Early Menopause & Premature Ovarian Insufficiency

Health consequences

Women who experience menopause young spend more years without estrogen’s protection. This translates to elevated lifetime risks of:

• Osteoporosis and fractures
• Cardiovascular disease
• Type 2 diabetes
• Dementia (some studies suggest earlier menopause is associated with higher risk)
• Premature death (untreated POI is associated with reduced life expectancy)

Treatment in early menopause & POI

MHT is strongly recommended at least until the average age of natural menopause (~51 years), and often beyond. The rationale is not primarily symptom management but health protection — these women are deprived of estrogen for years or decades longer than biologically intended.

In young women with POI, the combined oral contraceptive pill (COCP) is sometimes used as an alternative, providing both estrogen and contraception. However, standard COCP doses may not fully replicate MHT’s protective benefits — specialist guidance is important.

Diagnosing POI

POI diagnosis requires:

• FSH elevated AND estradiol low on at least TWO occasions, 4–6 weeks apart
• Further investigations to determine cause — may include autoimmune, chromosomal, or iatrogenic (cancer treatment) causes