicine at Mayo Clinic in Rochester. She is presently the Director of the Menopause and Women’s Health Clinic at Mayo Clinic in Rochester, which specializes in complicated menopausal hormonal and sexual health issues for adult women with a special focus on cancer survivorship. She is a Certified Menopause Practitioner with over 20 peer-reviewed publications, and a member of the Board of Directors for the Scientific Network on Female Sexual Health and Cancer.

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