Perimenopause, Menopause, and Post-menopause
It can take a long time for this cycle to stop altogether, often up to ten years. We use the term peri-menopause or perimenopause to describe the lead-up to the event when periods finally stop.
Menopause occurs after 12 months and one day without a bleed. After that, we call it post-menopause for the rest of our lives.
Premature menopause, also known as Primary Ovarian Insufficiency (POI) or premature ovarian failure, happens when a woman goes through menopause before 40. This is well before the average age of menopause, 51 years old, in the UK and USA.
Premature menopause can happen naturally when a girl or woman’s ovaries stop maturing eggs due to lower levels of oestrogen
For most women in premature menopause, no underlying cause can be identified. This is known as idiopathic or spontaneous premature ovarian insufficiency.
For others, possible causes include:
- chromosomal abnormalities, such as Turner’s syndrome
- autoimmune diseases like Addison’s disease or type-1 diabetes
- infections like tuberculosis, mumps, and malaria in rare cases
Some cancer treatments may cause premature ovarian insufficiency, which can be temporary or permanent.
Premature ovarian insufficiency can run in families, so it is important to be aware of your family history and discuss this with your doctor.
The symptoms of premature menopause are often similar to natural menopause.
In younger women, the condition is often diagnosed after irregular periods, no periods, or infertility.
Classic menopause symptoms, such as hot flashes, night sweats, changes in moods, and cognitive impairment, may be experienced. But in such young women, these symptoms may be misdiagnosed as other conditions, such as stress or the consequence of major life events.
It is important for younger women to undergo hormonal blood tests for a proper diagnosis.
Blood tests that examine levels of FSH can indicate that the ovaries are not working as they should. It is generally agreed that an FSH level of 30iu (international units) and above is a confirmation of premature menopause.
These blood tests are usually taken twice to check the consistency of results. It should be done 4-6 six weeks apart at around the beginning of a woman’s period.
It may also be appropriate to test for oestrogen levels, as high levels of oestrogen can suppress FSH and make FSH levels appear normal even when they are not
Once a diagnosis is confirmed, further investigations may be offered, such as genetic testing, antibody screening, or a bone density scan known as a DEXA Scan. It assesses the risk of osteoporosis, where menopausal women are susceptible.
Early menopause is often a difficult diagnosis to cope with. Women may suffer psychologically as they lose the opportunity to have a family at a time when they could reasonably plan for children.
It is important to consider reaching outside for support, such as having counseling, getting a referral to dedicated POI clinics, and joining specialist support groups. This is also an important and sensitive subject to be discussed in the workplace.
Treatment usually takes a holistic approach that includes both mental and physical well-being.
Medically, hormone replacement therapy (HRT) may be offered to counteract the effects of hormonal decline, especially estrogen. It can be delivered through different routes, including patches, tablets, and gels. Other hormone replacements, like testosterone, may be offered to address physical symptoms.
It is important that women in premature menopause are made aware that HRT does not increase their risk of developing breast cancer. The risks become the same as any woman taking HRT once they reach the average age of menopause.
The combined oral contraceptive pill can also be used for treatment as it contains estrogen. Clinical trials have demonstrated that the combined oral contraceptive pill is just as effective as HRT for women with early menopause.
If you feel that you are experiencing premature menopause, please don’t be afraid to see your doctor or healthcare practitioner. Tell them you are studying menopause and you would like to be tested.
Have courage—we are right with you! Feel free to explain your own experience in the comments section. It may help others.
Surgical menopause is the removal of both ovaries from a woman who has not yet reached natural menopause.
This surgery can be in two forms:
- oophorectomy – the removal of the ovaries only
- total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) – the removal of the ovaries and uterus
There are many reasons why a woman might undergo surgery that results in surgical menopause. These include:
- cancers affecting the reproductive system
- heavy menstrual bleeding
- severe Premenstrual Dysphoric Disorder (PMDD), a more serious form of premenstrual syndrome
- prophylactic surgery due to family history
- genetic risk of certain cancers (BRCA 1 and BRCA 2 genes)
As the ovaries are the main producers of estrogen, progesterone, and testosterone, the sudden drop in these hormones following removal of the ovaries causes surgical menopause.
It can develop suddenly. Symptoms are often more severe than in natural menopause, where hormonal changes generally occur more slowly over a longer period.
As we have mentioned previously, we have estrogen receptors throughout our bodies, affecting key areas like the brain, skin, heart, temperature, and blood vessels.
That is why following surgery, women may experience a variety of symptoms throughout their body, including hot flashes, night sweats, mood changes, anxiety, and brain fog.
Medical menopause occurs in women whose ovarian function has been affected by medical treatments or medication.
This could be from damage caused by medical treatment or unintended suppression of estrogen, progesterone, and testosterone due to drugs and treatments.
The most common treatments affecting the ovaries are chemotherapy and radiotherapy cancer treatments.
Some women with gynaecological conditions like endometriosis may be offered treatment to induce medical menopause. The suppression of hormones means that fewer symptoms are experienced, enabling the condition to be managed long-term without surgery.