Menopause is a natural part of ageing, typically occurring around age 51. However, when it happens earlier, it is known as premature or early menopause. Premature menopause occurs before the age of 40, while early menopause happens before 45. While this is rare, affecting only 1% of people with periods under 40 and even fewer under 30, it can be a life-altering diagnosis, especially for those hoping to conceive.

What Is Menopause?

Menopause is when periods stop due to hormonal changes and happens to anyone who has periods. Most people experience menopause between the ages of 45 and 55, with 51 being the average. During this time, the ovaries gradually produce fewer hormones—primarily oestrogen and progesterone—that regulate the menstrual cycle and fertility. The decrease in hormone production leads to physical and emotional changes, from hot flashes and mood swings to a decline in fertility. We talk a little more about the changes leading up to menopause in our blog on perimenopause.

It is estimated that there are around 13 million people who are currently peri or menopausal in the UK. Menopause is usually diagnosed when you haven’t had a period for 12 consecutive months. 

Premature Menopause vs. Premature Ovarian Insufficiency (POI)

Premature menopause and premature ovarian insufficiency (POI) are often confused but differ in subtle ways. Premature menopause occurs when the ovaries stop producing regular hormone levels before age 40. In contrast, POI refers to a period of irregular ovarian function before menopause, where hormone levels fluctuate, and ovulation becomes sporadic. POI affects 1 in 100 people under the age of 40, one in 1,000 people under 30 and one in 10,000 people under 20.

Those experiencing POI may still ovulate, although inconsistently, which makes natural conception possible. The likelihood of this significantly diminishes over time.

Causes of Premature and Early Menopause

Various factors contribute to premature or early menopause. Some of the most common include:

• Genetics: If a family member has experienced early menopause, your risk increases. Genetic conditions such as Turner syndrome (when the X chromosome is missing or partially missing)  and Fragile X syndrome are also linked to early menopause.
• Autoimmune disorders: Conditions where the immune system attacks the ovaries, like autoimmune oophoritis or Hashimoto's thyroiditis, can lead to early menopause.
• Cancer treatments: Chemotherapy and radiotherapy can damage the ovaries, triggering early menopause.
• Surgery: Surgical removal of one or both ovaries, especially in cases of ovarian cysts or endometriosis, can cause early menopause.
• Lifestyle factors: Smoking, exposure to environmental toxins, and even a low body mass index (BMI) have been associated with earlier onset of menopause, although more research is needed to understand these connections fully.

In many cases, the cause of premature menopause remains unknown, leaving many with little warning before they start experiencing symptoms.

Symptoms of Premature Menopause

Like natural menopause, premature menopause brings a range of physical and emotional symptoms:

• Irregular periods: Menstrual cycles may become shorter, longer, or more erratic before stopping entirely.
• Hot flashes and night sweats: Sudden heat waves, sweating, and rapid heartbeats can disrupt daily life and sleep.
• Vaginal dryness and changes in libido: Lower oestrogen levels can cause discomfort during sex and reduce sexual desire. This is due to the vagina and urethra tissues thinning, otherwise known as urogenital atrophy. 
• Mood changes: Hormonal imbalances often result in mood swings, irritability, anxiety, and depression.
• Difficulty sleeping: Sleep disturbances like insomnia and night sweats often contribute to daytime fatigue and a lack of energy.
• Brain fog: Some people going through premature menopause may experience memory lapses or a sense of confusion during menopause.

How Premature Menopause Affects Fertility

One of the most challenging aspects of premature menopause is its effect on fertility. As the ovaries stop releasing eggs and hormone levels decline, it becomes more difficult to conceive naturally. However, pregnancy is not impossible. Approximately 5-10% of people with premature menopause can still become pregnant through doing the baby dance if ovulation occurs sporadically.

For those who are diagnosed with early or premature menopause and wish to conceive, several fertility treatments are available. In vitro fertilisation (IVF) is a common option, but it is only viable if some ovarian function remains. For those with diminished ovarian function, egg donation offers a highly successful alternative.

IVF with Donor Eggs

Egg donation is often the most effective fertility treatment for those experiencing premature menopause. In this process, a donor's eggs are fertilised with sperm, and the resulting embryos are transferred to the recipient’s uterus. Donor eggs can significantly improve the chances of conception, particularly for people who no longer ovulate regularly.

Diagnosis and Support for Premature Menopause

If you suspect you may be experiencing premature menopause, your doctor will conduct a series of tests, including:

• A review of your symptoms and medical history.
• Blood tests to check hormone levels, including follicle-stimulating hormone (FSH), luteinising hormone (LH), and oestrogen.
• An ultrasound to evaluate the health of your ovaries.

Support systems also exist for anyone diagnosed with early menopause or POI. Organisations like The Daisy Network provide valuable resources, while social media influencers such as Becky Kearns share their personal journeys with early menopause and egg donation.

Key Takeaways: Navigating Fertility After a Premature Menopause Diagnosis

Being diagnosed with premature or early menopause can be overwhelming, particularly if you are hoping to conceive. While the diagnosis may reduce the chances of conception through doing the baby dance, options such as IVF or egg donation provide an option for many who are going through premature menopause.