Menopause happens when your reproductive hormones change and there are no eggs left in your ovaries. Menopause can happen at the expected age, prematurely or early.
What is premature and early menopause?
What causes premature and early menopause?
Cancer and menopause
Surgery and menopause
Premature menopause is when your final period happens before the age of 40.
Early menopause is when your final period happens between the ages of 40 and 45.
Up to 8% of women have had their final period by the time they are 45. This percentage is likely to be higher if we include menopause caused by surgery and cancer treatment.
Premature ovarian insufficiency (POI) can cause premature and early menopause.
Cancer treatment and surgery can also cause premature and early menopause.
POI is when your periods stop suddenly at an earlier than expected age.
The causes of POI are not always clear. In about 60% of women, a cause can’t be found.
The first signs of POI may be:
If you are younger than 45 and you haven’t had your period for more than 3 months, talk to your doctor. They will need to do a full physical examination and investigate the cause.
Your doctor may refer you to a specialist to do some tests. For example:
After POI is diagnosed, your doctor may ask you to do more tests to check for possible causes and other conditions.
If you have been diagnosed with POI and don’t want to get pregnant, you should use contraception. Many women are unable to conceive a baby naturally after POI, but there is a one in 50 chance of pregnancy.
If you do want to get pregnant, you can use hormone medicines to bring on monthly periods. Talk to your doctor about the benefits and risks of these therapies.
If you have POI and you’re finding it hard to fall pregnant, you can explore different ways of having children, for example, IVF or surrogacy using a donor egg.
You may be more likely to have premature or early menopause if:
Premature and early menopause can also be caused by:
POI is associated with autoimmune conditions such as Addison’s disease, thyroid disease, type 1 diabetes, Crohn’s disease and coeliac disease.
Symptoms of premature and early menopause are like those you would experience if you reached menopause at the expected age of 51 to 52 years, but symptoms can often be more severe due to the sudden change in hormone levels.
Watch this video to understand the causes of premature and early menopause, and available treatments. Download video transcript (DOCX 160KB).
If you experience premature or early menopause, different health professionals can help you manage symptoms. For example, endocrinologists, gynaecologists and psychologists.
You should also see your doctor regularly over the years to check your health needs, medicines and any health risks.
Monash University’s Ask Early Menopause helps you learn more about premature and early menopause, including stories from women who have experienced it.
Due to reduced levels of certain hormones, you will need to use hormone medicines – usually menopausal hormone therapy (MHT) or the Pill – until the expected age of menopause. MHT will reduce potential long-term health risks of osteoporosis and cardiovascular disease.
Like any treatment, MHT or the Pill can have side effects. If you use MHT or the Pill, there may be a small increase in the risk of thrombosis (a condition where blood clots block blood flow). Serious side effects of MHT in younger women are very rare.
Some people should not use MHT or the Pill. For example, if there is a history of breast cancer.
Your doctor will discuss the best treatment options for you.
Women who experience premature or early menopause can be at greater risk of mood changes, anxiety and depression.
It can be upsetting to experience menopause earlier than expected. It’s normal to feel a sense of loss, sadness and grief.
You may also have negative feelings about your body image, fertility, femininity and sexuality.
There are lots of things you can do to look after yourself during this difficult time.
It’s important to talk to someone if you feel anxious or depressed after your diagnosis. Your doctor can help with symptom relief and refer you to a psychologist if needed.
After a diagnosis of premature or early menopause, physical and emotional changes may reduce your desire to be intimate.
It can be distressing to have hot flushes and sweats at a young age.
You might also feel conscious of physical changes, like vaginal dryness, which can cause painful sex and result in a reduced sex drive (libido).
Depending on your stage of life and family plans, a diagnosis of early or premature menopause may change your plans and could affect your relationship.
It’s important to seek support from people close to you. If you have a partner, they might not know about menopausal symptoms or what you are going through. You can suggest going to your gynaecologist or doctor’s appointments together or seek counselling if required.
You can also suggest they read our information for partners.
Some studies suggest women who have premature or early menopause may have a higher risk of developing heart disease and osteoporosis compared with women who reach menopause at the expected age.
Given the potential risks, it’s important to talk to your doctor about different treatment options.
You can reduce your risk of developing heart disease by having a healthy lifestyle.
There is some evidence that suggests menopausal hormone therapy (MHT) can reduce the risk of heart disease.
After being diagnosed with premature or early menopause, it’s important to have regular health checks, including blood pressure, weight, cholesterol and sugar level checks.
Women who experience premature or early menopause can start to lose bone density at an earlier age than women who experience menopause in their 50s. This puts them at a greater risk of developing osteoporosis earlier in life. MHT is the treatment of choice for women with osteopenia or osteoporosis – until they are about 60 years of age.
After being diagnosed with premature or early menopause, it’s important to have regular checks of your bone mineral density.
Learn how to reduce your risk of osteoporosis with a healthy diet and exercise.
Menopause can happen because of cancer treatment, such as chemotherapy or radiotherapy, that causes your ovaries to stop working. This is known as ‘medically induced menopause’. The sudden change in hormones, particularly oestrogen and testosterone, may lead to more severe menopausal symptoms.
Not all cancer treatments will cause menopause. Depending on the treatment, menopausal symptoms may be temporary or permanent. Permanent menopause can also be influenced by factors like your age.
Breast cancer is the most common cancer that affects women, so much of the information and research about cancer and menopause relates to breast cancer. But treatment for other cancers, including childhood cancers, non-hormonal and hormonal cancers can also result in menopause.
Studies show that 25% of women who develop breast cancer have not reached menopause, so their cancer treatment may cause an earlier-than-expected menopause.
If you have medically induced menopause, the drop in oestrogen levels may increase your risk of osteoporosis. It can also increase the risk of early development of heart disease. Talk to your doctor about how to reduce these risks.
It can be hard to tell the difference between menopausal symptoms and symptoms caused by cancer treatment.
Research suggests that young menopausal women with breast cancer may experience:
If you go through cancer and menopause at the same time, it can be very distressing. It is normal to experience a sense of sadness and loss of control.
It’s important to talk to someone if you feel emotional, anxious or depressed. Your doctor can help with symptom relief and refer you to a psychologist if needed.
There are lots of things you can do to look after yourself during this difficult time. You can also discuss the risks and benefits of hormone therapy and non-hormone treatments with your oncologist and other treating doctors.
If you have been diagnosed with cancer and would like to have children (or more children) you can ask your oncologist about options to preserve your fertility. This must be done before you start chemotherapy or radiotherapy. Your options may include:
Check out these YouTube videos about fertility after cancer, produced by the Victorian Integrated Cancer Service.
For more information about chemotherapy and fertility:
Treatment for some types of cancer can affect your physical ability to have or enjoy sex. It can also affect your desire to be sexually intimate.
Visit the Cancer Council Victoria website to learn more about sex and intimacy after cancer.
Some surgeries can cause menopause. This is known as ‘surgical menopause’. For example, surgery to remove your ovaries or uterus (hysterectomy) due to cancer or other health conditions.
If you have menopause due to surgery, your levels of oestrogen and testosterone hormones will suddenly drop, causing symptoms to be more severe than normal.
Menopausal hormone therapy (MHT) can be an effective way to manage your symptoms, but it may not be an option for some women, for example, if you have a hormone-sensitive cancer. If this is the case, you can explore other options such as non-hormone treatments and medicines. Talk to your doctor about the options and the risks and benefits of each.
If your uterus is not removed during surgery and you choose to use MHT, the therapy will include oestrogen and progestogen. This is because progestogen protects against uterine cancer.
If you are under 45 years of age when you experience surgical menopause, the drop in oestrogen levels can increase your risk of osteoporosis. It can also increase the risk of early development of heart disease.
Talk to your doctor about how to manage menopausal symptoms and reduce the risk of other health problems.
After surgery you may feel different emotions, depending on the reason for your surgery and what’s happening in your life.
Your experience may be influenced by factors such as your age, whether you are in a relationship, your family plans and whether you have good supports.
There are lots of things you can do to look after yourself during this difficult time.
It’s important to talk to someone if you feel anxious or depressed after surgical menopause. Your doctor can help with symptom relief and refer you to a psychologist if needed.
This content has been reviewed by a group of medical subject matter experts, in accordance with Jean Hailes policy.
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