FAQs about Early Menopause

Sad contemplative woman by window

Q: I’ve got a lot of the symptoms I’ve seen listed. What tests should I ask my doctor for if I think I’m going through early menopause?

Answer: The key test to determine whether or not you are in menopause is an FSH test — which measures the blood levels of your FSH (follicle stimulating hormone).

Your FSH levels rise when your ovaries stop producing enough estrogen, so high FSH levels can signal that your body is entering menopause.

Stressed woman with head in handsFSH levels above 10 to 12 mIU/ml show that your ovaries are starting to fail. At this point, you might notice physical symptoms, but you may still be getting your period fairly regularly. Higher FSH levels — levels about 35 to 40 — are usually taken to signal ovarian failure, or menopause.

You might still be getting periods with your FSH levels this high, but, even so, it’s a sign that your body isn’t producing enough estrogen to maintain regular ovarian function.  The best time to get an FSH test to get the most accurate reading is on the third day of your menstrual cycle, if you’re still getting periods.

Estrogen (Estradiol) Levels

Another test you might want to ask for is a blood test of your estradiol levels. Estradiol is a form of estrogen in your body — and the levels of it drop when your ovaries start to fail. So low estradiol levels may indicate that you’re entering an early menopause.

Generally, if your estradiol levels are below 36 pg/ml (in conjunction with a high FSH level), you are considered menopausal. If your estradiol levels are lower than 50 picograms per milliliter, you may still be having a period, but also may be experiencing symptoms of low estrogen — including hot flashes, vaginal dryness, and sleep difficulties.

The FSH and estradiol tests are the two key tests given to see if you’re entering menopause, but there are other tests you can get in addition to these.  Some doctors will assess your levels of other ovarian hormones — like progesterone, testosterone, and luteinizing hormone (LH).

It’s also possible to use saliva testing to measure hormone levels. This isn’t as widely used as blood testing, as debate exists with regard to its accuracy in comparison to serum (blood) testing.

You may also have your thyroid examined as your doctor assesses you to reach a diagnosis (because many symptoms of thyroid disorder overlap with menopause symptoms). This is wise to determine whether your symptoms are due to thyroid problems or menopause.

You can learn more about this topic in our in-depth Hormone Tests helpsheet. This sheet includes charts and information on interpreting your results.

Q: What about getting an ultrasound of my ovaries?

Answer: In some cases, your doctor may perform high resolution ovarian ultrasound to view your ovaries. This will determine whether you still have any eggs and follicles. However, generally, this information doesn’t help that much.

Studies have indicated that perhaps up to two-thirds of women diagnosed with premature ovarian failure (POF) do indeed have remaining follicles. The problem is, even when eggs are detected, attempts to stimulate ovulation through hormones have been relatively unsuccessful. However, ultrasound may make sense if you are in the early stages of premature menopause and are intending to pursue an aggressive fertility program.

Q: I’m still getting periods — but I’ve got a lot of symptoms like hot flashes and night sweats. Is this normal?

Answer: Yes, it is. Even though the technical definition of menopause is not having your period for at least 12 months, it’s not uncommon for young women going through early menopause or premature ovarian failure to get their periods fairly regularly. For example, my FSH level was up at 158 (well into postmenopausal territory), yet I was still getting my period.

Your hormones often fluctuate with volatility at the beginning stages of early or premature menopause, so you may be producing enough estrogen to get periods — even while your FSH levels are high.  Many times, your periods will be “anovulatory” — in other words, you aren’t producing an egg. But you are producing enough estrogen to build up your uterine lining.

Q: How long will my symptoms last?

Answer: That’s the million dollar question and a difficult one to answer! There really is no definitive answer we can offer you.  Some women get symptoms for only a short time; others get intense symptoms for years (like me, unfortunately!). Most women get symptoms for a few years, then they fade out.  For most women, the common solution to managing your symptoms is by either going on hormone replacement therapy (HRT) or by using alternative treatments, like phytoestrogens, herbs, and vitamins. The efficacy of herbal supplements in treating menopausal symptoms is questionable, however.

It’s important to avoid exploitative retailers selling unproven formulations. Seek your doctor’s advice and if you do choose to take dietary supplements and/or herbal products, carefully select those with scientific research supporting the manufacturer’s claims.

Q: Does going through menopause early mean I’m aging more quickly?

Sad contemplative woman by window
Answer: Absolutely not! Going through menopause years before you expected it — and years before most other women go through it (age 51) — doesn’t mean you’re suddenly older. It does mean that your ovaries aren’t functioning in the same way as those of most women in their 20s and 30s.  Coping emotionally can be difficult enough let alone having to confront the idea of “feeling” older. But early or premature menopause doesn’t mean that you’ve fast-forwarded to the body of an older woman!

Yes, there are certain health risks that you now face — like the threat of osteoporosis. You might notice your skin getting drier or observe a change in your body shape.  Scientific evidence does appear to suggest that early menopause is associated with a wide variety of long-term health risks (source), but going on HRT appears to mitigate many of the symptoms, and consequences, of your diagnosis.

Some women opt to replace their hormones through natural methods to minimize those long-term risks, and manage their symptoms, but your best course of action should be established in collaboration with your doctor.  The ultimate goal is to make sure you feel like yourself again, physically and mentally!

Q: I’ve heard people talking about seeing an “RE”. What is that?

Answer: An RE is a reproductive endocrinologist — a doctor who specializes in infertility and hormonal disorders.  Many women with premature ovarian failure (POF) prefer seeing REs because they’re specialists and are particularly helpful if you’re hoping to pursue a pregnancy.

FAQs About Early Menopause Symptoms

Find a list of common symptoms and in-depth helpsheets on our symptoms page.

Q: I’m crying for no reason, my moods are all over the place… is this normal?

Answer:   It definitely is. One of the most upsetting aspects of early or premature menopause is the emotional fallout — mood swings, tears that come out of nowhere, anger, and a general feeling like you’ve lost your grip on your emotions.

But this is totally normal. It’s yet another symptom of fluctuating hormones. You’re not going crazy; it’s just one of the ways your hormones are affecting you. Not only that, but you’re suffering from the knowledge that you’re experiencing menopause well before you ever expected.  As well as seeking treatment, we recommend reading our helpsheet on coping emotionally.  You can also find like-minded women on our message board.  If fertility issues are the cause of your emotional fallout then you may find it helpful to attend a support group offering a positive environment to learn and meet others.

Q: Sex is very uncomfortable for me now. What can I do?

Dark haired woman covering face on bedAnswer: This is a common symptom — and often occurs when your estrogen levels are low. Your vaginal tissues get dryer, sex becomes uncomfortable; it takes longer for you to become lubricated, and many times your sex drive will start sagging because of the discomfort.

But there are some things you can do about it: first of all, boosting your hormone levels — either through hormone replacement therapy (HRT) or natural supplements — should reverse this condition. In addition to standard estrogen replacement therapy (by pills or patches) you can also use a vaginally-inserted estrogen cream specifically to deal with vaginal dryness and atrophy.

There’s also some natural remedies that may help with this problem. Among them: Vitamin E — taken by mouth or by inserting the capsule in suppository form directly into your vagina (source); Vitamins A, B, C and the mineral selenium — all of which help restore vaginal tissues; and phytoestrogens (like soy and flaxseed) — since they have estrogenic properties, they can help raise your estrogen levels, which, in turn, can help with dryness.

Stay Hydrated

This is an obvious one but drinking sufficient water helps to keep your tissues (including your vagina) hydrated.

Use Lubricant

Using lubricants — such as Astroglide, Lubrin, or KY Jelly, or a product that enhances vaginal moisture such as Replens

Vaginal Suppositories

Products containing lubricating ingredients such as hyaluronic acid can work to keep dryness at bay over an extended period of time.

Having More Sex

Okay, this is an odd thing to recommend since you’re in pain now, but ultimately this may actually help work to prevent vaginal dryness.

If you reach orgasm once or twice a week — either with a partner or through masturbation — you increase blood flow to your vagina and keep its muscles toned, all of which helps keep the vagina in shape.  Sex may actually also help to stimulate estrogen production in the adrenal glands.

Avoid Irritants

It’s important to avoid anything that can irritate or dry your vagina.  This includes perfumed bath oil or bubble bath and perfumed toilet papers. Also avoid antihistamines and certain over-the-counter decongestants — these are designed to help dry out mucous membranes in your respiratory system, but also will dry out mucous membranes in your vagina.

Q: How can I get my libido back?

Answer: Often your sex drive will drop when your estrogen levels are low — so going on HRT often helps boost it back to normal. And you may lose interest in sex because it’s so uncomfortable, so taking care of your vaginal dryness may make a difference.

But if you still don’t notice any improvement, you many want to consider testosterone. It’s the male hormone that we women produce small amounts of, especially in our ovaries. In fact, if you’ve had your ovaries surgically removed, there’s a good chance your testosterone levels are pretty low. There are a number of different testosterone replacements available — including Estratest (which is estrogen and testosterone) and testosterone cream. You may wish to raise this possibility with your doctor as a means of tackling low sex drive.

Q: I’ve started losing hair. Is this connected with premature menopause?

Answer: This is yet another symptom often connected with low estrogen levels. When estrogen levels drop, so do your collagen levels and this can result in thinning hair or hair loss.

But hair loss can also be due to other problems, such as thyroid disease, low iron levels in your blood, a low-protein diet, or unhealthy eating in general (such as extended crash dieting).

If you’re noticing hair loss — and if you’ve ruled out any other cause — taking estrogen may help since it replenishes the collagen in your body.  In addition, certain vitamins may help combat hair loss:  Vitamin A, B-complex and C, plus the minerals manganese, selenium and zinc.  You may also benefit from Omega-3 (which you can get in flaxseed oil capsules) and Omega-6 fatty acids as they help lubricate the hair shaft.

FAQs About Hormone Replacement Therapy (HRT)

For a list of the widely prescribed forms of HRT, see the table Available Forms of HRT, and if you live in the UK, see HRT (UK).

Q: What are the different types of HRT available to me — and which one works best?

Answer:  There are a wide range of different HRTs – patches and pills, natural and synthetic, combinations of estrogen and progesterones, and individual estrogen and progesterones. And different women find different forms of HRT work best. Some people think the patch is the best because it delivers a steady stream of hormones into your blood, mimicking your natural hormones.

Others like pills better because it’s easier. Some women swear by the well-known options of Premarin and Provera; others like the natural, plant-based hormones more. So there’s no “one size fits all” prescription, unfortunately! In fact, you may wind up trying different forms of HRT until you find the one that works best for you.

Q: What’s the difference between synthetic HRT and natural?

Answer: These are terms you’ll hear frequently — and it can get confusing (what else is new when it comes to early menopause?). Anyway, here’s a brief explanation of the terms as they’re usually used:

Natural HRT

Bottle of pills with contents spilling out

Natural HRT refers to estrogens and progesterone that are actually man-made — but from natural plant sources.  Most important, they are naturally occurring and bioidentical to the hormones your body makes.

In other words, they don’t just mimic your hormones; they have the exact same chemical structure as the hormones made by your ovaries.  (Natural estrogens include Estrace, Estratab, and all of the estrogen patches such as Climara, Vivelle, etc.  Natural prescription progesterone includes Prometrium and Crinone.)

Synthetic HRT

Synthetic HRT is, as you’d expect, hormone replacement made from synthetic sources. But (here’s where it gets tricky), Premarin — which is made from a natural source (horse urine) isn’t technically considered a “natural” because it isn’t exactly the same as the estrogen that is made in your body.  However, some individuals argue that the synthetics — particularly synthetic progesterone, or progestin — seem to be associated with a greater number of risks and a higher number of side effects than their bioidentical counterparts. (source)

On the whole, evidence is lacking to support the claim that bioidentical hormones are superior and much more research is needed on the matter. For now, most doctors and scientists agree that bioidentical hormones are not the elixir they’re made out to be by some.

Which is better?

As we said before, it’s really a personal choice. Not only that but discovering which option is best for you may involve significant trial-and-error whilst working closely with your doctor.

An assortment of colorful pillsMany people feel that natural hormones are preferable. They argue that, because these hormones are “bioidentical”, our bodies can work better with them.

It’s also claimed that we can more easily metabolize them and break them down, so our livers and kidneys can excrete them once they’ve done their work, and so they don’t accumulate in the body and cause side effects.

Be aware, however, that some of the claims made in support of bioidentical hormones are unproven and your best course of action is to discuss the pros and cons of natural vs synthetic with your doctor.

Its also worth remembering that many other people prefer the synthetics — primarily because they’ve been more widely studied. (Most studies about HRT have been done using Premarin and medroxyprogesterone acetate — the progestin, widely prescribed under the brand name Provera). And many of these women don’t suffer serious side effects from the synthetics.

So, with all that said, it’s really a matter of what you feel more comfortable with — and what works best for you.  In conjunction with your doctor the aim should be to identify which form of HRT makes most sense in a way that’s tailored to your exact situation.

Q: Will HRT make me gain weight?

For more detail on this topic and information on useful coping strategies, see our Weight Gain helpsheet.

Answer:  This is one of those questions that so many women ask — and one that definitely worried me a great deal!  It’s especially worrisome because it’s very common to put on weight when you’re first experiencing early menopause.

As your estrogen levels drop, your body tries to keep as much estrogen as possible circulating.  Since estrogen is both stored and produced in fat cells, your body may try to increase its fat content in response.  To make matters worse, you also often tend to put weight on in your middle — leaving you with disappearing waistline definition and a tummy bulge.

Woman attempting to zip jeans after weight gain

The good news?  HRT may actually help. This is what a number of studies have found (source) — women on HRT tended to gain less weight than those who weren’t on it.

In fact, when you raise your estrogen levels via HRT, you may actually notice a weight loss (this happened to me).  When you’re getting the estrogen your body would otherwise have if not for menopause, your body’s inclination to store fat to prop up estrogen levels may be reduced.

Plus your weight tends to redistribute back to its normal pattern — so your waistline reappears and your tummy may flatten a bit.  Its important to remember that the number on the scales itself isn’t always a particularly helpful measurement. Postmenopausal weight loss is hardly desirable if its caused by a loss of bone density!

Additionally, for many women, a desirable pattern of weight distribution (e.g. tummy vs hips) is as high a priority as keeping the weight off.

Some women do report noticing weight gain while on HRT. One culprit may be synthetic hormones, particularly the progestin “medroxyprogesterone acetate” or MPA (most common brand: Provera). This is because some women suffer side effects from this, including bloating and water retention. (source)

Natural progesterone doesn’t seem to have this side effect. And other women have found that lower dosages of estrogen and progesterone helps keep bloating down. Finally, others report good outcomes with patches instead of pills.

Q: My doctor put me on birth control pills. Is there a difference between these and HRT?

For a comparison of birth control pills and HRT for early menopause, see our helpsheet BCPS or HRT?

Answer: This is another of those areas surrounding early menopause that can get confusing, so hold tight!

Birth control pills are often prescribed to women in perimenopause — that time when they’re getting symptoms, but still are getting periods.  Birth control pills are synthetic hormones and often, even with the lower dose pills, you’re getting more estrogen than you would with regular HRT.

The jury is out as to whether its best to take birth control pills or regular HRT for early menopause.  Many people feel it’s safer to opt for regular HRT because your options are wider (you can take natural hormones, for example) and because the dosages tend to be lower.  But others feel that they need the extra punch of the stronger synthetic estrogen (most commonly, it’s ethinyl estradiol).

Again, this is one of those cases where it makes sense to do a little research, speak to your doctor and then decide what you feel works best for you.

Q: Will I keep getting a period on HRT?

Answer: Actually, it depends. If you go on cyclical HRT — that is, you take estrogen every day and progesterone for a few days each month, then, yes, you probably will keep getting a monthly period. (One side note, though: some women — like me — do stop getting periods, or they’ll only spot a bit, even on cyclical HRT. It’s not common, but it can happen).

If you’re on continuous HRT — you take both estrogen and progesterone daily, then you usually will stop getting a period.  It may take several months before your periods stop completely, but generally you’ll be done with them after a little while.

Q: I’m on HRT and I feel miserable. Now what?

Answer: Don’t give up! First, it sometimes takes a few weeks to notice a marked difference — so it may make sense to wait a little while to see if the HRT helps you. Second, often switching forms of HRT — from a synthetic to a natural, or from a pill to patch — can make a difference.

Our bodies are all different, so different forms of HRT may work better for you than for others. Talk to your doctor, explain that you’re not satisfied and that you’re interested in trying something new… and remember:  it’s your body — and you’re entitled to feel good!

Q: What if I can’t take hormones? Is there anything else I can take to help with my symptoms?

Answer:  There are a number of different things you can try — herbs, vitamins, and other supplements. Probably the one form of alternative treatment that’s getting the most attention is soy, as well as other phytoestrogens like flaxseed.  Phytoestrogens are plant estrogens.  They work somewhat like human estrogens, but they’re much weaker.  They may help to minimize symptoms and boost your estrogen levels safely. (source)

A number of different herbs and vitamins can also help.  For example, some women have reported taking Vitamin E and citrus bioflavanoids helps with their hot flashes.  The herbs chasteberry and black cohosh can also fight a number of symptoms (source). For a few specific suggestions, you can also see our helpsheet Natural Ways of Managing Early Menopause.

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