What links each of these situations is age — to put it as simply as possible, early or premature menopause is typically used to mean menopause that comes well before the average age of normal menopause — when you’re still in your 20s, 30s, or early 40s.
More technically, as used by many doctors and medical journals: early menopause refers to menopause (total cessation of your periods for 12 months) before the age of 45. Premature menopause is menopause that occurs before age 40.
If premature menopause occurs naturally — that is, if you haven’t had surgery, radiation treatment or chemotherapy that led to menopause — it is more commonly now referred to as premature ovarian failure (POF).
This diagnosis sounds devastating, I know. But basically, all it means is that your ovaries aren’t working as they should. They’re shutting down years, even decades, before their time.
Let’s start at the very beginning
What exactly is menopause itself? To put it very simply, menopause is the stop (pause) of your periods (menses). Your periods stop because your ovaries have run out of eggs, are no longer responding to your body’s hormonal signals, have been damaged or have been surgically removed.
Before your periods stop, you go through a transition period called perimenopause. This can last on average from two to six years, although some women have it for a shorter amount of time, and others longer. Once your periods have stopped for a year, you’re considered as being in menopause.
The average age for women to have completed menopause is 51 — and the majority of women will go through this change somewhere between the ages of 47 and 53.
If you go through menopause before this — for whatever reason — you’re usually said to have experienced premature or early menopause. So (here we go again!) the key factor is age.
The two key ways to determine whether or not you’re actually menopausal are:
Generally, if you’ve skipped periods for 12 consecutive months (or six, depending upon your age and/or doctor), if you still have your ovaries, and if your hormone levels test at post-menopausal levels, you will probably be told you are experiencing early menopause, premature menopause, or premature ovarian failure.
Here is a brief look at some of the different specific conditions that are often grouped together under the umbrella term “early menopause”.
Premature Ovarian Failure (POF)
In the case of premature ovarian failure (POF), you usually have menopausal symptoms — including a stop in your periods. Most importantly, when you get a hormone test (a test of your follicle stimulating hormone, or FSH, and estradiol, the main circulating estrogen), you will test at post-menopausal levels.
Unlike “normal” menopause, however, premature ovarian failure (POF) doesn’t necessarily mean that your ovaries are depleted of eggs. This can be the case, but for many women with POF, periods have ground to a halt simply because the body isn’t responding to the signals to ovulate.
For this reason, you may produce enough estrogen on your own to get periods on occasion — even after having your follicle stimulating hormone (FSH) tested at post-menopausal levels. This isn’t uncommon, and is one of the main differences between “normal” menopause and POF.
Moreover, you may not only get periods, but may also ovulate. Studies have found that up to 25% of women with POF do still have viable follicles and ovulate from time to time — and 8 to 10% of women with POF actually get pregnant.
Early Menopause caused by Surgery or Cancer Treatments
Sometimes, early menopause is a result of surgery or cancer treatments. In this case, there’s a clear outside cause for the change in your body.
You may have undergone an oophorectomy (your ovaries have been removed) — so you’re no longer producing ovarian hormones. Or you may have had another form of pelvic surgery (such as a hysterectomy) that interfered with blood flow to the ovaries and, over time, caused ovarian failure.
Both chemotherapy and radiation treatments hold the potential to cause your ovaries to fail — and, again, they may no longer produce the hormones they used to.
If you experience menopausal symptoms at an earlier than normal age, but are still ovulating and have your hormone levels tested at normal levels, you’ll sometimes be told you’re in early menopause. However, it’s probable that what you’re actually experiencing is perimenopause.
But what is perimenopause?
This is the time leading up to full-blown menopause. When you’re in perimenopause, your hormone levels are fluctuating. You’re usually still ovulating (although you many begin having anovulatory periods).
Often if you get blood tests of your hormones in this period, you’ll be told all is well. Nevertheless, you may understandably STILL feel rotten as you experience the onset of symptoms!
In fact, often when people talk about menopause, they’re really talking about perimenopause — since this is the time when you’ll first begin noticing hot flashes, night sweats, changes in your period, mood swings, and perhaps other signs and symptoms.
Depending upon your symptoms, your doctor may recommend going on low-dose birth control pills or even low-dose HRT.
Unlike women with POF or early menopause, usually this is intended to mediate symptoms, not as literal hormone replacement to stave off the consequences of low estrogen at an earlier than usual age.
Diminished Ovarian Reserve
This is yet another instance where you’re often still getting fairly regular periods — and your hormone levels aren’t testing at post-menopausal levels, but you’re getting symptoms.
When this occurs before the age of 40, it’s often viewed as a precursor to premature ovarian failure and is referred to as diminished ovarian reserve.
A caring word from a woman whose been there…
Okay — so that’s a brief explanation of a very complicated topic! The bottom line? Whatever the technical term that’s used and whatever the cause, early menopause means one simple thing: your reproductive system is no longer working the way it used to, and it’s happening at an age when you didn’t expect it to be happening.
You will need to get the proper testing from your doctor to be sure what is going on with your body — and you should discuss the different options open to you regarding hormone replacement, health consequences and so forth.
Finally, it’s important to remember that being told you are in early menopause, that you have premature ovarian failure, that you need to undergo surgical menopause, or whatever you’re told, doesn’t mean that you’re automatically older.
It doesn’t mean you’re less of a woman, less desirable, or somehow diminished. You’re still you — a young woman…with capabilities, dreams, and strengths. The only thing that has changed is your reproductive system — and you’re much more than that!
Selected Sources & Further Reading
Gordeski, G.L. “Premature Menopause.” Menopause Management 1997; 10-17.
Lieman, H., Santoro, N. “Premature ovarian failure: A modern approach to diagnosis and treatment.” The Endocrinologist 1997; 7; 314-321. (Link)
Shuster et al. “Premature menopause or early menopause: long-term health consequences.” 2009. (Link)
Menashe, Y., Pearlstone, A.C., Surrey, E.S. “Spontaneous pregnancies despite failed attempts at ovulation induction in a woman with iatrogenic premature ovarian failure.” Journal of Reproductive Medicine 1996; 41(3): 207-210. (Link)