Early Menopause

The following topics concern early menopause:

AMS Information Sheets - for health professionals | Early Menopause: Health Practitioners’ Perspectives digital resource (Healthtalk Australia) | Clinical Trials | Patient Resources

Spontaneous Premature Ovarian Insufficiency

Menopause in women younger than 40 years of age is called premature menopause. If this happens spontaneously it is called premature ovarian failure. Premature ovarian failure affects about 1 in a 100 women. Around 8 per 100 women have premature menopause due to other causes such as chemotherapy or surgery. Menopause occurring between 40-45 years of age is called early menopause, affecting approximately 5% of women. Menopause can occur spontaneously or can be a result of chemotherapy (See AMS information sheet:- Early Menopause Due to Chemotherapy) or ovarian surgery. There is no evidence that early menopause is brought on by the use of oral contraceptives, fertility drugs or artificial hormones in the environment. However, smoking or a family history of early menopause is associated with an earlier onset of menopause. Diagnosis of early ovarian failure often has long term physical and psychological consequences, so women may need emotional support and ongoing medical follow-up.

Early Menopause due to Chemotherapy and Radiotherapy

Chemotherapy is usually administered as part of cancer treatment but may also be given to women with severe connective tissue disorders such as systemic lupus erythematosis or kidney disease such as Wegener’s granulomatosis. Survival rates for many cancers in women of reproductive age are increasing. However, many treatments used to combat the disease carry a substantial risk for future infertility. Chemotherapy is toxic to the ovaries causing loss of eggs and destruction of the supporting ovarian tissue. This may cause temporary cessation of menstrual periods or early menopause which can develop quickly or gradually.

Surgical Menopause

Menopause means the final menstrual period. The average age of menopause is around 51 years, but most women will start to notice menopausal symptoms from around 47 years. This may be noticed as the onset of hot flushes, night sweats or vaginal dryness or a change in menstrual periods to more infrequent and sometimes heavier menstrual bleeding (1). Removal of both ovaries (bilateral oophorectomy) before the normal menopause is called “surgical menopause”.

AMS Surgical Menopause464.47 KB

These Information Sheets may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

A digital resource for health professionals caring for women with POI and early menopause

The Early Menopause: Health Practitioners’ Perspectives digital resource (Healthtalk Australia) is a unique resource aimed at supporting and informing health professionals from a range of specialties who work with women with POI and early menopause.

On this resource you can read, watch and listen to the experiences and perspectives of 16 health practitioners who provide medical care and psychological support for women diagnosed with spontaneous and medically-induced early menopause / POI, or menopausal symptoms as a result of cancer or other medical treatments. Health practitioners interviewed include breast care nurses, breast surgeons, clinical psychologists, endocrinologists, fertility specialists, general practitioners, obstetrician-gynaecologists, oncologists, and psychiatrists.

You will also find links to a comprehensive range of resources, including diagnostic and management (treatment) algorithms for early menopause, and links to a companion digital resource on women’s experiences for patients.

The online resource was developed as a result of a NHMRC Partnership Project involving academic endocrinologists and obstetrician-gynaecologists at the Monash Centre for Health Research and Implementation and the University of Melbourne and health sociologists at RMIT University. Partner organisations included AMS, National Breast Cancer Foundation, Healthdirect Australia, Women’s Health Victoria, Breast Cancer Network Australia, Monash Health, Endocrine Society of Australia, and Healthtalk Australia.

Clinical Trials

Early Menopause Medical Study

For more information and how to register go to:

Early Menopause Medical Study
https://trials.evrima.com.au/early-menopause-medical-study

Do you have Early Menopause?

Patient Resources

Fact Sheets

Menopause before 40 and spontaneous premature ovarian insufficiency

Early menopause – chemotherapy and radiation therapy

Early menopause chemotherapy and radiation therapy

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

Page updated October 2022

Uro-genital

The following topics concerning the uro-genital areas may be found in the AMS Information Sheets.

Vulvovaginal symptoms after menopause

As women age they will experience changes to their vagina and urinary system largely due to decreasing levels of the hormone oestrogen.

The changes, which may cause dryness, irritation, itching and pain with intercourse (1-3), are known as the genito-urinary syndrome of menopause (GSM)(4) and can affect up to 50% of postmenopausal women (4). GSM was previously known as atrophic vaginitis.

Unlike some menopausal symptoms, such as hot flushes, which may disappear as time passes; genito-urinary problems often persist and may progress with time. Genito-urinary symptoms are associated both with menopause and with aging (4).

Changes in vaginal and urethral health occur with natural and surgical menopause, as well as after treatments for certain medical conditions (Please refer to AMS Information Sheet 'Vulvovaginal symptoms after menopause').

Vaginal health after breast cancer: A guide for patients

Women who have had breast cancer treatment before menopause might find they develop symptoms such as hot flushes, night sweats, joint aches and vaginal dryness.

These are symptoms of low oestrogen, which occur naturally with age, but may also occur in younger women undergoing treatment for breast cancer. These changes are called the genito-urinary syndrome of menopause (GSM), which was previously known as atrophic vaginitis.

Unlike some menopausal symptoms, such as hot flushes, which may go away as time passes, vaginal dryness, discomfort with intercourse and changes in sexual function often persist and may get worse with time.

The increased use of adjuvant treatments (medications that are used after surgery/chemotherapy/radiotherapy), which evidence shows reduce the risk of the cancer recurring, unfortunately leads to more side-effects.

Your health and comfort are important, so don’t be embarrassed about raising these issues with your doctor.

This Information Sheet offers some advice for what you can do to maintain the health of your vagina, your vulva (the external genitals) and your urethra (outlet from the bladder), with special attention to the needs of women who have had breast cancer treatment.

AMS New directions in women's health

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

These Information Sheets may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content Updated May 2021

Menopause Management

menopause management AMS provides information for doctors and other health practitioners in supporting women through midlife health and the menopause.

Menopause Basics
What is Menopause?
Diagnosing Menopause
Weight management and healthy ageing
Glossary of Terms

Menopause Treatment Options
Healthy Ageing and Lifestyle
Menopause Management GP Tool
Oestrogen Only Menopausal Hormone Therapy
Combined Menopausal Hormone Therapy (MHT)
Tibolone For Post-Menopausal Women
AMS Guide to Equivalent MHT/HRT Doses
NonHormonal Treatments for Menopausal Symptoms
Early Menopause
Spontaneous Premature Ovarian Insufficiency
Early Menopause due to Chemotherapy
Surgical Menopause
Risks and Benefits
Risks and Benefits of MHT/HRT
Venous Thrombosis/Thromboembolism Risk and Menopausal Treatments
Uro-genital
Vulvovaginal symptoms after menopause
Vaginal health after breast cancer: A guide for patients
Bones
Calcium Supplements – a patient guide
Menopause and osteoporosis
Prevention of falls and fractures as you age past the menopause
SERMS after Menopause
Sex and Psychological
Sexual difficulties in the menopause
Sleep Disturbance and the Menopause
Mood problems at menopause - depression
Alternative Therapies
Complementary and Herbal Therapies for Hot Flushes
Bioidentical Hormone Preparations - History of Development
Bioidentical Hormones for Menopausal Symptoms

Contraception
Contraceptive methods, advantages and disadvantages

AMS New directions in women's health

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

These Information Sheets may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated May 2021

Menopause Basics

The following topics concerning the menopause basics may be found in the AMS Information Sheets.

What is Menopause?

The menopause is sometimes called 'the change of life' as it marks the end of a woman's reproductive life. At menopause, eggs are no longer produced by the ovary and production of oestrogen and progesterone ceases. The word "menopause" refers to the last or final menstrual period a woman experiences.

When a woman has had no periods for 12 consecutive months she is considered to be “postmenopausal”. Most women become menopausal naturally between the ages of 45 and 55 years, with the average age of onset at around 50 years. “Premature menopause” may occur before the age of 40 due to either natural ovarian function ceasing, following surgery to remove the ovaries, or as a result of cancer treatments. Menopause is considered “early” when it occurs between 40 and 45 years. (For more, see the information sheets “Spontaneous Premature Ovarian Insufficiency” and “Early menopause due to chemotherapy”).

AMS What is menopause?555.18 KB

Menopause - What are the Symptoms?

Diagnosing Menopause

AMS Diagnosing Menopause Symptom score sheet Frequently, the diagnosis of menopause has already been made by the woman herself. She attends her GP with symptoms such as hot flushes or night sweats interrupting her sleep, together with changes in her menstrual cycle. Not all women with menopausal symptoms will need treatment. Most women will be glad of information about menopause and about the safe and effective treatment options available. The questions we should be asking her are "Why did you come to see me", and "What do you hope to get out of this consultation?"

AMS Diagnosing menopause398.75 KB

AMS Diagnosing Menopause Symptom score card118.51 KB

Weight management and healthy ageing

For women at midlife, it can be difficult to separate the effects of ageing from the effects of menopause. Ageing is associated with weight gain in both women and men. Weight gain during and after menopause is associated both with lifestyle factors and the physiological changes of ageing, as well as with the hormonal changes of menopause.

Menopause - How will it affect my health?

Glossary of Terms

A description of words and terms used in menopause and women's health.

AMS Glossary of Terms655.37 KB

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

These Information Sheets may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated April 2023

Menopause Treatment Options

The following topics concerning menopause treatment options may be found in the AMS Information Sheets.

Lifestyle and behavioural modifications for menopausal symptoms

A healthy diet and lifestyle, incorporating exercise, lowers risk for many health problems associated with ageing, gives you more energy, and improves quality of life. A healthy lifestyle may reduce menopausal symptoms including hot flushes and sleep disturbance.

Menopause Management GP Tool

A Practitioner’s Toolkit for the Management of the Menopause498.32 KB

What is Menopausal Hormone Therapy (HRT)?

Oestrogen Only Menopausal Hormone Therapy

Women generally undergo menopause between the ages of 45 and 55 years. Around the time of menopause many women may experience symptoms such as hot flushes, sweats, vaginal dryness, loss of libido, irritability, sleep disturbance, and muscle/joint pains. There are a number of ways of managing these symptoms, but for those whose symptoms are troublesome and disruptive, oestrogen containing HRT may be considered.

Combined Menopausal Hormone Therapy (MHT)

The menopause is the final menstrual period and usually happens between the ages of 45 and 55 years. Around this time, women may experience symptoms such as hot flushes, sweating, vaginal dryness, loss of libido, irritability, sleep disturbance and muscle/joint pains. Oestrogen therapy is the most effective means of treating these symptoms. It will also prevent bone loss. In a woman with an intact uterus, unopposed oestrogen therapy increases the risk of endometrial hyperplasia and cancer (1). Therefore, women who have not had a hysterectomy should take a progestogen as well to provide endometrial protection. Note that there is no therapeutic advantage of prescribing progestogen (either a progestin or natural progesterone) to women who have had a hysterectomy, (with the possible exception of women with symptomatic residual intra-peritoneal endometriosis) (2). In fact, there is a distinct disadvantage in terms of increased breast cancer and thrombotic risk and adverse changes in cardiovascular risk factors (3).

AMS Menopause Combined MHT376.24 KB

Tibolone For Post-Menopausal Women

Tibolone is a type of hormone therapy (HT/HRT) designed to relieve menopausal symptoms and prevent osteoporosis (thinning of the bones) in post-menopausal women.

AMS Guide to MHT/HRT Doses

This information has been developed as a guideline only to approximately equivalent doses of the different HRT products available. The intention is to help physicians change their patients to higher or lower approximate doses of MHT/HRT if needing to tailor therapy, or remain within the same approximate dose if needing to change brands of MHT/HRT.

Australia only Read more...

New Zealand only Read more...

NonHormonal Treatments for Menopausal Symptoms

This information sheet is intended for medical practitioners and nurses to help provide information to their patients.

Women sometimes seek alternative treatments for the symptoms of menopause if they have not found relief with lifestyle changes or their hormone replacement therapy does not work. Some may be advised against hormones because of a medical condition and others want to avoid them after hearing about health risks. This pamphlet includes summaries of studies of treatments prescribed by doctors "off-label" for relief of menopausal symptoms. (The main symptom treated by these medications is hot flushes/night sweats.) Off-label means use outside the specific purpose for which the drug was approved by Australia's medicines regulator, the Therapeutic Goods Administration. Doctors prescribing off-label have a responsibility to be well-informed about the product and base its use on scientific evidence.

Menopause - Non-hormonal Treatment Options

Menopause - Complementary Therapies

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

These Information Sheets may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated June 2023

Contraception

The following topic concerning the contraception may be found in the AMS Information Sheets.

Contraception

While fertility declines with age, women are at risk of an unintended pregnancy until 12 months after the last menstrual period if over 50 years (24 months if below 50 years)
Women should be provided with evidence-based information about all contraceptive options in order to support informed decision making
Oestrogen containing methods (combined oral contraception and the vaginal ring) and the contraceptive injection are generally not recommended after 50 years as the cardiovascular risks outweigh the benefits
The LNG-IUD provides effective management of heavy menstrual bleeding as well as contraception and it can be used as part of an HRT regimen
Women in a new relationship should be advised about the use of condoms to prevent STIs
Women should be informed about the availability of the Emergency Contraceptive Pill without a prescription at pharmacies and its effectiveness up to 96 hours after unprotected intercourse

AMS Contraception 2016830.19 KB

AMS New directions in women's health

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated May 2016

Alternative Therapies

The following topics concerning the alternative-therapies may be found in the AMS Information Sheets.

Complementary and Herbal Therapies for Hot Flushes

Many women experience hot flushes and night sweats around the time of menopause. Hormone replacement therapy (HRT) has been proven to be effective in alleviating these symptoms (1). Some women however, choose to explore complementary or herbal therapies for relief of symptoms. There have been a great many trials of complementary and herbal medicines and some of these have suggested benefits from certain therapies and others have shown no benefit. It can be difficult for consumers and for doctors to interpret this mixed information (2). This information sheet provides a brief overview of the current evidence for complementary and herbal therapies.

Menopause - Complementary Therapies

Bioidentical custom compounded hormone therapy

‘Bioidentical’ hormone therapy refers to compounded products which are marketed as hormones that are identical to those produced by the body. The production of these products is not subject to the regulatory conditions of approved pharmaceutical products (1). “Bioidentical hormones” are defined as compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body (US Endocrine Society definition). It is important to realise that all hormones are synthesised. No hormone used in any preparation (regular HRT or “bioidentical therapy”) is ‘natural’ – they are all synthesised from some precursor by the action of enzymes. Both regular and compounded hormone therapies use bioidentical oestradiol but because of its rapid degradation and unsafe endometrial response, bioidentical progesterone is not used by commercial pharmaceutical companies.

This pamphlet explains why the Australasian Menopause Society does not endorse the use of compounded bioidentical hormone therapies.

AMS Empowering Menopausal Women

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

These Information Sheets may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content Updated September 2018

Sex and Psychological

The following topics concerning the sex and psychology may be found in the AMS Information Sheets.

Sexual difficulties in the menopause

Sexual response and therefore sexual difficulty can refer to desire, arousal, orgasm or pain with intercourse. Although these are classified as separate elements in sexual response, they become inextricably linked when dysfunction occurs. A clinical history should attempt to define what may be the initiating and maintaining problems.

Low libido refers to diminished desire for sex. When clinically a problem it is referred to as hypoactive sexual desire disorder (HSDD). Low libido is the most common sexual concern reported by women and is often inseparable from diminished capacity to become aroused. More recently HSDD has been merged with female sexual arousal disorders and re-named 'female sexual interest-arousal disorder' (FSIAD), which remains primarily based on sexual desire (1). It is still reasonable to talk about HSDD or simply loss of libido. Other common sexual concerns for women include delayed / inability to achieve an orgasm and vaginal pain, often due to vaginal dryness.

Sexual difficulties can be life-long or recently acquired, but they are a common presentation at the menopause. They may also be situational (limited to certain types of stimulation, situations, or partners) or generalized.

A useful reference for both women and their partners is the book “Where Did My Libido Go?” by Dr Rosie King.

Menopause - Will it affect my sex life?

Sleep Disturbance and the Menopause

Sleep disturbance, or insomnia, is a common problem in menopause. Having problems sleeping is not only unpleasant, it also affects quality of life, increases the risk of accidents, and can reduce concentration and memory.

Insomnia - unsatisfactory sleep - occurs in up to twice as many women during and after menopause compared to younger women. This deterioration in sleep usually starts a few years before menopause.

Mood and the menopause

Currently under review.

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

These Information Sheets may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated February 2023

Bones

The following topics concerning the bones may be found in the AMS Information Sheets.

Calcium Supplements

The use of calcium supplements has long been considered an integral part of managing osteoporosis, with detailed reviews of medical research indicating a reduction in fracture risk when calcium and vitamin D are prescribed. In addition to the bone health benefits, there is also evidence that calcium supplements may improve cholesterol levels, blood pressure, clotting risk and other cardiovascular risk factors.

Menopause and osteoporosis

Osteoporosis is a condition characterised by weakened bones that fracture easily. After menopause many women are at risk of developing osteoporosis.

Peak bone mass is usually reached in your 20s to 30s when the skeleton has stopped growing and bones are at their strongest.

The female sex hormone oestrogen plays an important role in maintaining bone strength. After menopause oestrogen levels drop and this may result in increased bone loss. The average woman loses up to 10 per cent of her bone mass in the first five years after menopause. Research suggests that about half of all women over the age of 60 years will have at least one fracture due to osteoporosis.

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The Role of SERMS after Menopause

SERMs is the shorthand term for a class of drug called selective oestrogen receptor modulators. These compounds act like oestrogen in some parts of the body and in other parts of the body they have an anti-oestrogenic effect. They are a versatile group of drugs that can be used to treat a number of conditions associated with aging such as osteoporosis (bone thinning disease) and hormone responsive cancers, and also in infertility.

AMS Empowering Menopausal Women

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

These Information Sheets may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated September 2018

Risks and Benefits

The following topics concerning menopause risks and benefits may be found in the AMS Information Sheets.

Risks and Benefits of MHT/HRT

Women making decisions about treatment during menopause - or any other medical decisions - are going to be presented with information about risk, for instance the risk of taking hormone therapy (HT). How does a woman know if increased risk is relevant to her? It helps to have a good grasp of the way the terminology is used by doctors and researchers.

Is Menopausal Hormone Therapy (HRT) safe?

Venous Thrombosis/Thromboembolism Risk and Menopausal Treatments

Hormone Replacement Therapy (HRT) containing oestrogens in tablet form and also selective oestrogen receptor modulators (See AMS Information Sheet - The Role of SERMS after Menopause) increase the risk of deep vein thrombosis (DVT) (1-6) and pulmonary embolus (PE).

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

These Information Sheets may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content updated September 2018

AMS: MenopauseDown Under

A Practitioner’s Toolkitfor Managing Menopause

AMS eLearning

Health Information

Menopause management

About AMS

AMS Members

Health Professionals

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AMS eLearning

Early Menopause

Spontaneous Premature Ovarian Insufficiency

Early Menopause due to Chemotherapy and Radiotherapy

Surgical Menopause

A digital resource for health professionals caring for women with POI and early menopause

Clinical Trials

Patient Resources

Uro-genital

Vulvovaginal symptoms after menopause

Vaginal health after breast cancer: A guide for patients

Menopause Management

Menopause Basics

What is Menopause?

Diagnosing Menopause

Weight management and healthy ageing

Glossary of Terms

Menopause Treatment Options

Lifestyle and behavioural modifications for menopausal symptoms

Menopause Management GP Tool

Oestrogen Only Menopausal Hormone Therapy

Combined Menopausal Hormone Therapy (MHT)

Tibolone For Post-Menopausal Women

AMS Guide to MHT/HRT Doses

NonHormonal Treatments for Menopausal Symptoms

Contraception

Contraception

Alternative Therapies

Complementary and Herbal Therapies for Hot Flushes

Bioidentical custom compounded hormone therapy

Sex and Psychological

Sexual difficulties in the menopause

Sleep Disturbance and the Menopause

Mood and the menopause

Bones

Calcium Supplements

Menopause and osteoporosis

The Role of SERMS after Menopause

Risks and Benefits

Risks and Benefits of MHT/HRT

Venous Thrombosis/Thromboembolism Risk and Menopausal Treatments

Menopause Management

Top Information Sheets

Position Statements

Studies Published

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AMS: Menopause
Down Under

A Practitioner’s Toolkit
for Managing Menopause