Premature menopause / premature ovarian failure (POF)

Premature Menopause & Premature Ovarian Failure (POF): Early Hormonal Decline

Most women expect menopause to happen in their late 40s or early 50s — but for some, it happens much earlier. When periods stop before 40 or ovarian function declines early, it’s called premature menopause or premature ovarian failure (POF).

This unexpected change can bring a tidal wave of emotional, physical and fertility worries — but you’re not alone. At Happiher, we offer clear answers, expert care and compassionate support. Looking for a private gynaecologist in London with experience in early menopause? We’re here to help.

What Is Premature Menopause?

Premature menopause means periods stop before 40 and are permanent. It affects women between 15 to 44 years old due to the ovaries no longer producing eggs and hormones (oestrogen, progesterone). Early or premature menopause affects fertility and can lead to various health problems. Note primary ovarian insufficiency (POI) is different from premature menopause as POI may involve intermittent ovarian function and irregular periods.

This condition means lower levels of certain hormones which can increase the risk of various health conditions.

When ovarian function is lost or significantly reduced before 40 — even if periods come and go irregularly — it’s also called: Problems with ovarian follicles are often related to primary ovarian insufficiency, though the exact cause is often unknown.

• Premature ovarian insufficiency (POI), where the ovaries stop working

• Premature ovarian failure (POF) (older terminology)

It can happen naturally, after surgery (e.g. removal of ovaries), or as a result of medical treatments such as chemotherapy or radiotherapy. Primary ovarian insufficiency can develop suddenly or over months or years of irregular periods.

Symptoms of Premature Menopause / POF

Symptoms are similar to natural menopause but may feel more sudden and unexpected:

• Irregular or missed periods (then no periods at all, as periods stop)

• Hot flashes and night sweats

• Vaginal dryness

• Low libido

• Mood changes, anxiety or low mood

• Difficulty concentrating (“brain fog”)

• Fatigue* Infertility or difficulty conceiving

• Joint aches or bone thinning (due to low oestrogen)

• Other symptoms such as weight gain, hair loss, and dry skin

The symptoms of primary ovarian insufficiency may be similar to natural menopause, making diagnosis tricky.

For many women, the emotional impact of premature menopause can be as big as the physical symptoms. The risk of developing depression is high and NHS talking therapies can be helpful for those experiencing mental health issues.

What Causes Premature Menopause or POF?

In most cases, the cause is unknown. However, possible triggers include:

• Autoimmune conditions (e.g. thyroid disease, Addison’s disease)

• Genetic conditions (e.g. Turner syndrome, Fragile X premutation)

• Family history of early menopause

• Cancer treatments (chemotherapy or radiotherapy)

• Surgical removal of ovaries

• Certain infections or viral illnesses

• Lifestyle or environmental factors (less common)

Primary ovarian insufficiency affects about 1% of women between 15 to 44, so it’s important to understand these triggers.

These triggers can lead to other health conditions due to hormonal imbalances.

Whatever the cause, timely diagnosis and hormone support is key to long term health.

Other conditions, such as certain medical treatments for other health issues, can also affect reproductive health.

Identifying specific factors that increase a woman’s risk of primary ovarian insufficiency (POI) is crucial to raising awareness and managing the condition.

Risk Factors and Complications

Primary ovarian insufficiency (POI) is a condition where the ovaries stop working and hormone levels decrease before 40. Women with a family history of POI or premature ovarian failure are at higher risk of developing the condition. Other risk factors include autoimmune disorders, certain medical conditions such as Turner syndrome, and exposure to toxins, radiation and certain chemicals. POI can increase the risk of osteoporosis, cardiovascular disease and cognitive decline. Women with POI may experience infertility and may need assisted reproductive technologies (ART) to conceive. It’s important to diagnose POI early to prevent long term health consequences such as brittle bones and heart disease which can be associated with low oestrogen and low levels of other hormones.

How Is Premature Menopause Diagnosed?At Happiher we take a gentle and empathetic approach to early menopause assessment.

Research shows there is a link between hormone levels and premature menopause.

You may be diagnosed with POF or POI if:

• You are under 40 and have not had a period for 4+ months

• Your blood tests show consistently high FSH (follicle-stimulating hormone) levels

• Oestrogen levels are lower than normal

We may also recommend:

• AMH testing (anti-Müllerian hormone) to check ovarian reserve

• Thyroid and autoimmune screening

• Bone density scan (DEXA) to check bone health

Diagnosis can be overwhelming but it’s also the first step to rebalancing hormones and planning for the future.

Can I Still Get Pregnant with Premature Menopause?

Women with POF may occasionally still ovulate and have occasional periods — so natural pregnancy is rare but not impossible. However, fertility is significantly reduced. About 5% to 10% of women with primary ovarian insufficiency will conceive spontaneously without treatment. Women with premature menopause may also have irregular periods as a symptom, resulting in either complete cessation of menstruation or intermittent ovulation.

At Happiher we support women with:

• Fertility counselling and hormone testing

• Referral for IVF or egg donation if desired

• Emotional and psychological support to process fertility decisions

• Information on fertility treatments such as IVF and donor eggs, which are options for women with primary ovarian insufficiency.

Whether or not you’re planning a pregnancy, your hormonal health matters.

Treatment

Treatment for primary ovarian insufficiency (POI) focuses on managing symptoms and preventing related health conditions. The most common treatment is hormone replacement therapy (HRT) which helps to restore normal hormone levels and relieve symptoms such as hot flushes, vaginal dryness and irregular periods. HRT also helps to prevent osteoporosis and heart disease which are common health risks associated with POI. In addition to HRT women with POI may also be prescribed other medications to manage specific symptoms, such as antidepressants for anxiety and depression.For women who want to get pregnant IVF using donor eggs may be an option. It’s important to work with a healthcare provider to determine the best course of treatment and to discuss the risks and benefits of each option. Women with POI should also focus on their overall health and wellbeing by eating well, exercising regularly and sleeping well. Regular check-ups with a healthcare provider can help to monitor hormone levels and adjust treatment as needed.

Why HRT Is So Important

Women who go into menopause early lose years of natural oestrogen exposure which can increase long term risks of:

• Osteoporosis

• Heart disease

• Cognitive decline

Oestrogen plays a crucial role in preventing these long term health risks by maintaining bone density, cardiovascular health and cognitive function.

That’s why Hormone Replacement Therapy (HRT) is usually recommended up to at least the natural age of menopause (around 51) unless contraindicated. Low oestrogen levels can be very risky so HRT is an important consideration for managing these risks.

At Happiher we offer:

• Body-identical HRT in patches, gels, tablets or sprays

• Vaginal oestrogen for local symptoms

• Tailored HRT planning based on lifestyle and preferences

We want to rebalance your hormones and protect your wellbeing — now and in the long term.

Managing Ovarian Insufficiency

Managing ovarian insufficiency requires a holistic approach to physical, emotional and reproductive health. Women with POI should prioritise self-care and stress management as high levels of stress can exacerbate symptoms. Regular exercise such as yoga or walking can help to reduce stress and improve overall health. A balanced diet that includes plenty of fruits, vegetables and whole grains can also help to support hormone health and reduce the risk of related health conditions.

Women with POI should also stay informed about their condition and work closely with their healthcare provider to manage symptoms and prevent complications. Regular blood tests can help to monitor hormone levels and adjustments to treatment can be made as needed. Women with POI should also be aware of the risks associated with their condition including osteoporosis, heart disease and infertility. By focusing on their health and wellbeing women with POI can reduce their risk of these conditions and improve their overall quality of life.### Sexual Health and Wellbeing

Women with primary ovarian insufficiency (POI) may experience sexual health issues including vaginal dryness and low libido due to low oestrogen levels which can impact a woman’s reproductive health. Hormone replacement therapy (HRT) can help with these symptoms and overall sexual wellbeing. Women with POI should discuss their sexual health with their healthcare provider to get the right treatment and advice. Regular check-ups and open communication can help women with POI have a healthy and fulfilling sex life. Women with POI may also need to consider alternative ways of getting pregnant such as donor eggs or adoption which can be a difficult and emotional journey.

Lifestyle Changes and Prevention

While there is no proven way to prevent primary ovarian insufficiency (POI) certain lifestyle changes can reduce the risk of developing the condition. Being a healthy weight, exercising regularly and avoiding cigarette smoke and other toxins can support ovarian function. Women with a family history of POI or premature ovarian failure should discuss their risk factors with their healthcare provider and have regular check-ups to monitor their ovarian function. A balanced diet rich in vitamin D and calcium can also maintain bone health and reduce the risk of osteoporosis. Managing stress and anxiety through meditation and yoga can also help with POI symptoms.

These lifestyle changes are also important in reducing the risk of early or premature menopause.

Long-Term Health Consequences

Primary ovarian insufficiency (POI) can have long term health consequences including osteoporosis, heart disease and cognitive decline. Women with POI are at higher risk of these conditions due to low oestrogen levels. Hormone replacement therapy (HRT) can help with symptoms and reduce the risk of these conditions. Regular check-ups and monitoring of bone density and cardiovascular health can help women with POI maintain their overall health and wellbeing. Women with POI should work closely with their healthcare provider to manage their condition and prevent long term health consequences. Women with POI should also be aware of the risks associated with certain cancer treatments such as chemotherapy and radiation therapy which can increase the risk of POI. By being informed and proactive women with POI can protect their health and wellbeing.

Emotional and Psychological Impact

Being told you’ve gone into menopause in your 20s or 30s can be a huge shock. Many women experience:* Grief about fertility

• Loss of identity or femininity

• Anxiety about relationships or future health

• Anger or frustration at not being diagnosed earlier

For some women primary ovarian insufficiency may involve irregular or occasional periods for years adding to the emotional complexity of the condition.

For women who have had breast cancer treatment options may be limited due to the health risks associated with hormone replacement therapies so menopause management needs to be tailored.

At Happiher we approach care with deep empathy and always offer referrals for psychological support or counselling when needed.

Why Choose Happiher for Early Menopause Support?

If you’re looking for a specialist for premature menopause in London Happiher offers:

• Private, compassionate consultations with a gynaecologist experienced in early menopause

• Full hormone and fertility assessment

• Personalised HRT advice and prescription

• Ongoing care to monitor bone, heart and emotional health

• A supportive, woman-centred approach every step of the way

• Management of other health conditions associated with primary ovarian insufficiency (POI)

We take time to explain, reassure and offer you choices — never rushing your decisions or dismissing your concerns.

Final Thoughts

Premature menopause is life changing — but with the right care you can protect your health, rebalance your hormones and regain confidence about the future.

At Happiher we’re here to guide you through every stage of this journey — with clarity, clinical excellence and kindness. Our personalised care covers every aspect of a woman’s health so you get comprehensive support and treatment.