Premature menopause / premature ovarian failure (POF)

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

Most women expect menopause to occur in their late 40s or early 50s — but for some, it begins far earlier. When periods stop before the age of 40, or ovarian function declines prematurely, it’s called premature menopause or premature ovarian failure (POF).

This unexpected transition can bring a wave of emotional, physical, and fertility concerns — but you are not alone. At Happiher, we offer clear answers, expert care, and compassionate support. If you’re looking for a private gynaecologist in London with experience in early menopause, we’re here to help.

What Is Premature Menopause?

Premature menopause refers to the complete and permanent stopping of periods before the age of 40, affecting women typically between the ages of 15 to 44, due to the ovaries no longer producing eggs and hormones (oestrogen, progesterone). Early or premature menopause significantly impacts fertility and can lead to various health complications. It is important to note that primary ovarian insufficiency (POI) is different from premature menopause, as POI may involve intermittent ovarian function and irregular periods.

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

When ovarian function is lost or significantly reduced before age 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 frequently unknown.

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

• Premature ovarian failure (POF) (older terminology)

It can occur 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 progress over months or years of irregular periods.

Common 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 closely resemble those of natural menopause, often making diagnosis challenging.

For many women, the emotional impact of premature menopause can be just as intense as the physical symptoms. The risk of developing conditions such as depression is significant, and support resources like NHS talking therapies can be beneficial for those experiencing mental health challenges.

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 the ages of 15 to 44, highlighting the importance of understanding these potential triggers.

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

Whatever the cause, timely diagnosis and hormone support are key to protecting long-term health.

Other conditions, such as certain medical treatments for various health issues, can also influence reproductive health.

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

Risk Factors and Complications

Primary ovarian insufficiency (POI) is a condition where the ovaries stop functioning and hormone levels decrease before the age of 40. Women with a family history of POI or premature ovarian failure are at a 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 require assisted reproductive technologies (ART) to conceive. It is essential to diagnose POI early to prevent long-term health consequences, such as brittle bones and heart disease, which can be associated with low estrogen levels and low levels of other hormones.

How Is Premature Menopause Diagnosed?

At Happiher, we take a careful and compassionate approach to early menopause assessment.

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

You may be diagnosed with POF or POI if:

• You are under 40 and have missed periods for 4+ months

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

• Oestrogen levels are lower than the typical amounts

We may also recommend:

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

• Thyroid and autoimmune screening

• Bone density scan (DEXA) to assess bone health

Diagnosis can feel overwhelming, but it’s also the first step toward restoring hormonal balance and planning for the future.

Can I Still Get Pregnant with Premature Menopause?

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

At Happiher, we support women with:

• Fertility counselling and hormone testing

• Referral for assisted conception 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 available options for women with primary ovarian insufficiency.

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

Treatment Options

Treatment for primary ovarian insufficiency (POI) typically 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 alleviate symptoms such as hot flashes, vaginal dryness, and irregular menstrual periods. HRT can also help 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 wish to get pregnant, fertility treatments such as in vitro fertilization (IVF) using donor eggs may be an option. It’s essential to work with a healthcare provider to determine the best course of treatment and to discuss the potential risks and benefits of each option. Women with POI should also prioritize their overall health and wellness by maintaining a healthy diet, exercising regularly, and getting enough sleep. 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 enter menopause early lose years of natural oestrogen exposure, which can increase long-term risks of:

• Osteoporosis

• Heart disease

• Cognitive decline

The hormone estrogen 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 estrogen levels can pose significant health risks, making HRT 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

Our goal is to restore hormonal balance and protect your wellbeing — both now and in the long term.

Managing Ovarian Insufficiency

Managing ovarian insufficiency requires a comprehensive approach that addresses physical, emotional, and reproductive health. Women with POI should prioritize self-care and stress management, as high levels of stress can exacerbate symptoms. Engaging in 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.

It’s also essential for women with POI to stay informed about their condition and to 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 potential risks associated with their condition, including osteoporosis, heart disease, and infertility. By prioritising their health and wellness, 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 estrogen levels, significantly impacting a woman's reproductive health. Hormone replacement therapy (HRT) can help alleviate these symptoms and improve overall sexual wellbeing. It is crucial for women with POI to discuss their sexual health concerns with their healthcare provider to receive appropriate treatment and guidance. Regular check-ups and open communication can help women with POI maintain a healthy and fulfilling sex life. Additionally, women with POI may need to consider alternative methods of getting pregnant, such as donor eggs or adoption, which can be a challenging and emotional experience.

Lifestyle Changes and Prevention

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

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

Long-Term Health Consequences

Primary ovarian insufficiency (POI) can have long-term health consequences, including osteoporosis, cardiovascular disease, and cognitive decline. Women with POI are at a greater risk of developing these conditions due to low levels of estrogen. Hormone replacement therapy (HRT) can help alleviate 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. It is essential for women with POI to work closely with their healthcare provider to manage their condition and prevent long-term health consequences. Additionally, women with POI should be aware of the potential 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 take steps to protect their health and wellbeing.

Emotional and Psychological Impact

Being told you’ve entered 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, necessitating tailored menopause management.

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 seeking 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, restore hormonal balance, 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 personalized care focuses on every aspect of a woman's health, ensuring comprehensive support and treatment.