What is early and premature menopause?

Early menopause is when the final menstrual period occurs before the age of 45 and is thought to affect up to 8 per cent of women. Premature menopause is when the final menstrual period occurs before the age of 40, affecting about 1 per cent of women. Early or premature menopause may:

• occur spontaneously, where the cause is unknown in most women affected (referred to as premature ovarian insufficiency/failure)
• be caused surgically when a woman has her ovaries removed either alone or with a hysterectomy
• be caused chemically by chemotherapy or radiotherapy for cancer treatment

Symptoms experienced during menopause are essentially the same at any age, although for younger women they can be more severe. As well as this, due to the long-term effects of lack of oestrogen, the risks of developing osteoporosis or heart disease are higher for these women than for those reaching menopause at the usual age (average age of menopause in Australian women is 51 years and ranges from 45-55 years). For this reason, it is important that management advice is sought from your doctor.

Treatment is usually hormone replacement therapy (HRT) until the average age of natural menopause. The possible risks of HRT (including breast cancer) are similar to women of the same age group. Regular assessment by your health practitioner will determine appropriate treatment and management options for you.

The decrease in ovarian hormones (especially oestrogen) and loss of egg cells that occurs with removal of the ovaries or cessation of normal ovarian function results in the symptoms of menopause and infertility.

Symptoms

Menopause symptoms experienced are unique to each woman and may vary from very mild to severe symptoms that can affect quality of life. Hot flushes are the most common symptom of menopause, however women may also experience one or more of the following symptoms:

• night sweats
• aches and pains
• crawling or itching sensations under the skin
• headaches
• vaginal dryness
• reduced libido (sexual interest and desire)
• urinary frequency
• tiredness
• irritability
• depression
• sleeping difficulty
• low self esteem
• forgetfulness

Premature loss of female hormones may lead to the earlier onset of:

• osteoporosis (thinning of the bones) leading to increased risk of fractures (see 'Bone Health – Preventing Osteoporosis' fact sheet for more information)
• an increase in the risk of heart disease/heart attack (see 'Heart Health and Women' fact sheet for more information)
• a possible increased risk of neurological problems including cognitive problems, such as Parkinson's disease and Alzheimer's disease

Note, research suggests that using HRT until the usual age of menopause minimises the above risks.

Managing early and premature menopause

Self management strategies

It is possible to reduce some symptoms of menopause with changes to your lifestyle, as outlined below:

Healthy eating

Maintaining a healthy and balanced diet containing a variety of fresh foods may help reduce menopause symptoms. (See 'Healthy Eating for You' fact sheet for more information).

Regular physical activity

Aim for at least 30 minutes of moderate intensity physical activity on most, preferably all days of the week.

Advantages of regular physical activity include:

• maintains heart health as well as general health
• helps to prevent weight gain
• weight bearing exercise (e.g. walking briskly, dancing) helps to keep bones healthy and reduce bone loss
• provides a feeling of relaxation and wellbeing
• helps us to cope better with stress in our everyday lives

Emotional and mental health

The diagnosis of an early menopause can be devastating and bring many changes and challenges. Take action to deal with mood changes if you need to; try talking with a friend, writing in a journal, physical activity or even things like art therapy and meditation to help improve your mood. If you need help for depression, anxiety or low self-esteem it can be very valuable to seek help from a health professional, as there are many effective treatments available. This may enable you to feel better informed, in control, and more able to find strategies to help you cope with the changes of an early menopause.

Your environment

You can make simple changes to your environment to help ease hot flushes, such as:

• create a cooler environment
  - have fans throughout the house and always carry a little hand fan
  - install air conditioning in your home to cool your environment
  - use a water facial spray when experiencing a hot flush
  - have cool drinks available when experiencing flushes
• wear layers of clothing, so you can take off as much as you need when hot

Avoid smoking

Quitting smoking reduces many health risks. Need help to quit? Call the Quitline on 131 848 or visit www.quit.org.au.

Other treatment options:

Hormone replacement therapy

Hormone replacement therapy (HRT) is recommended as the treatment of choice in early and premature menopause as it helps manage most menopause symptoms, and can also reduce the long-term risks of osteoporosis and early onset of heart disease. Following premature menopause, moderate to higher doses of oestrogen are usually needed. Testosterone therapy may also be considered, especially after a surgical menopause, when low libido or unexplained fatigue may be particular problems. Discuss the advantages and disadvantages of HRT and other therapies with your doctor, your treatment should be individualised depending on your symptoms and medical history (see 'Hormone Replacement Therapy' fact sheet for more information).

Non-hormonal therapies

In women who have developed menopause following chemotherapy or radiotherapy for cancer or following surgery for a hormone dependent cancer, such as uterine cancer, HRT is not usually recommended. There are a number of different non-hormonal medicines that are suitable. It is important to discuss these with your doctor.

Complementary therapies

Some women may choose complementary therapies and they can often be taken in conjunction with HRT. For example, a woman might take HRT to address some symptoms and complementary therapies for others. However, it is important to note that currently there is no consistent evidence that complementary therapies are effective in relieving menopausal symptoms or long term bone or heart protection.

'Natural' herb and plant medications should be treated as medicines, therefore if considering complementary therapy for long-term management throughout the menopausal years, it is important to see a qualified naturopath with an interest in women's health. It is also important to talk this through with your medical practitioner before starting treatment, as some natural therapies have interactions with other medications you may be taking.

In women with a history of breast cancer or hormone-dependent cancers, the safety of some herbal therapies is not known. You should always consult your cancer specialists to determine whether using 'natural' therapies is appropriate for you.

Where can I find more information?

www.jeanhailes.org.au

www.earlymenopause.org.au

www.managingmenopause.org.au

www.menopause.org.au – Australasian Menopause Society

Content updated November 2011