What is early menopause?

Most women begin menopause between the ages of 45 and 55. The average age is 51 years old and research on 58,000 women has shown that 95% are infertile at 45 years, and almost 100% at age 50.

But the important word is almost, as all women are different and premature menopause or premature ovarian insufficiency occurs before the age 40.

Menopause occurs when your ovaries stop producing eggs, resulting in low hormone levels of both progesterone and oestrogen is the hormone that controls the reproductive cycle.

Anything that damages your ovaries or stops hormone production can cause early menopause. This includes chemotherapy for cancer or an oophorectomy (removal of the ovaries).

In these cases, your doctor will help prepare you for early menopause. But you can also go into menopause early even if your ovaries are still intact.

What causes early menopause?

There are several known causes of early menopause, although sometimes the cause can’t be determined.

Genetics

If there’s no obvious medical reason for early menopause, the cause is likely genetic.

Knowing when your mother started menopause can provide clues about when you’ll start your own. If your mother started menopause early, you’re more likely than average to do the same.

However, genes tell only half the story.

Lifestyle factors

Some lifestyle factors may have an impact on when you begin menopause. Smoking has anti-oestrogen effects that can contribute to early menopause.

An analysis in 2012 of several studies showed that long-term or regular smokers are likely to experience menopause sooner. Women who smoke may start menopause one to two years earlier than women who don’t smoke.

Body mass index (BMI) can also factor into early menopause. Oestrogen is stored in fat tissue and so women who are very thin have fewer oestrogen stores, which can be depleted sooner.

Some research also suggests that a vegetarian diet, lack of exercise, and lack of sun exposure throughout your life can all cause early onset of menopause.

Chromosome defects

Some chromosomal defects can lead to early menopause. For example, Turner syndrome is a genetic disorder that only affects females.

It causes a wide range of symptoms and some distinctive characteristics and involves being born with an incomplete chromosome. Women with Turner syndrome have ovaries that don’t function properly which often causes them to enter menopause prematurely.

Other chromosomal defects can cause early menopause, too. This includes pure gonadal dysgenesis, a variation on Turner syndrome.

In this condition, the ovaries don’t function. Instead, periods and secondary sex characteristics must be brought about by hormone replacement therapy, usually during adolescence.

Women with Fragile X syndrome, or who are genetic carriers of the disease, may also have early menopause. This syndrome is passed down in families.

Women should discuss genetic testing options with their doctor if they have premature menopause or if they have family members who had premature menopause.

Autoimmune diseases

Premature menopause can be a symptom of an autoimmune disease such as thyroid disease and rheumatoid arthritis.

In autoimmune diseases, the immune system mistakes a part of the body for an invader and attacks it. Inflammation caused by some of these diseases can affect the ovaries and menopause begins when the ovaries stop working.

Epilepsy

Epilepsy is a seizure disorder that stems from the brain and women with epilepsy are more likely to experience premature ovarian failure, which leads to menopause.

An older study from 2001 found that in a group of women with epilepsy, about 14 percent of those studied had premature menopause, as opposed to 1 percent of the general population.

What are the symptoms of early menopause?

Early menopause can begin as soon as you start having irregular periods or periods that are noticeably longer or shorter than your normal.

Other symptoms of early menopause include:

• heavy bleeding
• spotting
• periods that last longer than a week
• longer amount of time in between periods

In these cases, see your doctor to check for any other issues that might be causing these symptoms.

How is early menopause diagnosed?

The time leading into menopause is called perimenopause. During this time, you may have irregular periods and other symptoms that come and go.

You’re generally considered to be in menopause if you go 12 months without menstrual bleeding, and you don’t have another medical condition to explain your symptoms.

Tests aren’t usually needed to diagnose menopause. Most women can self-diagnose menopause based on their symptoms.

But if you think you’re experiencing early menopause, you may want to see your doctor to be sure as they can order hormone tests to help determine whether your symptoms are due to perimenopause or another condition.

These are the most common hormones to check:

Anti-Mullerian hormone (AMH). The PicoAMH Elisa test uses this hormone to help determine whether you are approaching menopause or have already reached your last menstrual cycle.

Hormone levels. Your doctor may check your levels of oestrogen and progesterone as at menopause, both levels decrease.

Follicle-stimulating hormone (FSH). If your FSH levels are consistently above 30 mIU/mL, and you haven’t menstruated for a year, it’s likely that you’ve reached menopause. However, a single elevated FSH test can’t confirm menopause on its own.

Thyroid-stimulating hormone (TSH). Your doctor may check your levels of TSH to confirm diagnosis. If you have an underactive thyroid (hypothyroidism), you’ll have TSH levels that are too high. Symptoms of the condition are similar to the symptoms of menopause.

However, be aware that hormone tests are sometimes unhelpful because hormone levels still change and fluctuate during perimenopause.

Even so, if you’re concerned about any signs of menopause, do discuss this with your doctor.

Helpful information:

If you feel you may be at risk from premature menopause, it is very helpful to take action and maintain hormone balance as well as you possibly can.

Although oestrogen levels definitely decline, so too does progesterone and it is the relationship and ratio of these that is critical for maintaining hormonal health and dealing with menopausal symptoms.