Early menopause and premature ovarian insufficiency

Most women reach menopause around the age of fifty-one. When it happens before forty-five it is called early menopause, and before forty it is called premature ovarian insufficiency, or POI. It affects around one in a hundred women under forty. It deserves its own article because the approach is genuinely different from menopause at the usual age, and getting it right protects your health for decades.

Why it is different

At the usual age, HRT is offered to relieve symptoms, and the decision weighs benefits against small risks. When menopause comes early, the framing changes. Your body would normally still be making these hormones for years to come, so replacing them is not an optional extra for comfort; it is putting back what should still be there. The aim is to keep your hormone levels close to what they would naturally be until at least the average age of menopause.

This is why, for early menopause and POI, the risk conversation is different too. The concerns that apply to starting HRT in your sixties do not apply in the same way to a woman in her thirties replacing hormones she should still have.

How it is diagnosed

Under forty, the diagnosis is made carefully, because it has lifelong implications. It usually involves two blood tests for the hormone FSH, taken four to six weeks apart, alongside your symptoms and menstrual history. Because the diagnosis can be unexpected and difficult to hear, it should come with time to talk it through, not just a result. There is often no identifiable cause, though sometimes there is a genetic, autoimmune or medical one, and surgery or cancer treatment can bring it on.

How it is treated

Treatment is hormone replacement, usually at somewhat higher doses than the standard menopause dose, because the goal is to reach normal pre-menopausal levels rather than just to take the edge off symptoms. Sometimes the doses needed are above what the licence specifies, which is expected and appropriate here, and we explain that openly. Testosterone is often part of the picture too, as the ovaries are a source of it. Some women use a combined contraceptive pill instead, particularly if they also need contraception, and that is a reasonable alternative.

Looking after bones and heart

Because oestrogen protects bone and the cardiovascular system, an early loss of it raises the long-term risk to both. So alongside hormone replacement, care includes a bone density scan, repeated every few years, and active attention to cardiovascular health: blood pressure, cholesterol, activity, weight, not smoking. These are not afterthoughts; they are central to why early menopause is treated proactively.

Fertility and the emotional side

A diagnosis of POI does not always mean fertility is completely gone, though it usually reduces it significantly, and anyone hoping to conceive deserves a proper conversation with fertility services. Beyond the practicalities, an early menopause can be a genuine loss, and the emotional impact is real. Good care makes room for that rather than treating it as only a hormone problem.

How we help

A GP experienced in menopause care can confirm the diagnosis where it is suspected, set up replacement at the right level, arrange the bone and cardiovascular monitoring, and coordinate with gynaecology, fertility or endocrinology where needed. The thread that holds it together is continuity, someone who knows your history and tracks the same things over the years this needs.

Read next

• perimenopause and menopause what is happening

• testosterone for women

• higher doses and off label hrt

Ready to start?

If you want to move from reading to acting, the next step is a short assessment with a GP who has specific menopause expertise. It takes about ten minutes and tells you what will help.

Begin your assessment at this link. Online or in person at Westfield London.