Related Topics: Conditions, Features, HRT, Menopause, Pregnancy

What Is Premature Menopause?

Dr Bond explains this common phenomenon, its causes and consequences.

Dame Dr Shirley Bond

The menopause, strictly speaking, starts at the time of your last period although the term is usually used to cover a longer time span. The average age at which periods stop is 50 but anything between the ages of 45 and 55 is considered normal. The term ‘premature menopause’ is usually used to describe any menopause that occurs before the age of 45. This may be related to a pattern in your family history, and an enquiry into your immediate female relatives will tell you if this is the case. If it occurs like this in your family, then this would be considered normal for you.

What can cause premature menopause?
Apart from family factors, a premature menopause may result from medical or surgical treatment. Any surgery that involves the removal of the ovaries will obviously do this, but other surgery in the region of the ovaries, such as a hysterectomy, can impair their blood supply and lead to atrophy of the ovaries and thus to premature menopause.

Treatment involving chemotherapy and radiotherapy can cause a premature menopause as can treatment with certain drugs and this condition may be permanent or temporary, depending upon the cause. Other conditions such as autoimmune disease, hormonal imbalances and excessive emotional or physical stress can be also bring about a premature menopause

Temporary Hormone Imbalance
If you are diagnosed as having a premature menopause it is very important to ensure that this diagnosis is correct, and to ensure that it is not just a temporary hormone imbalance that can happen for a number of reasons, stress being among them. It is also seen in women in their late thirties or early forties who, having taken the contraceptive pill for many years, then stop it and find that their periods do not return. Their hormones are out of balance, but this does not necessarily mean that they are in an early menopause. Although if their doctor does a hormone test at this time it will often show a menopausal picture and they will usually be offered Hormone Replacement Therapy (HRT). This can be devastating news especially if you were hoping to become pregnant, but in my experience a misdiagnosis of a premature menopause can easily be made.

The reason the test shows this menopausal result is because the ovary has not yet recovered from the suppression caused by the contraceptive pill, and natural ovulation has not yet recommenced. It is therefore always worth waiting for a few months before accepting a diagnosis of premature menopause.

At this time it is essential to eat a good whole food diet and to take nutrients to help the restoration of a normal hormone balance. The periods will often reappear and all will be well, but if HRT is taken the restoration of a normal hormone balance cannot occur.

Trying to become pregnant
If you have been on the contraceptive pill and come off it in order to become pregnant and your periods do not restart, you should not despair. In a normal menstrual cycle when you ovulate the ovary produces large quantities of progesterone to prepare the body and the lining of the uterus for a pregnancy. If no fertilisation occurs, the ovary stops making the progesterone after about 12 days and the lining of the uterus is shed as the menstrual flow. This drop in progesterone level seems to stimulate the pituitary to start the next cycle and stimulate the ovary to ovulate. If this mechanism has been stopped by the pill, or stress, it can take time for it to get going again

It is sometimes possible to restart this cycle artificially by using progesterone for two weeks and leaving it off for two weeks to fool the pituitary that ovulation is taking place.

Consequences of premature menopause and how to treat them
If there is a true premature menopause, and not a temporary situation, then treatment should be considered. One particular risk that increases is that osteoporosis and other problems that are associated with the normal menopause are often more severe. A good diet and nutritional supplements can help these problems, but if the symptoms are severe HRT may be recommended. If HRT is recommended, this is usually offered in the balance and dosage normally prescribed to older women, who have experienced a natural menopause and is advised for long term usage.

It is far better to consider the use of natural or bio-identical hormones as this ensures that you replace the actual hormones that are missing in the correct dosage for you, rather than chemicals in a standard dose. Whether or not it will be necessary to take these long-term or not varies from person to person.

It is interesting that women who frequently experience a premature menopause, and need hormone supplementation, find that this is no longer necessary once they reach the years when the menopause would have been expected to occur naturally. In fact at that time they often experience problems with the hormone supplements that, up until then, have kept them in balance.

This is due to the usual and normal change in hormone production that occurs with the natural menopause, as the premature menopause was due to a malfunction of the ovary. However, it does not seem as if this in any way affects the mechanism whereby fatty tissue starts to make oestrogen, rather than the ovary, at the time of the natural menopause. As a result the woman who had a premature menopause due to ovarian failure or removal now starts making her own oestrogen again, but from a different source – the fatty tissue of her own body.

It is essential that when this occurs that the dosage of the supplemental hormones is adjusted and often such women find that they no longer need to take additional hormones.

All women who experience a premature menopause should have regular screening to ensure that their hormone balance is correct and that they are not developing osteoporosis.

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Please feel free to discuss this article in the comments section below, but note that the author cannot respond to queries made there.
Comments 10
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StolenEggs | 3:56 am, June 23rd, 2010

Is it really necessary to wait a few months to find out? I thought an AMH test was pretty definitive. As well as an ultrasound to determine antral follicle count. If you really have premature ovarian failure I would NOT advise you to wait a few months. Especially not if you want to become pregnant.

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AnnA Rushton | 2:23 pm, June 24th, 2010

Dear StolenEggs:
I confess I’m not quite clear about what you are inferring here, but I have spoken with Dr Tony Coope about this and hope the following may be of help.
To take your last point first, if a woman ‘really has’ premature menopause, with atrophy of the ovaries, then sadly it is already too late for her to become pregnant, however much she might wish it.

If however the follicle count is normal, there is the potential for pregnancy. Then the possibilities are:
1. The hormone levels of LH and FSH are low and irreversible; ovarian atrophy will soon follow, leading to no possibility of pregnancy.

2. The hormone levels are low, but the test has by chance picked out a low point in a fluctuating pattern. Markedly variable levels occur frequently during the pre-menopause, so these tests are definitely not definitive during this phase. The chances of conception and a continuing pregnancy however would be patchy at best.

3. Hormone levels are low, but are due to ovarian suppression by oral contraception, severe/ chronic stress, etc. They may well recover given time, good diet and appropriate supplementation as Dr Bond suggests in her article. In this case not only is it advisable to wait a few months, there is no benefit in not doing so, as a pregnancy cannot occur even with healthy follicles, (or be maintained), until the right hormonal balance is restored.
Unfortunately, in this situation patience has to be a necessity.

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Stolen Eggs | 5:59 pm, July 6th, 2010

Perhaps I wasn’t being clear. In women UNDER 40, early menopause is actually called premature ovarian failure/insufficiency. And unlike naturally occurring menopause, the ovaries may continue to ovulate from time to time. It will not happen on any discernible schedule but it can still happen. Fertility treatments can be used to induce ovulation for those who want to try to get pregnant before losing all of their eggs. It is important to treat this condition early as it puts women at higher risk for osteoperosis and heart disease. So again, I would encourage people to go to their doctor at the first sign of trouble rather than waiting to see if things normalize. That’s my point. Don’t wait. Go get tested. There are hormones that can be tested that do not fluctuate (AMH) that are good indicators of this condition.

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AnnA Rushton | 8:55 am, July 8th, 2010

Thank you for your contribution on this topic, and for clearing up any misunderstanding or confusion.

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flushing fool | 10:40 am, November 15th, 2010

im looking for a cream that is suitable for ladies to help during these flushing episodes following removal of ovaries. Any ideas?

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Michaela Beveridge | 7:13 pm, August 19th, 2011

Its interesting that you say anyone who had a premature menopause should have regular screening for their hormones and also osteoporosis. How do we go about this. When I asked in the early days nothing was forth coming and it has never been suggested to me by my GP despite my concerns.

Thank you
Michaela

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wellsprings | 8:44 pm, August 19th, 2011

Michaela – it is available on the NHS through your doctor, but will depend on them agreeing to this and not all of them will fund it depending on your age and reason for the screening.

I would go back to your GP first and if not available ask them for a private referral as they may be willing to do that for you. Well Woman clinics often also offer this service, but again you will have to pay for it.

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Gaylord | 8:44 am, October 26th, 2012

In @Francheska7778 In our center’s DHEA stideus, DHEA’s effects were evaluated within the framework of comprehensive fertility treatment. DHEA, taken by itself, is unlikely to work. If you have been diagnosed with POF and are trying to conceive, you should consult a reproductive endocrinologist and follow his/her advice. Good luck with your treatment!

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zaza | 10:25 pm, March 25th, 2013

Im 40 and am in or through my menopause since 3 years, not realizing it at the begining. I have not taken any hormons, the only advice was to take the pill till 45, which I didnt take. symptoms like hot flushes have nearly disapeared by now, no menstruations since months, nearly a year, I feel quite settled after a lot of ups and downs and could keep going like this but I am a bit worried about my bones futur. i find there is a lot of scaring women going on, on one side of the bad effects of menopause (like bones or sex hurts- not true for me!) and on the other side a lot of fear of side effects of hormonal treatment, mainly cancer!
is there any possiblity and utility in starting a treatment once you are on “the other side” of premature menopause? thanks for any advice!

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AnnA Rushton | 8:36 am, March 26th, 2013

Many post menopausal women take Serenity to help build bone and guard against osteoporosis, heart disease and breast cancer. Women need adequate hormone balance throughout their lives and there is no age limit to the benefit that can be had. Progesterone is also protective against cancer, synthetic progestogens and oestrogen are both linked to it but the reverse is true for bioidentical natural progesterone. YOu might find this article helpful:
 http://www.bio-hormone-health.com/2012/01/16/what-your-doctor-may-not-tell-you-about-osteoporosis-and-bioidentical-natural-progesterone/

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