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These days, it seems that everyone from Gwyneth Paltrow to Michelle Obama is talking about perimenopause and menopause. And, thank goodness. After all, the more awareness we bring to this once-taboo topic, the better chance we all have of coping with the hot flashes, mood changes, and lower libido it inevitably brings.
There is, however, one topic that isn’t as regularly discussed: premature or early menopause, which, according to the National Institutes of Health, impacts approximately 5% of women. “Early menopause occurs when a woman goes through menopause at an earlier age,” explains Dr. Roger Lobo of Columbia University Fertility Center. “We typically classify early menopause as menopause with an onset before age 45. Premature menopause is prior to age 40—before age 45 it is earlier but not premature.”
Causes of early menopause
When it arrives unexpectedly, menopause’s impact on physical and emotional health “can be significant,” says Dr. Alexandra Henríquez Linares, a specialist in gynecological oncology, breast pathology, and integrative medicine. This is because the decline in estrogen and progesterone production that takes place between 45 and 55 years of age is usually progressive, while early menopause often occurs more abruptly.
In most cases there is no clear cause, although Henríquez says there are several factors that may influence early menopause.
- Genetics: If your mother or grandmother had menopause very young, it may be hereditary.
- Autoimmune diseases: Early menopause may be related to lupus or autoimmune hypothyroidism.
- Aggressive medical treatments: Radical surgeries, chemotherapy, or radiotherapy could accelerate the process.
- Environmental factors: Toxins such as tobacco, heavy metals, solvents, pesticides, or industrial chemicals and plastics could act as endocrine disruptors, which confuse our endocrine system by decreasing ovarian reserve.
- Viral infections: such as mumps in childhood, although this is less common.
Symptoms of early menopause
Early or premature menopause has the same symptoms as natural menopause. “Those who have early menopause will see a stop to monthly menstruation and can also see other common menopause symptoms like hot flashes, mood swings, difficulty sleeping, and vaginal dryness,” explains Lobo.
Because these symptoms can come on unexpectedly, however, many women do not recognize them as menopause symptoms. Thus, they may delay seeing a doctor, which can further prolong diagnosis and treatment. “Menopause and early menopause comes with increased health risks including cardiovascular disease, diabetes, bone loss and memory loss,” warns Lobo. “Memory loss and cognitive decline is only transient, but untreated premature menopause has also been linked to increased mortality, dementia risk and Parkinson’s as well as an increased risk of cancer.”
To that end, Henríquez emphasizes that the below symptoms should be taken seriously:
- Increasingly irregular periods, with the absence of some of them for several months.
- Hot flashes or night sweats.
- Vaginal dryness and discomfort with sexual intercourse. Increasingly less lubrication.
- Mood swings, anxiety, or unexplained sadness.
- Difficulty concentrating or mental fogginess.
- Decreased libido or sexual desire.
- Fatigue with no apparent cause.
There’s also a symptom which is a little more nebulous but equally important: “There is a term called NFLM, or ‘not feeling like myself,’” explains Dr. Molly McBride, an OBGYN and advisor at Lubify. “Menstrual cycles may still be regular, but changes can begin to show with variability in length and flow. This can start as early as 35 and last years. Be sure to find a provider who will validate your concerns and offer treatment options.”
Your gynecologist can confirm early menopause via a hormonal blood test, “where we see the increase of a hormone called FSH and decreased estrogen,” explains Hernandez, who notes that a doctor may also do an ultrasound to evaluate the follicles in the ovaries. “These are small sacs of liquid that contain our eggs, and if menopause is confirmed, they will be very few or non-existent,” she says.
How to deal with early menopause
Treatment methods for early menopause are also similar to perimenopause and menopause, though “I recommend patients speak with their healthcare provider for options that would be best suited for their needs,” says Lobo, who adds that hormone replacement therapy (HRT) is helpful for most women unless there are contraindications such as estrogen-dependent breast cancer. “In women with early menopause, it reduces the increased mortality associated with not using hormones, which can be beneficial, especially in younger women, to help manage many menopause symptoms like vaginal dryness, mood swings and poor sleep,” he notes.
If fertility and early menopause are a concern, Lobo also says it’s important to speak with a fertility specialist sooner rather than later to discuss options like egg freezing and in-vitro fertilization. “By the time women are already in perimenopause, egg freezing and IVF are usually no longer successful,” he adds.
Henríquez that HRT is one of the most valuable tools in the treatment of early menopause—especially when the cause, the symptoms, and family and personal history are taken into account. “The objective is to replenish the hormones that the ovaries have stopped producing early, in doses similar to those corresponding to age,” she says. “In this way we can help alleviate uncomfortable symptoms such as hot flashes, insomnia, and vaginal dryness while protecting bone and cardiovascular health and improving cognitive health.”
However, she also points out that there are instances where HRT is not always necessary—nor advisable. “When women do not present intense symptoms or with certain types of hormone-dependent cancers or in cases in which the patient has blood coagulation problems, other alternatives to hormone treatment should be offered,” she says, echoing Lobo. She also notes that both the doses and the form of administration must be adjusted to the profile of each woman depending on the predominant symptoms and the clinical situation. “An integrative approach seeks balance,” she explains.
Healthy habits during early menopause
For biologist and nutritionist María Pastor, taking an integrative approach is also key for optimizing the wellbeing of anyone dealing with menopause—early or otherwise. She recommends following an anti-inflammatory diet centered around omega-3 fatty acids that’s low in grains, cow dairy, processed foods, refined flours, and vegetable oils. She also says to focus on antioxidant foods such as flax, sesame, fermented soybeans, cruciferous vegetables, tahini, and legumes. And, “don’t forget prebiotic fiber to take care of digestive health, since the microbiota of the colon can be a great ally to reduce the symptoms,” she says, adding that it’s best to avoid alcohol, simple sugars, and make sure “that each main meal has a sufficient supply of quality protein.”
Pastor and Henriquez also recommend the use of certain supplements—although they stress that treatments should always be guided by an expert and personalized. Among their favorites:
- Vitamin D
- Red clover (to relieve hot flashes)
- Sea buckthorn (omega 7) to ease vaginal dryness
- Phytoestrogens such as black cohosh or soy isoflavones
- Probiotics
- Coenzyme Q10 or resveratrol
- Ashwagandha or Siberian ginseng
Of course, stress management and emotional support are also key. “Faced with the diagnosis of early menopause, we may feel more delicate—especially if we were expecting to become mothers,” says Henriquez. “We must remember that mental health is also important in our hormonal health.” To that end, she recommends talking with a mental health expert or therapist and adding strength training into your workout: “It is one of the best allies to protect the bone, mood, improve body composition, and avoid insulin resistance.”
McBride agrees, emphasizing that incorporating healthy habits into your daily routine is especially important. “The loss of estrogen at a younger age has longterm health implications, like heart disease, osteoporosis, depression, and dementia,” she says. “Prioritize exercise and eating well and limit alcohol. And remember, the approach should be tailored to the patient. It is not one size fits all.”