Menopause typically begins between the ages of 45 and 55, but for some women, it can start much earlier

According to research, 1 in 100 women under 40, 1 in 1,000 under 30 and 1 in 10,000 under 20 experience early menopause or premature ovarian insufficiency.

This can happen naturally or as a result of certain medical treatments. 

Recognising the signs of early menopause is important, especially for women under 45 who experience changes in their menstrual cycle.

What is Early Menopause?

Early menopause is diagnosed when periods become infrequent or stop entirely before the age of 45. It is not caused by pregnancy or other common reasons for period irregularities. 

While it can occur on its own, certain treatments like chemotherapy, radiotherapy, or surgeries can trigger early menopause.

If you’re under 45 and notice changes in your period, such as infrequent cycles or if they stop altogether, it’s important to speak with your GP. 

They can help assess whether these changes are due to early menopause or another underlying condition.

Symptoms 

The most common symptom of early menopause is irregular or missed periods. 

However, women may also experience a range of other physical and emotional symptoms, including:

• hot flushes
• night sweats
• difficulty sleeping
• low mood or anxiety
• problems with memory or concentration
• vaginal dryness and pain, itching or discomfort
• reduced sex drive (libido)
• discomfort during sex
• fatigue
• headaches
• heart palpitations (a fast-beating, fluttering or pounding heart)
• recurring UTIs
• lack of energy
• loss of muscle
• weight gain
• joint aches and pains

Women who go through early menopause also face an increased risk of developing osteoporosis and cardiovascular disease, as the body produces less oestrogen, a hormone crucial for bone and heart health.

Causes 

There are several causes of early menopause, including:

1. Ovarian Function Decline  

Early menopause can occur if the ovaries stop producing enough hormones, particularly oestrogen. 

If periods cease entirely before the age of 40, this is known as 'premature ovarian failure' or 'primary ovarian insufficiency.' 

The exact cause is often unclear, but contributing factors can include:

• Chromosomal abnormalities like Turner syndrome
• Autoimmune diseases, where the body’s immune system mistakenly attacks its own tissues
• Rare infections such as tuberculosis, malaria, or mumps

In some cases, premature ovarian failure runs in families, especially if a close relative experienced menopause in their 20s or 30s.

2. Cancer Treatments  

Radiation and chemotherapy, especially when administered around the pelvis or brain, can damage the ovaries, potentially leading to early menopause. 

The likelihood of this occurring depends on several factors, including the patient's age and the specific type of treatment.

3. Surgical Removal of Ovaries

If both ovaries are surgically removed, either during treatment for other conditions or as part of a hysterectomy, early menopause will result. 

Most hysterectomies, however, do not involve the removal of the ovaries.

Diagnosing Early Menopause

If you suspect you may be experiencing early menopause, your GP will look into your symptoms, medical history, and may recommend a blood test to measure hormone levels, particularly follicle-stimulating hormone (FSH). 

High levels of FSH can indicate that the ovaries are no longer functioning properly. If necessary, your GP might refer you to a specialist for further evaluation and treatment.

Treatment Options

Treating early menopause often involves hormone replacement to restore the body's balance. 

This is usually achieved through the combined contraceptive pill or hormone replacement therapy (HRT). 

Your GP might recommend taking these treatments until around the natural menopause age of 51, to reduce the risk of osteoporosis and cardiovascular disease.

However, hormone therapy may not be suitable for all women, particularly those who have had certain types of cancer, like breast cancer. 

In such cases, your GP will discuss alternative treatments and lifestyle changes to manage your symptoms and protect your health.

If hormone replacement is not enough to relieve symptoms, further specialist support may be necessary.

Support 

Early menopause can have a significant emotional impact, particularly for women hoping to have children. 

While early menopause affects fertility, there are still options available. Some women may choose to use donated eggs, while others consider surrogacy or adoption as potential paths to motherhood.

Emotional support is also so important. Joining support groups or seeking counselling can help women navigate the emotional and physical challenges of early menopause. 

Organisations like The Daisy Network, which supports women with premature ovarian failure, and Cancer.ie, which provides information on managing menopausal symptoms after cancer treatment, can offer valuable resources.

Early menopause is relatively uncommon, but it’s important to recognise the signs and seek medical advice if you experience any symptoms before the age of 45. 

With the right treatment and support, many women can manage the symptoms and health risks associated with early menopause, improving their quality of life. 

If you are concerned about early menopause, speak to your GP to get the help and guidance you need.

*all information provided in this article references HSE information, more of which you can find here.