Menopause before 40 and spontaneous premature ovarian insufficiency

Menopause before 40 and spontaneous premature ovarian insufficiencyMAIN POINTS

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Premature ovarian insufficiency (POI) is a loss of function of the ovaries in women who are less than 40 years of age. The ovaries do not release eggs regularly and do not produce usual amounts of oestrogen.

Women with spontaneous POI have irregular or no menstrual periods. Women may or may not have menopausal symptoms such as hot flushes. 

Up to 4% of women will spontaneously have POI and enter menopause before the age of 40. Spontaneous early menopause (menopause between 40 and 45 years) affects approximately 12 in every 100 women.

POI can affect your short- and long-term physical and mental health. Speak with your doctor about emotional support and lifestyle and treatment options to manage your health.

Symptoms and consequences of premature ovarian insufficiency

POI has a number of symptoms and long-term health problems, but your doctor can advise you about treatment and other options to manage your symptoms and health (see below).

Signs and symptoms of POI can include:

These symptoms can come on suddenly or gradually and can occur while you are still having periods. Long-term health consequences of premature ovarian insufficiency can include a greater risk of:

Causes of premature ovarian insufficiency

In up to 90 per cent of women with spontaneous POI, the cause is unknown. In some cases, the condition can be associated with:

Risk factors for spontaneous POI include:

Diagnosis of premature ovarian insufficiency

Diagnosis of POI is difficult and can be delayed because women and their doctors might not consider the possibility of menopause in younger women. Excluding other potential causes for the loss of your period will be needed.

Criteria for a diagnosis of POI include:

A diagnosis of POI can be distressing and you will need to plan for your future health. Make sure you are comfortable with your healthcare team because you will need followup support and management options.

Treatment and other options for managing your health

Women with POI should discuss with their doctor the possibility of using hormone therapy.

In women more than 50 years of age, hormone therapy is called menopausal hormone therapy (MHT). In women who are aged less than 50, similar hormone therapy can be called hormone replacement therapy (HRT) because the treatment is replacing hormones that would otherwise be produced in younger women. If you choose to use HRT, international guidelines recommend that you continue HRT until the typical age of menopause (around 51 years) to reduce your risk of long-term health problems. Oestrogen therapy is not suited to everyone and is best avoided if you have breast or endometrial cancer. In these cases, non-hormonal options are available to help manage hot flushes and other symptoms.

HRT options include (see AMS fact sheet – What is MHT and is it safe?):

If contraception is required, hormonal options include the oral contraceptive pill or an intrauterine device plus oestrogen (usually as a patch or gel). If hormones are not recommended for your situation, discuss non-hormonal contraceptive options with your doctor

Managing fertility issues

There is a very small chance that some women with POI can become pregnant. If you do not want to become pregnant, you should use contraception.

Losing fertility at an early age can cause emotional distress. The support of a partner, family, friends and your healthcare team can help you manage fertility issues.

Women can manage their infertility in a number of ways including:

Managing health risks associated with premature ovarian insufficiency

Adopting healthy lifestyle changes (see AMS fact sheets – Lifestyle and behaviour changes for menopausal symptoms and Weight management and healthy ageing) can reduce the risk of some of the health impacts associated with POI. Long-term health risks include:

It is widely known that regular physical activity, a healthy diet and healthy sleep patterns can improve these problems, no matter what the cause. In addition, regular check-ups (including blood tests and bone scans) with your doctor can help you to manage your health.

Osteoporosis

Osteoporosis in women with POI can be caused by:

In addition to lifestyle changes (quitting smoking, engaging in regular weight-bearing activities, and ensuring adequate dietary intake of calcium and vitamin D) women should have regular bone density scans every one or two years. Use of HRT can help to maintain bone health.

Cardiovascular or heart disease

POI can result in an earlier increase in the risk of heart disease in women.

Taking HRT early and continuing treatment until the age of a natural menopause (51 years) can reduce the risk of heart disease. Regular check-ups for high blood pressure, diabetes and fats in the blood will help you manage your heart health.

Learning and memory problems

There is only limited evidence that low levels of oestrogen affect memory. Taking HRT early and continuing treatment until the age of a natural menopause (51 years) might reduce the risk of any potential learning and memory problems.

Emotional issues

A POI diagnosis means women have the stress of having to cope with potential menopause, infertility and the related long-term consequences. It is only natural to feel some psychological distress and some women might have anxiety and depression. Women can feel confused, sad, old before their time and have mixed feelings about other women’s pregnancies. Psychological counselling can ease this distress. Support from the woman’s partner, family and friends is important.

Support groups

In addition to the support of family, friends and a healthcare team, some women find it useful to talk to other women in the same situation. Available support groups include:

ACCESS Australia (Australia’s National Infertility Network) – www.access.org.au

The Daisy Network Premature Menopause Support Group – www.daisynetwork.org.uk

NZ Early Menopause Support group – www.earlymenopause.org.nz

Where can you find information about other treatment options?

If your symptoms are bothering you, your doctor can help. Your doctor can tell you about the changes in your body and offer options for managing your symptoms. Other fact sheets about treatment options include:

The Healthtalk Australia Early Menopause online resource contains women’s stories, information, question prompt list and links to services: https://healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/overview-womens-experiences/

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

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NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individual’s personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated October 2020

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