How does an early menopause affect your bones?

We chat to Gynaecologist, Trustee of the British Menopause Society and founder of Menopause Matters, Heather Currie, to discover how periods stopping before the age of 45 can impact your bone health.

What is an ‘early’ menopause and what are the signs and symptoms?

The average age of menopause - when periods stop because of low oestrogen - is 51. 

Early menopause is when the menopause occurs before the age of 45. If it occurs before the age of 40 - which is believed to happen in about 1 per cent of women – it’s known as premature ovarian insufficiency.

A few years before the final period, during the perimenopause, there can be a shift in the pattern of your menstrual cycle and that might be the first sign that things are starting to change. Periods might become irregular, lighter or heavier.

A decline in oestrogen can cause a number of symptoms and there can be a huge variation in the type, severity and duration of these symptoms from person to person.

Flushes and sweats are the most common sign of gradually becoming low in oestrogen but there can be other changes too - low mood, irritability, anxiety brain fog, joint aches and pains and many more.

What causes early menopause before 45?

For women who have an early menopause, discussion, and sometimes tests, will be needed to try to determine the cause. Family history, surgery to remove the ovaries, or some medications are all potential causes.

Women who experience a surgical menopause have quite severe symptoms because of the sudden drop in oestrogen.

There are also certain medications which can affect the ovaries - for example, medications used in gynaecology to temporarily switch off the ovaries for various reasons - but ovarian function would be expected to return to normal once medication like this was stopped.

Some people may require chemotherapy or radiotherapy treatment and, depending on the type, these can also have a significant effect on the ovaries kickstarting an early menopause.

Are there tests that can confirm if you’re going through an early menopause?

We usually carry out specific blood tests if a woman appears to be having menopausal symptoms under the age of 40. It’s a really important diagnosis to make, as it often has a devastating effect on women, particularly young women who haven't yet completed their family. Blood tests check for raised levels of follicle-stimulating hormone (FSH). Two blood samples taken 4 to 6 weeks apart are recommended because levels can fluctuate. 

We also look for underlying correctable causes first, like thyroid function. We would check prolactin levels in the blood because sometimes high prolactin can affect the function of the ovaries. In very young women, we may also test chromosomes because there are some chromosomal-linked conditions that can affect the ovaries as well.

Blood tests can sometimes be helpful to diagnose early menopause between ages of 40 and 45, but are not recommended to diagnose perimenopause or menopause at age 45 and over. 

What are the long-term effects of having an early menopause?

Having an early menopause increases the risk to your bones. Within the bones there is a balance needed all the time between different cell groups. Osteoblasts are the bone builders, which make good, healthy bone. Osteoclasts, on the other hand, are bone munchers, breaking down the bone.

A lack of oestrogen means the osteoclasts live longer and have a predominant effect, which can lead to bone thinning and osteoporosis. The earlier your oestrogen starts to deplete, the greater the risk to your bone health.

We also know that young women who have an untreated early menopause have an increased risk of cardiovascular disease because of the lack of oestrogen.

There’s also evidence that oestrogen affects brain function and that having an early menopause could lead to an increased risk of dementia later in life. More research is needed to understand the link between menopause and dementia and if HRT can help.

Can HRT help?

For women who have an early menopause, it is now recommended that unless they have a specific reason not to take it - for example, hormone-dependent cancer - they should be offered hormone therapy and that they should take it at least until the average age of the menopause at 51.

This is regardless of whether they have symptoms or not, so their bones don’t lose out from all those extra years without the protective effects of oestrogen.

Women going through menopause around the average age of 51 can choose to take HRT if they feel it would help their symptoms.

There are many different types of HRT and a GP can help you find one that works for you.

What can you do to protect your bones?

The first thing is to make sure you’re getting the right nutrition - a well-balanced, varied diet with adequate amounts of protein and calcium. We need around 700 milligrams of calcium a day.

But it’s not just diet. You should also think about stopping smoking if you smoke, cutting down on drinking excessive amounts of alcohol and make sure you get enough vitamin D.

Weight-bearing impact exercise, like running, and muscle-strengthening exercise (for example, with bands and weights) can help keep your bones and muscles strong. Exercise can also improve your balance, which will help to reduce your risk of falls.

Sarah's story

Sarah went through an early menopause and had her first fracture in her late 40s.

“When I first started breaking bones, at the age of 48, I’d been a busy working mum of three. My daughter was 8 years old, and my sons were 12 and 15.”  

Her doctor said that he was “99% sure” her back pain had nothing to do with the osteoporosis but an MRI showed otherwise - she’d suffered eight spinal fractures.

“I was sitting up on the sofa to sleep and I was in a lot of pain. I could barely stand up and walk, even with a walking frame. I couldn’t wash or dress myself or get upstairs. It was very depressing and upsetting.”

Read Sarah’s full story here.

Find out more

Download our free fact sheet on HRT and learn how hormone therapy can help with menopausal symptoms and benefit your bones.