Menopause usually occurs between age 51 and 52, but some women stop having menstrual cycles before age 40. This is known as premature menopause.
Women who experience possible signs of premature menopause, like irregular periods and hot flashes, should visit their health care provider.
A provider trained in menopause care can help you manage your risks and symptoms, and can also discuss fertility options for women who wish to become pregnant.
For many women, perimenopause symptoms like irregular menstrual cycles, hot flashes and vaginal discomfort start in their late 40s or early 50s. If you’re experiencing these symptoms in your 20s or 30s, you should visit your health care provider.
The average age of menopause, which occurs when you have gone 12 months without a cycle, is 51-52. Women who stop having cycles before age 45 are in “early menopause,” and women who stop before age 40 are in “premature menopause,” or primary ovarian deficiency.
Pallavi Khanna, MD, OB/GYN, FACOG, a Certified Menopause Practitioner at Regional One Health, said about 1 in 1,000 women experience premature menopause. “It can be scary,” she said. “A lot of women are starting their married life and trying to have kids around that time.”
A Certified Menopause Practitioner is an excellent resource to help women protect their health, address symptoms and discuss fertility options.
Pallavi Khanna, MD is a Certified Menopause Practitioner at Regional One Health. She said women shouldn’t feel like they need to deal with premature menopause alone: “We’re here to help you, and it is important to seek treatment.”
Dr. Khanna’s first goal is to reach an accurate diagnosis. She gets a detailed medical history, does a comprehensive exam and talks to patients about their symptoms. Irregular, light or skipped menstrual cycles are the main indicator of menopause, Dr. Khanna said, but patients also report issues like hot flashes, vaginal dryness, fatigue and mood changes.
These symptoms don’t necessarily signal premature menopause. A preexisting condition such as thyroid problems, diabetes or an autoimmune disorder like lupus or rheumatoid arthritis could be to blame. Therefore, “We do an entire blood workup when it’s indicated,” Dr. Khanna said. “Sometimes, it’s the first time a woman realizes she needs care for another issue.”
She also rules out pregnancy, the most common reason women under age 40 skip cycles.
If she suspects a woman is indeed in premature menopause, she can order a follicle stimulating hormone test. The test, which involves a blood draw and is performed twice, checks levels of a hormone released by the pituitary gland. A high level indicates a woman is menopausal.
There are factors that increase a patient’s risk of premature menopause:
- A history of childhood cancer (radiation and chemotherapy can damage the ovaries)
- Removal of an ovary, hysterectomy, pelvic surgery or cervical cancer surgery
- Smoking
- Autoimmune disease
Premature menopause can also be based on genetics, and Dr. Khanna can screen patients for these factors. “There are cases where premature ovarian insufficiency runs in a family,” she said. “In general, the age you start menopause is often similar to when your mother started.”
Ethnicity can play a role too. Premature menopause is most prevalent in African American and Hispanic patients, followed by Caucasians. It is least common in women of Asian descent.
If you’re experiencing premature menopause, it’s important to find a provider who specializes in menopause care. They can help manage your risk of serious illness, address your symptoms and talk about fertility options.
While risk factors and health history are important, patients often don’t know the reason for premature menopause. “Most cases are idiopathic – we don’t know why it happens,” Dr. Khanna said. “But no matter what, we’re here to help you, and it is important to seek treatment.”
Treating premature menopause not only eases symptoms, it helps reduce risk of serious medical problems like heart disease, stroke and osteoporosis.
“Premature menopause occurs when your ovaries stop working sooner than they’re expected to, and you experience a decrease in estrogen,” Dr. Khanna explained. “Therefore, the most common treatment is to provide estrogen with a patch or a pill.”
If a patient still has her uterus, she will also take progestin to guard against uterine lining cancer. Treatment usually continues until a woman is in her early 50s, the average age of menopause.
Eating healthy, exercising, quitting smoking and limiting alcohol can also help. “There are many lifestyle changes that can make the transition and symptoms easier,” Dr. Khanna said.
Along with managing symptoms and risk of serious conditions, Dr. Khanna can talk to patients about pregnancy. “You can still carry a pregnancy if the uterus is still there,” she said. “If you’re in premature menopause and wish to become pregnant, we can refer you to a fertility specialist who can help you consider all your options, including egg and embryo donation.”
As a Certified Menopause Practitioner, Dr. Khanna has additional training and expertise to help women navigate challenges like premature menopause and other issues related to menopause.