Menopause symptoms at a young age: POI or premature ovarian insufficiency
What the f…? Is that possible? Yes, it is.
What is POI?
The average age of menopause is 51 (though the process begins much earlier). Sadly, this happens much earlier for some. About 1 in every 1000 women+ enters menopause before their 40th birthday. We speak of premature ovarian insufficiency (POI) if you’re below the age of 40. So, that also includes young girls of 19 years old. What causes it? Sometimes, there’s a clear cause such as certain cancer treatments, genetic diseases, autoimmune disorders, or surgeries in which the ovaries are removed. In most cases, however, doctors are at a loss as to what’s caused it. And that can be very frustrating and disheartening for those affected.
No one looks forward to (peri)menopausal symptoms, but it’s extra tough if you’re still young. Hot flashes, night sweats, vaginal dryness, all the things that you’d rather postpone. And those are just some of the physical issues that might rear their head. Don’t forget about worsened concentration, not being able to sleep as well, and feelings of gloom and fear. And then there is also the impact that this diagnosis has on a potential child-wish. It’s a severe diagnosis that has many implications for the person receiving it, as well as their potential partner and/or family.
A holistic is necessary to treat POI
For premature menopause, a treatment plan is needed. Preferably, one with a holistic outlook.
The first step in treatment is hormone replacement therapy (HRT) to increase the estrogen levels to return them to what is conventional for your age. There are lots of different forms of hormone therapy, and you’ll often have to search around to find the one that works best. We suggest going to a gynecologist who is an expert in POI and hormone replacement since it doesn’t occur that frequently. Hormone replacement therapy is often needed to decrease the risk of osteoporosis (which increases the risk of broken bones) and cardiovascular diseases. For women+ who enter menopause at a normal age, it’s recommended to use hormone replacement for a maximum of five years. For women+ in premature menopause, it’s suggested to use it until the age of 51, plus five more years if necessary. Strength training, exercise, and a healthy lifestyle can certainly also help to decrease menopausal complaints.
Besides medical treatment, it’s also important to try to live with the effects of POI and to become familiar with the mental issues it causes. The diagnosis itself can often evoke feelings of loneliness and shame. It’s good to talk about this with a psychiatrist or psychotherapist, but also with your family and partner. That way, you can learn to handle your feelings surrounding POI better.
Never having kids
The fact that you’ll never (again) be able to have children from your own ova is difficult and can cause lots of complicated emotions. Having children is a big wish for many, and when that turns out not to be possible, it is a big loss. However, there are alternative ways of getting pregnant or bringing children into your life. Think of adoption, egg donation, or foster parenting. These can be possibilities, though they won’t be suitable for everyone. There are plenty of women+ and couples who cannot or will not do this, as a result of their personal background, view on life, and/or faith.
The belief that a woman is not a ‘real woman’ if she can’t have children is a theme that often pops up. Being a woman is often placed in connection with being a mother. Sometimes this is based on your upbringing, but it can also be based on your culture and/or faith. Lots of women+ are ashamed of their POI diagnosis, and even keep it a secret from their partner because they’re worried that they’ll otherwise leave them for someone else. In particular, this plays a big role in the Islamic and certain African cultures.
No desire for sex
Amongst the menopause symptoms, you can find a decreased desire for sex, pain during sex, and vaginal dryness. These things may also occur in premature menopause. There’s a big chance that you begin to feel less sexy as a result of your diagnosis, which is completely understandable. The symptoms are very normal, so you shouldn’t feel ashamed.
Sex should never hurt, let's make that clear. Because of the menopause, the skin of the vagina becomes more delicate. But, the good news is that the vagina can also become properly lubricated when it’s aroused. Lots of women+ have sex even though they're not fully relaxed and aroused. In menopause, this can make it so that the experience becomes painful and less enjoyable. That’s why it is all the more important to be fully relaxed and stimulated. So, (re)discover your sexuality and don’t rush yourself during sex. Spend time on learning how sex during menopause can be enjoyable for you (and your partner).
Social environment
Many people with POI find it difficult to inform their environment. How do you bring up that you’re in menopause when all of your friends are having babies? We often notice undue feelings of shame and inferiority in these women+, which only makes them lonelier. Psychiatrists and Cycle expert Geranne Jiskoot advises her clients to tell their family, friends, and colleagues, no matter how difficult this may be. “That way, there will be more understanding of the situation, and it’ll be possible for feelings of shame to decrease. Family, friends, and colleagues play an incredibly big role, and can therefore be a huge support for overcoming this sadness and grief. Bringing it up with your employer makes it possible to discuss what you can and can’t handle. It helps to give it a bit of space.”
Tips for premature menopause
Do you suspect that you’re in premature menopause, or have you been diagnosed with it? Make sure to go to a specialized gynecologist. POI is a complex disorder, and a certain amount of experience is required to treat it. It can also be nice to work together with a multidisciplinary team (gynecologist, sexologist, psychologist). In the Netherlands, the hospitals Erasmus MC (Rotterdam) and OLVG (Amsterdam) have such teams available! If you live elsewhere, you should look into whether such teams are available in your region.
