By definition POI (Premature Ovarian Insufficiency) is only diagnosed in under 40s and occurs in about 3 in 100 women. It takes on average 7 years to diagnose as clinicians and patients often do not consider the diagnosis as women may still be having periods or may be on contraception which stops periods anyway.

Signs & Symptoms of Early Menopause

Symptoms may vary considerably but include, anxiety, low mood, irritability, muscle aches, poor sleep, tiredness, headaches, lack of interest in sex and palpitations.

Women often present to their doctor believing they are suffering from depression or even fibromyalgia.

There is often a family history of POI, but it can also relate to thyroid disease, diabetes or cancer treatment. If you think you might be experiencing Early Menopause then book an appointment at our Women’s Health Clinic as soon as possible.

The Importance of Early Diagnosis

It is very important to diagnose, not only because we can provide relief from the many symptoms mentioned, untreated, it increases the risk of heart disease¹, bowel cancer, osteoporosis², osteoarthritis³, type 2 diabetes and dementia⁴.

It is important to be aware that 5-10% of women with POI remain fertile and so contraception needs to be considered if pregnancy is not desired. The Mirena coil is the best option as it is very reliable and allows the use of topical oestrogen alone for HRT.

Contrary to social media scare stories, there is no increased risk of breast cancer in young women taking HRT, particularly oestrogen only HRT in those with a Mirena coil or who have had a hysterectomy.

There is an increased  risk of osteoporosis due to the early decline in oestrogen, and so it is recommended to have a bone density scan called a dexascan at diagnosis.

Diagnosis & Treatment of Early Menopause

How then is it diagnosed? In POI and in those under the age of 45 we measure the hormone called FSH, twice , 4-6 weeks apart as well as thyroid hormone and thyroid antibodies, a diabetes screen, B12 and folic acid and a coeliac screen.

We then offer HRT usually in patch, gel or spray form, with or without progesterone. It can take up to three months to get the full impact so we tend to review at this point or earlier if there are concerns or no improvement at all. We then adjust the dose as required and discuss any troubling symptoms that may require additional medication.

HRT should be continued until at least the age of 51 in this group but can be continued longer than this of course.. Women with POI often need higher doses of HRT to relieve symptoms. We usually prescribe cyclical HRT for 6-12 months after which continuous, period free HRT can be used.

If you think you might have symptoms of menopause, or early menopause, book an appointment with our Women’s Health Private GP Dr Seema Chakravarti.

You can use the Green Climacteric scale to give a picture of the type of symptoms you might have that could relate to POI to prepare for your appointment.

Dr Allan Fox, Private GP near Canterbury.

1. Cardiovascular Risk Factors in Premature Ovarian Insufficiency using Hormonal Therapy
   Gabriela Pravatta Rezende, Thamyse Dassie, Daniela Angerame Yela Gomes, and Cristina Laguna Benetti-Pinto ↩︎
2. Effect of early menopause on bone mineral density and fractures
   J Christopher Gallagher ↩︎
3. Menopause and Osteoarthritis: Any Association ?
   Annil Mahajan and Ranu Patni ↩︎
4. Cognitive Decline in Early and Premature Menopause
   Marta Sochocka et al ↩︎