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Premature ovarian insufficiency - premature menopause.

Menstrual cycles stopping earlier than they’re meant to…flipping awful…anyone affected needs really good specialist care and support…it can have a profound affect both physically and mentally.

When I started writing this post I got so caught up in trying to write as much detail down as possible instead of my usual chatty posts…why…well menopause, as we all know, and its accompanying symptoms can be an incredibly difficult time for a lot of women to get through, add into the equation going through it at a young age and it somewhat changes the goal posts with a whole host of additional challenges both mentally and physically to deal with.

Fear not though…I reigned myself in because, as always, there are already fabulous resources out there. So, you’ll be pleased to hear I’ve edited it down to my usual shorter version…not much humour in this post, for obvious reasons, but hopefully for anyone reading it a little bit more of an insight and good resources to look into…see below.

Ok, so the main theme of World Menopause Day this year (2020) was premature menopause, also known as premature ovarian insufficiency, you’ll get some clinicians just saying POI and then another term is premature ovarian failure — for simplicity let’s stick with premature menopause.

Why is it important to know about this…lots of young women are still slipping through the net, being misdiagnosed or not being taken seriously…key message from any clinician who specialises in this area…’there is no such thing as too young’.

It affects your physical, your emotional and psychological well-being and your long term health. It requires specialist treatment to help protect that long term health and to provide the essential physical and emotional support required.

What does it mean…basically, your menstrual cycles stop earlier than you either want or would expect them to because your ovaries are no longer working properly. This can be due to a variety of reasons…will cover in a minute. Officially you’re diagnosed as being prematurely menopausal if you’re under the age of 40 years and very sadly this happens to a larger proportion of women than you might expect with roughly 1% of the population being under the age of 40 and 0.1% being under the age of 30, this works out at approximately…1 in 100 under 40, 1 in 1000 under 30 and 1 in 10,000 under the age of 20. I know…too many.

So, now you understand why it’s incredibly important for this topic to become mainstream, for everyone to be aware of the most common symptoms and for all Health Care Professionals (HCP) to be vigilant when key symptoms raise their heads. Hence, quite rightly and thankfully, the powers that be decided to have this as their main theme for World Menopause Day this year, because unfortunately there are many out there who haven’t even heard the term premature menopause let alone know anything about it.

Why does it occur…sadly approx 90% of cases will never find a reason as to why it’s happened. It can be a result of surgery or following medical treatment like chemotherapy or radiotherapy. It’s associated with genetic disorders like Turner’s syndrome and autoimmune disorders.

There’s a 10-20% connection through family history making it really important to get chatting, to be open and to raise awareness, which then obviously helps younger women to get diagnosed sooner.

Getting this early diagnosis is so important but sadly many women and girls just don’t go to seek help and advice, maybe not realising the seriousness of missing periods or sometimes putting it down to other reasons like over exercising or maybe stress.

Key point…if your periods have stopped for 2 or 3 months then you should go and have a chat with either your GP or practice nurse. This should ring an alarm bell in their heads and they should start looking into why this is happening.

So it’s really really important for any of you out there to…know your body, take notice of what’s happening with your menstrual cycle and if you’re concerned at all seek advice straight away. Don’t put it off because you don’t want to bother someone about it or you just can’t be bothered …the sooner you seek help and advice the better and remember those HCP aren’t telepathic no-one’s going to phone you up every month to ask what your menstrual cycles up to - it’s up to you to go and make the first move!

For any HCP out there — please hear those bells — I’m not trying to be flippant, it doesn’t matter how you phrase it does it but please listen, ask the right questions and be proactive!

Absent or irregular periods — don’t ignore — this is the time when you can and should be offered a blood test, the one called the follicle stimulating hormone (FSH) test, but it needs to be done accurately. One test is not enough, you need at least two and they should be done 4 to 6 weeks apart and around the 3rd day of your cycle to make it as accurate as possible.

There are so many additional challenges to cope with if prematurely menopausal such as infertility…another reason why specialist treatment is required...circulating testosterone levels can drop by 50% after surgical removal of the ovaries so this is obviously going to have an impact on your body, another reason to go and seek advice from a specialist. The list goes on...

So do make sure you are taken seriously, that you get referred to speak to the right specialist - being able to talk through all potential solutions for your individual challenges and needs with someone who really understands can make such a difference.

Premature menopause requires really good support and management of symptoms. Getting the right medication for the right person is essential.

The loss of oestrogen at an earlier age impacts on long term health, there’s no gentle or easy way to say this …thinking about bone health, heart health and cognitive function, so, if there are no reasons why you shouldn’t be taking Hormone Replacement Therapy (HRT), then you are encouraged to do so as soon as possible. If you can’t take HRT then there are alternative medications which can help you to cope with symptoms but again you need to seek specialist advice.

With HRT, by replacing those hormones you help to restore as closely as possible your bodies natural hormonal environment which will then help you to cope with the menopausal symptoms you may be suffering from and helps to prevent those long term symptoms like osteoporosis from developing.

Sensitivity as to which medication is right for which person is key…a much younger person might feel more comfortable being on the combined oral contraceptive pill initially instead of going straight onto HRT and then at a later date moving onto HRT. Think carefully about the best delivery routes for you, for example using an oestrogen spray rather than a patch would be less conspicuous...lots of things to think about.

Kindness and compassion are often required in bucket loads — this can be such a challenging and traumatic time, never underestimate the psychological and emotional impact it can have.

Remember complementary therapies like herbal remedies and supplements might help to cope with the menopausal symptoms but they can’t provide the additional benefits that hormone treatment provides by replacing the oestrogen which helps to prevent the long term symptoms.

Lifestyle choices…I know here I go again but seriously they will help to cope with symptoms…reduce those stress levels, release those endorphins and nourish that body of yours…watch the caffeine and alcohol levels and stay hydrated…it’s a no brainer to give your body it’s best chance isn’t it! Have a look at previous posts on nutrition and exercise all really important to think about for any woman going through the menopause, but even more so when prematurely menopausal thinking about that bone, heart and brain health.

End goal…long term you achieve a better quality of life.

On a lighter note there is a 5% chance of pregnancy in those who have actually gone through premature menopause — your ovaries could suddenly decide to start to work, ovulate and then you could get pregnant — I know the human body eh! This might be something you’ve been desperate to achieve for a long time but if you aren’t intending to get pregnant then can obviously be a bit of a shock! Do remember HRT is not a contraceptive so just make sure you cover your contraception as well — an option would be the combined pill which would cover you for both.

As always the better informed you are the more prepared you will be so do go and have a look at the resources below and remember communicate.

Communicate not only with your GP, your practice nurse, or specialist but communicate with those who love and care about you and who are probably trying their best to support you but sometimes it can be really hard to say and do the right thing can’t it! It can be so hard looking on when someone you care about is going through something like this you can feel at such a loss as to how to help, what to say and what to do for the best, so take a moment now and then and remember to talk - you’re more likely to get better support if you let them know how you’re feeling!

Ok I’ll stop babbling on, here are some really good resources…

The Daisy Network is an invaluable resource - you can contact them for help and advice.

Their aim is to:

  • Provide a support network of people to talk to

  • All members to share information about their personal experience of POI

  • Provide information on treatments and research within the fields of HRT and assisted conception

  • Raise awareness of the condition among GPs and the broader medical community

(There’s fabulous info on there but if you join - membership fee is only £20 - it’s a charity they need support too! - you get access to even more fantastic resources).

If you’re on twitter or instagram two doctors I'd highly recommend following who are obviously passionate about this topic, amongst others are Dr Anita Mitra aka the Gynae Geek and Dr Hannah Short

Nick Panay a leading specialist in this field founded also an excellent resource for women and clinicians.


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