Early menopause – when time suddenly fast forwards

When the cycle gives up too soon

Karin still clearly remembers the moment her gynaecologist told her she was already in menopause. She was 36 years old – and shocked. “I didn’t even know such a thing existed,” she says.

What does “early menopause” mean?

From a medical perspective, the terms “early menopause” and “premature menopause” can't be used interchangeably. Professionals refer to an “early menopause” between the ages of 40 and 44, and to “premature ovarian insufficiency (POI)” before the age of 40, when the ovaries no longer function adequately – meaning they produce very few egg cells or hormones. However, “early menopause” is a more familiar term for many and is widely used in everyday language.

Possible causes of POI

POI is often caused by genetic factors. It can also result from chemotherapy, surgery on the ovaries or autoimmune diseases that damage egg production. Smoking has also been linked to an earlier onset of menopause compared to non-smokers.

How do you recognise early menopause?

Many women initially put symptoms such as irregular periods or hot flushes down to stress, and don’t take them seriously. Karin was no different. She had been taking the pill until the age of 35 and afterwards experienced irregular periods, including a three-month gap. Unfortunately, her gynaecologist at the time played down her concerns, saying that her menstrual cycle would take a while to settle naturally. When Karin experienced hot flushes, she initially blamed spicy food and the changing temperatures during her travels in Sri Lanka rather than hormone changes. After all, who thinks about menopause at the age of 36?

Hormone levels provide clarity

It wasn’t until her next annual check-up that a blood test revealed the issue: Karin’s ovaries were already functioning far below normal levels, virtually beyond menopause. “We measure the status of various hormones in the blood at several points in time,” explains Dr Susanna Weidlinger, gynaecologist at Inselspital. “This allows us to diagnose POI, even if menstruation hasn’t yet completely stopped.” And the diagnosis is important, as early oestrogen deficiency isn't harmless but a serious medical condition that needs treatment.

Early menopause is a medical condition

From a medical standpoint, premature ovarian insufficiency (POI) isn't simply an earlier life stage – it’s a hormonal disorder that, if untreated, can have serious consequences.

Impact of early hormone deficiency

The immediate symptoms of menopause are one thing, but the associated health risks are another: Early hormone loss increases the risk of other conditions such as osteoporosis, cardiovascular disease and dementia.

A personalised hormone therapy can lower these risks. “The body needs these hormones, whether they come from the ovaries or are provided externally,” says Susanna Weidlinger. “In this case, we're truly talking about hormone replacement therapy – giving the body what it can no longer produce, even if this happens too early. By contrast, in ‘normal’ menopause, hormone therapy is more about prolonging hormonal support to ease symptoms.”

Loss of control and ability to have children

No egg cells means no children. Karin describes this diagnosis as a double blow: no chance of children, and suddenly thrown into menopause. “I had to process it like a bereavement,” she says openly. The unfulfilled wish for children hit her harder than she had expected. “I always thought I could be happy either way, with or without children. But when the decision was made for me, it was very hard.”

Support and counselling

Susanna Weidlinger is familiar with such reactions. She recommends psychological support where needed: “Some women manage without it, but everyone should have the option of talking about it. The diagnosis can trigger a real identity crisis.”

Depending on when the diagnosis occurs and other individual factors, the wish for children may not necessarily have to end immediately: “The few egg cells that remain are still young and of good quality,” she explains. Reproductive medicine also offers various possibilities, and these are now being re-discussed by policy-makers in Switzerland. Whatever the circumstances, every woman thrown off course by early menopause deserves advice and support.

Suddenly “old”? The fear of ageing too quickly

Another aspect that unsettled Karin was the image she had in her head of menopause. “I panicked that in a few months I’d soon be looking like the women you see in menopause adverts.” No longer feeling young, fit and healthy was a particularly hard blow, especially since she’d always looked younger than her age. Now she felt she had aged by years overnight.

Susanna Weidlinger offers reassurance: “Menopause isn't visible from the outside. It’s about hormones – not age.” Many of the physical changes can be addressed with targeted hormone therapy. “What matters is that a woman feels at home in her own body again.”

Hormone therapy: giving the body what it needs

Initially, the idea of hormone therapy stressed Karin out: She’d only just stopped taking the pill and was now expected to take hormones again. But she soon recognised the key difference: “With this therapy, I’m simply giving my body what it’s supposed to be producing naturally, rather than manipulating my cycle like the pill did.”

Karin’s treatment

Today, she receives a personalised hormone therapy consisting of three components:

1. oestrogen, which she uses alternately as a gel or a patch
2. progesterone
3. testosterone
   

The testosterone was added later, when she began to feel increasingly overwhelmed emotionally. Although research on testosterone use in women is still limited, for Karin it was a game-changer: “I suddenly had more drive and felt emotionally more stable.”

A different life – and new strength

Karin had to let go of the dream of having her own children. “In time, I was grateful that the decision had been taken out of my hands. But it was a long process,” she says. Coming to terms with the diagnosis was emotionally challenging and made her question many things. But the more she embraced her child-free life, the more freedom she found: spontaneous travel, commitment to her career, close friendships. Today she says: “I live a different life – and I really love it.” Her experience shows: Early menopause may change your life, but it doesn’t take everything away – and opens up new opportunities.

Talking about it helps

With medical support, an open environment and time, women can find their own new path. An early diagnosis can help prevent health risks. And talking about it helps in any case: “We should do that much more, so no woman ever feels alone again,” Karin says.