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The average age of menopause is between 45-55 years of age. However, many individuals will experience it prior to this age. 40-45 years is classed as “Early Menopause” and prior to age 40 the term often used is: Premature Ovarian Insufficiency, (POI).
Sometimes other terms can be seen, including: Premature Menopause or Premature Ovarian Failure. This can occur in individuals as young as teenagers.
POI is not common, but it is also not rare. Statistically, 1:100 aged under 40 years; 1:1,000 aged under 30 years and 1:10,000 under 20 years will develop POI.) The cause is often unknown and this can be distressing to the individual.
Some causes can be auto-immune, where the body turns against itself to cause problems; genetic conditions – including rare conditions like: Turner Syndrome; Fragile X Syndrome; Infections like Mumps, TB or Malaria; Surgical removal of womb, (Hysterectomy) especially where the ovaries are removed, as well; Cancer treatments.
POI can be distressing for a number of reasons and can affect the individual's mental health through isolation and often shame and embarrassment; physical health with impact on cardiovascular systems, bone health, brain function, fertility and urinary system. Individuals have often felt dismissed by the healthcare profession and may be told they are "Too young for the menopause".
Diagnosis
Diagnosis of POI is different from Menopause occurring between 45-55 years. It involves two blood tests for Follicle-Stimulating Hormone six weeks apart. Other tests should be performed to ensure other causes are ruled out, including Thyroid function, anaemia, Diabetes, etc.
Once POI is confirmed, a bone mineral density scan should be performed to ensure baseline bone health. Individuals should be offered counselling and support and close monitoring of the individuals should continue once treatment is commenced.
Complications
When Oestrogen levels drop in Menopause the individual may experience a number of different symptoms throughout the body, sometimes mild, other times, severe. This is because Oestrogen works on a number of different aspects of the body, not just the reproductive system.
Similarly in POI the individual may experience symptoms but also be at risk of serious, long-term complications. A lack of Oestrogen in individuals with POI can increase the risk of Cardiovascular Disease, Diabetes, Osteoporosis, Alzheimers, Vaginal dryness, recurrent Urinary Tract Infection and fertility problems.
Treatment
Provided the individual has no medical reasons not to take Oestrogen-based medication, Hormone Replacement Therapy (HRT) should be offered to them. It is important to discuss the benefits of HRT on bone health, cardiovascular health, mental health, etc. It is essential to discuss contraception and sexual health as well as even though fertility may be reduced in individuals with POI it is still possible to get pregnant therefore adequate contraception should be discussed along with condom use and safer sex advice.
Menopause in every individual is different and treatment is always dependent on the needs of that person. This is no different in POI and treatment and long-term monitoring is essential to ensure the person can lead a full life and prevent long term difficulties.
If the individual does not get a satisfying response from one healthcare professional they must be supported to get a second, third or even fourth opinion. We are all different and all important and deserve to be treated as such.
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