Menopause is the time in a woman's life that marks the end of her menstrual periods. In most cases, this is a normal body change that completes when you haven't had your period for a year, and almost always happens between the ages of 45 and 55 (51 years on average). It is a natural process, and it is called early menopause before the ages of 45(1). If it occurs before the age of 40 it is called Premature Ovarian Insufficiency (POI) (2). 

Symptoms and signs you may experience during early menopause

The main symptom of early menopause or POI is that menstruation becomes infrequent or completely interrupted, for no other reason, before the age of 45. However, every woman experiences menopause differently. They may have symptoms and signs that begin before your period ends and last for several years. These include (3,4): 

• Hot Flushes caused by a sudden feeling of heat in the upper body. They are most common in the years just before and after menstruation ends but may continue for many years in some women. 
• Vaginal dryness and discomfort during sexual intercourse. It can begin during perimenopause (transition to menopause) and can worsen over time, becoming even more troublesome in the postmenopausal years
• Sleep disorders that cause sleep problems such as anxiety, night sweats and increased need to urinate. 
• Emotional changes such as low mood, irritability, depression, and anxiety. 
• Reduced sex drive (low libido). This leads to a decrease in sexual interest or changes in sexual response. 
• Low fertility. 
• Memory problems and difficulty concentrating. 
• Physical changes such as weight gain, fat buildup in the abdomen, reduction in breast size and tenderness, hair and skin changes, and urinary incontinence.

Health risks that early menopause can bring

Women who experience early menopause may experience increased health risks. Among the effects of menopause that stand out most are (4, 5): 

• Increased risk of cardiovascular (heart) disease and osteoporosis (weak bones) due to low oestrogen levels. 

• Feeling sad and depressed about loss of fertility or changes in your body. You may feel less energy and lack of interest in things you once enjoyed. 

These risks can be mitigated by living an active and healthy life. It's important that you eat a healthy diet, have good sleep habits, and practice exercise. Also, it can help to seek counselling or other treatments for depression and explore your experience by talking to your friends and family (4). 

Causes of early menopause

According to the NHS (3), the early menopause and POI occur when a woman's menstruation stops for a year before age 45. It can develop by several factors:  

• Because the ovaries naturally stop producing normal levels of certain hormones. 

• As a side effect of cancer treatment. 

• Surgery to remove the ovaries 

• Certain diseases, infections or hereditary causes. 

However, factors that may be involved in the development of early menopause are (3,6):  

Impaired reproductive hormone levels

The early menopause can happen naturally if the ovaries stop producing normal levels of certain hormones (particularly the hormones that regulate menstruation: oestrogen and progesterone), due to genetic causes, an autoimmune disease, or certain infections. This may happen when you get close to 40, leading to a decrease in fertility. Likewise, your periods can undergo changes, making them longer or shorter, more intense or less frequent, until you stop having them. 

Cancer treatments

Cancer treatments of radiation therapy and chemotherapy can induce menopause permanently or temporarily. This they cause symptoms such as hot flushes during or shortly after treatment. Chemotherapy can affect the ovaries with interruption of menstruation and fertility, although it is not always permanent after treatment. Whereas radiation therapy only affects ovarian function if it is specifically targeted at these organs. Also, the risk of premature menopause may be increased if you receive radiation therapy around the brain or pelvis.

Surgery to remove the ovaries

Surgical removal of the ovaries can also cause early menopause. Following this surgery, menstrual periods stop, and you may experience hot flushes and other signs and symptoms that can be more severe, than if menopause occurs naturally. This is because hormonal changes can happen abruptly rather than progressively over several years.

Primary ovarian failure

POI is when menopause occurs before the age of 40. The cause is often unknown, but in some women it may be due to: 

• Chromosomal abnormalities, which are alterations in the structure of the chromosome, such as turner syndrome. 
• Autoimmune disease such as type 1 diabetes or multiple sclerosis where the immune system attacks body tissues. 
• Less often from other infections such as tuberculosis, malaria, and mumps. 
• For hereditary reasons, if any of your relatives went through the early menopause. 

Treatments to relieve symptoms of early menopause

Not all women will experience symptoms of early menopause and for some women the symptoms any symptoms can settle in time. However, treatment with hormones is usually recommended in order to help with any symptoms, but also to reduce the risk of chronic disorders that can develop with age (such as osteoporosis and heart disease). The main ones are (6, 7, 8): 

Hormone therapy (HT)

Oestrogen hormone replacement therapy is an effective treatment to relieve the symptoms of low oestrogen during early menopause such as hot flushes, night sweats, vaginal dryness and low mood. If you still have a uterus, it is also combined with progesterone.  

Recommendations for starting hormone therapy during early menopause are: 

• Women who have POI (menopause before the age of 40) are advised to have HRT until at least the average age of menopause which is 51 (unless there is a medical reason why HRT would not be suitable) 
• Women who have early menopause between 40 and 45 should be offered HRT (unless unsuitable) as it will help to reduce the increased risks of osteoporosis and heart disease associated with early menopause. 

Vaginal estrogen

Giving oestrogen directly into the vagina is a treatment that relieves vaginal dryness, sexual discomfort, and urinary incontinence. This can be applied using a vaginal tablet, cream, or ring, which releases a small amount of oestrogen that is absorbed into the vaginal tissues..

Healthy lifestyle

Living a healthy lifestyle can help reduce the effects of early menopause. For that, eat a balanced diet that provides essential nutrients such as vitamins A, group B, C, D, E and K and minerals such as calcium, magnesium, selenium and zinc. 

This should include a variety of fruits, vegetables, and whole grains. Limit saturated fats, oils, and sugars. Check with your doctor if you need supplements of these nutrients to help meet your daily needs.

Exercise regularly to protect yourself from age-related illnesses. Sleep well and avoid smoking. These healthy habits can help you manage menopausal symptoms, in addition to hormone treatment, where appropriate.  

Early menopause happens when menstrual periods are rare or stop before age 45. It can happen naturally or be induced by various treatments, and its development can bring health risks. Going through this stage of your life can be difficult, but there are treatments to relieve your symptoms, which should be guided by medical advice. A healthy lifestyle that includes a balanced diet and regular physical exercise will promote change and improve your well-being. 

References

1. MedlinePlus. Menopause [Internet]. 2019 Jun 30 [cited 2023 Feb 12]. Available from: https://medlineplus.gov/spanish/ency/article/000894.htm   
2. Daisy Network. What is POI? [Internet]. [cited 2024 Sep 13]. Available from: https://www.daisynetwork.org/about-poi/what-is-poi/   
3. National Health Service (UK). Early menopause [Internet]. 2021 Feb 2 [cited 2023 Feb 12]. Available from: https://www.nhs.uk/conditions/early-menopause/  
4. Brazier A. Signs and symptoms of menopause, and treatments if you are experiencing them [Internet]. Medical News Today. 2021 Oct 3 [cited 2023 Feb 12]. Available from: https://www.medicalnewstoday.com/articles/155651#_noHeaderPrefixedContent  
5. Office for Women's Health. Early or premature menopause [Internet]. 2018 May 22 [cited 2023 Feb 12]. Available from: https://www.womenshealth.gov/menopause/early-or-premature-menopause 
6. Mayo Clinic. Menopause: Symptoms and causes, diagnosis and treatment [Internet]. 2021 Jul 29 [cited 2023 Feb 12]. Available from: https://www.mayoclinic.org/es-es/diseases-conditions/menopause/symptoms-causes/syc-20353397   
7. U.S. Food and Drug Administration. Menopause [Internet]. 2019 Aug 22 [cited 2023 Feb 12]. Available from: https://www.fda.gov/consumers/womens-health-topics/menopause   
8. McDermott A. Can vitamins help relieve menopause symptoms? [Internet]. Healthline. 2019 Apr 22 [cited 2023 Feb 12]. Available from: https://www.healthline.com/health/menopause/vitamins-for-menopause#takeaway