Early menopause (EM) is marked by the absence of menstrual periods, which may or may not be associated with menopausal symptoms such as hot flushes and/or night sweats (vasomotor symptoms), vaginal dryness, loss of libido and/or incontinence (genitourinary symptoms), mood changes, sleep disturbance, fatigue, and cognitive difficulties. Symptoms vary between women, by cause of EM, and over time. Women who experience surgical menopause (bilateral oophorectomy or hysterectomy with oophorectomy) often experience more severe symptoms (see also Symptoms of early menopause (Health Practitioners’ perspectives)). To learn about treatments that have been shown to be effective for EM symptoms (including Hormone Replacement Therapy (HRT) and selected non-hormonal medications), and complementary medicines and alternative therapies or lifestyle changes that some women find helpful, see ‘Further Information’ at the end of this Talking Point.
This Talking Point covers women’s experiences of early menopause-related mood changes, sleep disturbance, fatigue, cognitive difficulties, the absence of menstrual periods, and EM symptoms in the context of cancer. For experiences of vasomotor (hot flushes and night sweats) and genitourinary (vaginal dryness, loss of libido and bladder problems) symptoms, please see
Women’s experiences of symptoms of early menopause – Part 1.
Mood changes
Many women we spoke to mentioned mood changes as a symptom of EM, describing themselves as more ‘irritable’, ‘snappy’ or ‘depressed’ than usual, or prone to tearfulness for no apparent reason. Nancy recalled that it was ‘very easy to [get] angry’ after her bilateral oophorectomy.
Jenni said she began experiencing ‘temper tantrums’ with EM.
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I’ve always been a very even tempered person, and I started getting what I could really only describe as temper tantrums [laughing].
I’d be driving down the road and everything was fine, and then someone would cut me off, and I would just fly into this emotional rage and think I was going to ram the car. So I would pull over to the side of the road and take my keys out of the ignition and sit on it, in case I actually did [laughing] ram the car in front of me, which I never did. But, eventually the emotional outrage would pass and I could go “Oh, well, I don’t know what that was all about”, and start the car up and drive off again. So there were things that were clearly outside of my character that were going on that couldn’t be explained; for any reason. So that was the lead-up to it.
Disturbed sleep, fatigue and cognitive difficulties
Many women experienced interrupted sleep as a result of night sweats, which meant they were tired during the day. As Anna said, ‘if I’ve had disturbed sleep I’ll be awake for hours, and I’ll feel tired, but just not be able to drop off to sleep again … I’d probably have a couple of nights a week like that, and that’s really awful, because you’re really wrecked the next day.’
Kate said night sweats and fatigue had led her to cut back on socialising at night.
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I don’t sleep as much anymore because I wake up absolutely drenched a few times a night and the hot flushes get so bad that I just can’t concentrate. I can’t do anything.
I’m not as social as I was any more and that might come down to being way too tired but I’ll still go to things like baby showers and weddings, of course, and birthdays. But I think for me, it’s more about the fact that I’m too tired to go and do these things. I think my friends picked up on that, and I guess I don’t get invited to things anymore because they know that I’ll probably say no, and it’s not that I don’t want to. It’s just that to try and put that in at a night time, I just can’t do it.
Other women reported experiencing a general decline in sleep quality (unrelated to night sweats), and/or lower energy levels. Before she began taking Hormone Replacement Therapy (HRT) for spontaneous EM, Melinda described feeling ‘depleted’ and ‘drained’. HRT made her feel as though she had her ‘energy back.’
Sonia, who experienced spontaneous EM and had decided not to take HRT, compared how she felt before and after EM.
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You are young, so you feel young, but then your body starts to change so much that you don’t necessarily feel as physically vibrant as you did. Before early menopause I felt full of beans, and after menopause, I mean, I still have a lot of energy, and I still work a very physical job, I’m just more tired. I think it just kind of goes with the territory [laughing]. Also insomnia, or partial insomnia doesn’t help because post-menopause, sleep was just never the same [laughing]. And I hear lots of women say the same thing.
Another distressing EM symptom women mentioned was ‘brain fog’; becoming forgetful or frequently losing their train of thought. Women attributed memory or concentration problems to ageing, fatigue, cancer treatment, or early menopause itself. Maree thought her memory problems had been affected by ‘a wide range of things’ including chemotherapy and sleep deprivation.
Linda, who experienced surgical EM for endometriosis at 33 then was diagnosed with breast cancer at 39, described the ‘cognitive decline’ she had noticed in recent years and how she had adapted to this.
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I have noticed some cognitive decline in the last probably four years and I wonder if that’s due to getting older. So maybe more at an age where I would have naturally gone through menopause. Because other things have also worsened during that time as well. I don’t know, though, whether it’s partially due to my heart condition and the fainting disorder. So it’s hard for me to separate what might be the cause of some of these things. And I see a neurologist as well. So some of the things that I notice is memory; in terms of particularly short term memory.
And also, just being forgetful, that sort of thing. But the other thing I noticed is that the ability to task switch or to apply myself to high cognitive demand tasks for any period of time, I just get fatigued. So I’m way more fatigued now than I used to be. And my ability to do two things at once is decreasing and impaired. And some of the things I do, and I find it so frustrating, is being a facilitator, you’re often talking to somebody and scribing at the same time. Now I can’t do that, so I have to stop talking while I scribe. And I also noticed that when I’m scribing, I’ll sometimes leave out letters, all that sort of thing.
So just that kind of cognitive stuff. The advice from the neurologist just to slow down, be more mindful, because they think it’s a cognitive demand kind of thing. But it’s hard to do in those sorts of roles. And I find at the end of the day, I will literally sometimes drag myself out of a workshop because I am just so tired.
Less common symptoms
Less commonly mentioned symptoms of EM among the women we interviewed included facial hair, aching joints or muscles, and dry skin. Facial hair was a source of anxiety for a few women, including Fiona: ‘at the start [facial hair] was a huge shock for me and that was really hard to get my head around, because that was part of being female.’
Muscular or joint aches were particularly common among women who had experienced surgical menopause or cancer treatment, including Maree who described feeling ‘rusty.’ Many women also said their skin had become drier after EM. Those taking HRT found this helped.
For
Vicki, flaky skin was a sign that she was late changing her HRT patch
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I find my skin gets extremely flaky. So even if I’m more than a day late with changing my patch and go, “oh no, I meant to change my patch”, often what will make me think is, “Gee, why is my arm flaking or why is my leg flaking,” and there have been some times where I’ve ripped my skin because I’ve been itchy and scratched, and my skin has just been fragile and flaky. So I try not to itch, but rub myself with some olive oil, because I’ve been very blessed that my grandparents have olive trees, so we get really pure oil, and I rub myself down with that. I’ll often be found in my dressing gown, with cotton wool and olive oil, and I’ll just rub myself down, and it works better than cream.
Symptoms of EM in the context of cancer
Many women who experienced EM following cancer treatment described finding it hard to distinguish between symptoms of EM, symptoms of cancer, and the effects of cancer treatment. This could be both confusing, and frightening for some women who remembered worrying that EM symptoms were a sign of cancer ‘coming back.’ Alex, who had a radical hysterectomy for ovarian cancer, said: ‘my experience of menopause was mixed with recovery from major surgery and chemo … I couldn’t pinpoint what was just being really sick and what was menopause.’
Fiona recalled that it was ‘really hard’ to know what were symptoms of EM and what were the effects of breast cancer treatment.
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So I had what they call a BSO or a bilateral salpingectomy-oophorectomy done in 2013, which essentially put me straight into menopause. I think they call it the premature menopause, which when I was younger than 40, happened because of the chemo treatment. And that was sort of temporary during the treatment. I honestly can’t tell you what the symptoms were there, because all the symptoms were tied in with all the cancer treatments and all the chemo and all the radio. And that makes it really hard to say, “Okay well it was definitely this and it was definitely that, that was the early menopausal symptoms.”
But honestly early menopause is nothing compared to breast cancer treatment. But it’s one of those contributing factors to being worried and stressed about your health, because you don’t quite know sometimes when you’re going through those menopausal symptoms. You don’t quite know if they’re menopausal or if it’s something to do with the cancer coming back. And that was the most stressful thing of all, just understanding that you’ve just got to give it time and you’ve just got to learn what your body is capable of.
Absence of menstrual periods
Many women reflected on what it was like to no longer have menstrual periods. Some found the loss of their periods sad or unsettling, including Kirsty: ‘it’s amazing how periods bookmark your month … when you don’t have it anymore, it is a strange experience to not … have the cycles and body changes.’
For
Alex, the loss of her period was ‘heartbreaking’ as it signified the loss of her fertility.
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You do have at our age, some silly people saying things like, “Well, at least you won’t get your period anymore” and that is heartbreaking because I would have my period every single day if I had a choice to still be fertile [laughing]. So that’s pretty mean. And weird things, like at our age, we’re not in our 50s, we’re not expecting menopause. So I had all these boxes of tampons and pads and stuff and I just looked at them, like, “What am I going to do?” I gave them away to my sister. You’re not prepared, and it’s very unnatural at our age to be feeling infertile.
However, for most, the end of menstruation was one of the few ‘positives’ of EM. Women commented on the freedom of no longer having to use pads or tampons, being able to ‘do anything any time’ (Jessica), and not having to worry about becoming pregnant. As Mary said, ‘I don’t miss having periods. That was the one good thing about EM … there’s no sort of, “Oh shit, maybe that condom broke.”’ It was, like, “Whatever!”’ A few women who had experienced endometriosis or heavy or painful periods were particularly relieved.
Yen-Yi, who was having ovarian suppression therapy, reflected on the benefits of not having her menstrual periods.
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My mum was very concerned. She said, “How come you still haven’t got your menstrual cycle back?” I say, “I’m okay. It’s not too bad, you know.” Because I used to have fairly bad menstrual cycles, like about a day or two, I would be in pain, and then I’d have to take painkillers, and then I have this whole wheat bag, and then I feel really lousy, and then I had these food cravings. So I don’t miss all of that; physically, I don’t miss any of that.
Further information:
Talking Points (Women)
Talking Points (Health Practitioners)
Other resources