What is early or premature menopause?

Premature ovarian insufficiency (POI) is when a women’s final period is before the age of 45 years. Most women in the UK will go through menopause between the ages of 45-55 years.

POI is how we now describe early menopause. The word “menopause” has lots of negative associations but is a natural and normal event in all women, whilst POI is a medical issue that happens in young women. Women with POI can sometimes resume their periods which can cause confusion if they have been sure that they have gone through menopause.

A woman is born with all the eggs she will ever have. Hormones are produced (oestrogen and progesterone) when eggs are released every month. POI is when the ovary has run out of eggs. Without eggs, a woman cannot conceive. If eggs are not being released, then the hormones are not being produced, causing medical symptoms.

Early menopause can also occur following surgical removal of the uterus and/or ovaries (hysterectomy) or following chemotherapy or radiotherapy.

How common is it?

POI affects more women than is commonly thought, affecting around 1 in 100 women before 40, and 1 in 20 women before 45. That’s quite a lot. There are many more women who will develop symptoms of POI.

What are the symptoms of early menopause? (And what does it ultimately mean for a woman’s reproductive life?)

Every woman is different but the earliest symptoms may be related to fertility – not being able to conceive or miscarriage. Irregular cycles and changes in mood are also common symptoms.

How is early menopause treated?

Unfortunately, there is no scientifically accepted treatment to reverse premature ovarian insufficiency. There is a lot of research, and the internet is full of hopeful treatments but at this moment in time, there is no concrete treatment based on medical evidence.

There are several areas that need to be thought about, each with different approaches for different people. Many women will be diagnosed with POI during fertility investigation. The treatment options need to be discussed with their fertility doctor and range from no treatment to egg donation. These are often quite difficult choices. It’s common for patients (and even some doctors!) to think that IVF will be the answer, but IVF needs to use a woman’s eggs. POI is caused by the absence of eggs, so IVF can’t be used.

The treatment of irregular cycles, hot flushes, mood and loss of libido can be helped with hormone treatment. Hormone replacement will not improve fertility.

There are important long-term issues that are caused by POI including thinning bones (osteopenia and osteoporosis) as well as heart disease. Happily, both bones and the heart can be protected by hormonal medication.