Women’s experiences of symptoms of early menopause – Part 2

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.

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.

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.

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.

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

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.

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.

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.

Further information:

Talking Points (Women)

Talking Points (Health Practitioners)

Other resources