What is early menopause?
Although most women go through menopause in their early 50’s, many women will experience an early menopause (before the age of 45) or premature ovarian insufficiency (where the ovaries stop working properly before the age of 40).
For women with early menopause or POI, the ovaries stop producing enough oestrogen which causes menopausal symptoms. Estrogen is very important in the maintenance of bone, heart and brain health and so women with early menopause or POI are at increased risk of heart disease, osteoporosis (thinning of the bones) and dementia.
What investigations are usually required to diagnose POI?
Blood tests
The first step is blood tests – most importantly FSH. If this is elevated it should be repeated in 4-6 weeks in order to confirm the diagnosis. This is usually requested alongside LH and estradiol. If you are still having periods this must be done on days 2-5 of the menstrual cycle otherwise the results can be inaccurate.
Other hormone tests may also be recommended to look for other causes of irregular periods, for example, thyroid function, prolactin, testosterone.
Ultrasound scan
This is often recommended to look for other causes of irregular bleeding and assess the number of follicles in the ovaries (relevant for women trying to conceive)
If the diagnosis of POI or early menopause is confirmed some other tests may be recommended depending on your individual circumstances:
- Bone Density scan – A DEXA scan
- Autoimmune screen – to assess risk of other autoimmune conditions
- Genetic testing – to look for a genetic cause of POI
- Cardiovascular screening – to assess risk of cardiovascular disease
What treatment options are there for POI and early menopause?
Generally, HRT is the recommended treatment option for early menopause and POI. This is to help with menopausal symptoms and to protect against the long term effects of low estrogen.
For women who can’t take HRT or do not wish to there are non-hormonal options to manage symptoms but they do not have the same benefits as HRT and so it is recommended to see a specialist in this situation to have an individualised assessment.
There are many different types of HRT for women with POI and early menopause and it’s a about finding the preparation that works for you and fits in with your lifestyle. Even if you have tried several different preparations before we can advise on different options including bioidentical hormones.