Symptoms of early menopause: Health Practitioners’ perspectives

The characteristic symptom of early menopause (EM) is irregular or absent menstrual periods. This may be associated with other menopausal symptoms including hot flushes, night sweats, mood changes, vaginal dryness, sleep disturbance, sexual function problems, fatigue, joint pain and cognitive difficulties . Symptoms can vary in severity between women and by cause of EM and are often more severe than for women who experience natural menopause at the usual age.

EM symptoms and quality of life

Health practitioners observed that, among their patients, hot flushes and night sweats are particularly common symptoms of EM. They noted that in addition to being uncomfortable, vasomotor symptoms are one of the causes of sleep difficulties for women and as EM is also associated with changes in mood and anxiety, these can lead to a ‘cumulative effect’ on a woman’s quality of life. Ms Hay, a breast care nurse, described hot flushes as ‘quite troubling’ for some women because of their impact on sleep quality: ‘no sleep – it’s not conducive to a happy life, combined with hot flushes and sexuality.’

Dr W, an endocrinologist, explained how symptoms of EM can impact various aspects of women’s lives.

While symptoms of EM can be debilitating for some women, health practitioners commented that others experience fewer or less intense menopause symptoms, including after medically-induced EM.

Dr C shared her thoughts on patients who do not experience strong EM symptoms.

Health practitioners commented on the psychological and cognitive symptoms of EM their patients experienced, including increased irritability, depression, anxiety, or memory and concentration problems. They noted that these symptoms could cause women to experience difficulties in their personal relationships or at work, or could affect their body image. See Early menopause and identity, social connection and future plans: Women’s experiences.

Dr G, a clinical psychologist, shared her thoughts on symptoms of early menopause and quality of life.

For Professor Kulkarni, a psychiatrist specialised in women’s mental health, depression and anxiety are the major symptoms of EM among the women she sees.

Urogenital problems including vaginal dryness and incontinence were mentioned by several health practitioners as difficult symptoms. Dr Barker, a general practitioner, noted that vaginal dryness was ‘common’ in women with EM and could lead to difficulties in intimate relationships. An obstetrician-gynaecologist, Dr C commented that ‘bladder urgency’ could be ‘quite debilitating’ because it can impede women from doing certain things, for example travelling.

Dr G shared how she approaches sex and relationship difficulties arising from EM symptoms with her patients.

Cancer treatment and EM symptoms

Premenopausal women diagnosed with cancer may undergo treatments such as bilateral oophorectomy, chemotherapy or radiotherapy which may cause EM (see Telling women that cancer or medical treatment may cause early menopause). Women diagnosed with oestrogen positive breast cancer may have monthly gonadotrophin releasing hormone (GnRH) agonist injections (e.g. goserelin) to cause ovarian suppression. This treatment does not cause EM as it is potentially reversible, but causes menopausal symptoms due to lack of oestrogen. Hormonal therapies such as aromatase inhibitors or tamoxifen can also cause menopausal symptoms due to their anti-oestrogen effects but do not cause EM. A few health practitioners noted that for women diagnosed with EM as a result of cancer treatment or undergoing ovarian suppression , the experience of symptoms can be sudden and more difficult to deal with, compared with women diagnosed with spontaneous EM.

The symptoms of cancer-related EM can also be difficult to manage because Hormone Replacement Therapy and any products containing oestrogen (see Hormone-based medications for early menopause) may not be appropriate. As general practitioner Dr Goeltom said, cancer patients have a ‘double whammy of problems … cancer and the effects of the medication they’re taking’, which includes EM.

Dr Richardson, a medical oncologist, spoke of the range symptoms that women could experience when undergoing cancer treatment.

Dr S, a medical oncologist, discussed the symptoms that she sees among her patients, and explained how she approaches the severity of symptoms such as hot flushes.

Further information:

Talking Points (health practitioners)

Talking Points (women)

Other Resources