I am less than 40 could this be an early menopause?

Dr Alison Vickers, a Sydney GP with a special interest in the care of women during perimenopause and menopause, explains

The short answer

Yes, about 4 in 100 women experience menopause before the age of 40. This is known as premature ovarian insufficiency (POI). For 2 in 100 women the cause is medical treatment, such as cancer therapy. For the other 2 in 100 women, the cause can be genetic, autoimmune, or, in some cases, the cause is unknown. If you’re under 40 and haven’t had a period for four months, see your health professional to find out the reason why. POI is associated with an increased risk of osteoporosis, dementia and heart disease. Depending on your medical history, you may be able to take Menopause Hormone Therapy(MHT), which has proven benefits in POI for preventing osteoporosis, dementia, and heart disease. The benefits are greatest if you start the MHT early.

The long answer

If you are less than 40, and you have had no period for 4 months, you may have premature ovarian insufficiency (POI). It is even more likely if you are having symptoms of menopause like hot flushes or night sweats. I feel like this is a condition we often miss when looking after women and it is so important to make the diagnosis.

What is the cause of premature ovarian insufficiency (POI) or menopause before the age of 40?

POI may be because you have had a medical treatment which has affected your ovaries, like surgery for cancer or endometriosis or chemotherapy or radiotherapy, and you may already know this is the cause.

Or POI may not be related to any medical treatment. This is called spontaneous POI and affects 1-2 women in 100. For this group of women, the cause may be genetic, autoimmune, or unknown. Genetic and autoimmune causes often run in families. Autoimmune causes are when your body’s immune system acts against your ovaries, and you may already have another autoimmune illness or have one in your family.

What else would make me think I may have spontaneous premature ovarian insufficiency (POI)?

If you are less than 40 and have had 4 months with no period and think you may have POI, you may also be having symptoms of menopause like hot flushes and night sweats and mood change or joint pains.

It would be worth checking when your mother or sisters or other female members of your family went through menopause. You may also be a little more at risk of this happening if you already have an autoimmune illnesses.

How is premature ovarian insufficiency (POI) diagnosed?

POI, particularly spontaneous POI, is diagnosed by two blood tests six weeks apart. Once POI is diagnosed, you may need to have other blood sets to check whether the underlying cause could be genetic or autoimmune.

Why is making the diagnosis so important?

Premature Ovarian Insufficiency increases your risk of osteoporosis, heart disease and dementia and so it is important to diagnose so you can understand the available treatments. Of course, it may not be POI, and it might be important to exclude other causes of no periods like pregnancy, eating disorders and PCOS. Making the diagnosis as early as possible is especially important if you have not completed your family since it might still be possible to collect some eggs for future use. 

What treatment are available for premature ovarian insufficiency (POI)?

There are all the same treatments as for menopause starting after 40. Options depend on your medical and family history. If However you are able to take menopause hormone therapy, it has proven benefits, including preventing osteoporosis, dementia, and heart disease. The benefits are greatest if you start MHT early.

What about if I am 42?

If you go through menopause between the ages of 40-45, this is called early menopause and probably has the same causes as before the age of 40 and is also important to diagnose.