When we talk about menopause, most of us immediately start thinking of women in their 50s. It’s only recently that the conversation around perimenopause has become mainstream, with more of us recognising that the hormonal transition begins in our 40s. That process can last up to 12 years – culminating when periods finish and post-menopausal life begins. But menopause can also affect women under 40 too, and it’s about time we raised awareness for those whose experience isn’t spoken about quite so often. 

You may have heard the terms ‘early menopause’ and ‘premature menopause’ bandied about, but the two aren’t synonymous; they refer to separate conditions.

Early menopause

If you experience the hormonal change leading to the menopause before the age of 45, you’re going through early menopause. 

Premature menopause

Menopause kicking in under 40 can be the result of premature ovarian insufficiency, and that’s known as premature menopause. 

Emma Bardwell, a specialist menopause nutritionist and author of The Perimenopause Solution, tells Stylist: “Early menopause is classed as between the ages 40-45. This is estimated to happen to 12 in 100 women, and it’s usually permanent, so a woman’s periods won’t return and she won’t be able to get pregnant.

“POI (premature ovarian insufficiency) happens under the age of 40, and it can even affect teens, with some girls never starting their periods.”

“Unlike the early menopause, some women who have POI may still have periods (albeit intermittently) and there’s still a chance of getting pregnant (5% of women with POI conceive naturally),” Bardwell says.

As with the menopause occuring at an expected age, symptoms vary hugely from person to person, spanning low mood, anxiety, hot flushes, night sweats, dizziness, fainting, insomnia and heart palpitations. “The possible signs of POI and EM are as extensive as those relating to ’normal’ menopause and for very young girls there are often not many signs other than a change in periods. But it’s worth searching the Greene Climacteric Scale for the official list if you’re unsure,” Bardwell advises.

Genetics

“Many women never know why this has happened to them, although it can run in families.” says Bardwell. 

Surgery 

She also flags that both can be a result of medical treatments like chemotherapy and radiotherapy, or surgery such as hysterectomies (even if the ovaries are left intact).

Certain medical conditions

“There seems to be a possible link with infections like mumps (although this is very rare), autoimmune disorders such as type 1 diabetes and Addison’s disease or genetic disorders like Turner syndrome or Down syndrome,” Bardwell continues.

She also says that smoking can also bring on earlier menopause, as outlined in a 2018 National Library of Medicine study.

Be kind to yourself

Firstly, Bardwell emphasises: “It’s important for women to realise that it’s not their fault; it’s not down to anything they did or didn’t do and there was nothing they could’ve done to prevent it happening.”

Speak to your GP

“Sometimes it’s worth using the term ‘premature ovarian insufficiency’ rather than menopause or early menopause as many GPs have more training in this aspect of menopause,” suggests Bardwell.

Tests can be done to rule out other conditions or find out other underlying causes such as thyroid imbalance, diabetes or ferritin or folate deficiencies, but ultimately a blood test to measure your FSH levels (two tests are needed four to six weeks apart) is required for diagnosis of POI and EM. According to NICE guidance >40IU/1 is a positive diagnosis,” Bardwell adds.

Don’t be afraid to seek a second opinion

“If you’re not getting the answers or support you need or feel you’re being fobbed off, don’t be afraid to ask for a second opinion or to be referred to a specialist such as an endocrinologist, gynaecologist or menopause specialist,” Bardwell says. 

Look for support

“Living with POI and EM can feel incredibly lonely, but it’s important to remember that there are lots of really useful, evidence-based resources out there and there is help available,” Bardwell highlights.

“Whether you can or can’t take HRT, it’s vital that you look not just at your existing health status through nutrition and lifestyle strategies but also work on future-proofing against the risk factors associated with POI and early menopause.”

Bardwell finishes by emphasising the importance of reaching out to get the help you need, listing endocrinologist Dr Annice Mukherjee, menopause specialist Dr Lindsey Thomas, The Daisy Network, earlymenopause.com and The Complete Guide To POI And Early Menopause by Dr Hannah Short and Dr Mandy Leonhardt as practical resources.

If you’re experiencing early or premature menopause, it’s crucial to seek help and guidance, so you feel as supported as possible during this chapter and beyond.

Images: Getty