Shocked and sad at early menopause

[TakeABreath2023]

Hi - I’m 41. I suffer from two autoimmune conditions - Addisons’s (which has wiped out adrenal function) and Hashimoto’s (wiping out thyroid) meaning I have been on steroid and thyroxine replacement since 33. As a result I have very regular endocrine screening. My endocrinologist has picked up a steady march upwards in my FSH over the last 6 months from c.4 in January until today on Day 2 at 9.3 with my oestradiol <100. I know this all means I am rapidly approaching menopause. It’s all happened faster than expected. I have suffered with some breast tenderness and PMS moods but my cycles have been pretty regular between 25-28 days since I finished breastfeeding my last child four years ago. I haven’t had hot flushes. I honestly wouldn’t have felt I needed to go to the doctor about perimenopause or menopause if I wasn’t having the reality spelled out to me in blood tests. I have been really stressed since starting a new job in January. I wonder if this tipped things over the edge. I feel really tearful about it all - it’s all an earlier than expected and seems to be moving so suddenly. I feel like in a few months I have gone from being still young and vaguely attractive to suddenly an unattractive barren husk and past my useful purpose. I know there are far worse things to get but also the prospect of another condition to manage just seems so overwhelming and a little unfair. No other member of my mother’s family or my sisters have had an early menopause. Just looking for some handholding, and like I can handle this and maybe feel better. We have a strong history of osteoporosis and so I’m obviously worried about that. I have a history of eating disorders so really worried about what HRT
will do to my weight. Not sure if I’m
making any sense.

I don't mean this unkindly because you're clearly upset and feeling emotional about this, but did your endocrinologist tell you you are menopausal?
FSH of 9 isn't usually confirmation of menopause - 30 plus would indicate menopause. 'early menopause' aka premature ovarian insufficiency is only when you're under 40- at 41, whilst definitely on the younger end, it's not actually abnormal to be entering menopause. Not that you are, as I say, from your FSH level.
https://cks.nice.org.uk/topics/menopause/diagnosis/diagnosis-of-premature-ovarian-insufficiency/

I think seeing it as another condition to manage is a little bit of an overreaction, honestly. When the time comes to consider HRT once you know the information it's relatively straightforward. But do inform yourself because there is huge variety in how knowledgeable doctors are about it.

Menopause has been the best time of my life! Don't worry about it. Also, you are in your 40s, so its not very early. My sister went through menopause at 21, before she had had her family, so she never could.

My FSH was 11 five years ago and I haven’t hit menopause yet (I’m 45). No symptoms, normal regular periods. I agree with PP, you are looking for problems here that you don’t actually have yet.

From the OP, you managed to have 1 child. Was your family complete? I'm sorry if you were planning more. I'm far from an expert, but I didn't think someone in peri or full menopause in their 40's was classed as early menopause?

I'm not trying to discount the worry you have. Maybe focus on the positives, such as being able to conceive 1, healthy, child to term. Many of us, me included, never got that far. x

41 is not early menopause

Thanks to all the replies and for the reassurance. To be clear I am extremely grateful to have been able to conceive, and know that I am lucky, and I’m so sorry if I have been insensitive. Some context for my reaction: my route to diagnosis for my Addison’s was quite traumatic, via respiratory failure and coma on ITU - I very nearly died - and as a result I struggle with huge health anxiety and am permanently worried about what bit of my body might not be working/might be stopping working. I recognise this is a problem in itself. Because of the autoimmune history, my endocrinologist actively screens for other areas of potential autoimmunity? Including early menopause, which is defined as before 45 (before 40 is premature ovarian insufficiency; average age of menopause I believe is 51). Today’s tests were done after ending picked up FSH was beginning to rise sharply from low levels, and this confirms that. I don’t know how long this transition phase can last though, nor whether I am meant to/should take oestrogen replacement at this stage (especially given osteo history). I’m interested to hear that other women have had higher FSH levels but not much has really changed. Perhaps sometimes proactive screening and regular copious blood tests does more harm than good to mental health at least. Thanks again everyone and I do not mean to be over dramatic or insensitive. I’m just so anxious.

I went through the menopause at 41, it is considered early,50 plus is considered normal. GP said as I was small build,had a couple of fractures and "this very early menopause" I needed HRT for the osteoporosis protection. The symptoms kicked in very quickly,hot flushes, brain fog, terrible joint pains. I was still completely positive about it, because I had had such heavy painful periods since I was 11.

I have Addison’s and and lupus and all sorts of things. Oestrogen deficiency is really common in women with Addisons and it’s not unusual for women to go into early menopause around a year after their diagnosis- this is what happened to me. I was diagnosed with Addisons aged 36 and went into complete menopause aged 37. I tried HRT but it caused heavy bleeding related to my lupus - long story, under several specialists etc.

If you are on Facebook join the U.K. Addisons and adrenal insufficiency group - there are 8k of us in it and you’ll get lots of support. Lots of things about oestrogen/ HRT etc etc.

Not sure if the link will work but here -

https://www.facebook.com/share/rughfwDg4vtQNtUP/?mibextid=K35XfP

Typical advice re menopause doesn’t work with Addisons because there’s a link / cause between them both and also make sure you aren’t due to have any more cortisol tests before you start HRT (if you decide to) as the oestrogen falsely elevates cortisol and you’ll need to be completely off it for at least 6 weeks for any cortisol tests.

Amazing to hear from someone else with Addison’s!! Thanks so much - high five to you! I worry my endo is perhaps not clued up on the link between earlier meno and AD. He has always said I would be unlikely to go into meno before 45 (which also is making me feel worse now). I’m really worried about the step risk given family history and being steroid-dependent. How has your own experience been? Do you feel generally ok these days?

Endocrinologists and doctors generally just don’t know much about Addisons. It’s so rare they hardly see anyone with it. That’s been my experience. I’ve been under endocrinologists for nearly 20 years for things - started with hypothyroidism and pituitary issues and gradually added more and more things! The Addisons side of things has been difficult, it took me 18 months to get a diagnosis and I was misdiagnosed with panic disorder for ages. I was in a panic because I felt so unwell! I was eventually diagnosed with zero cortisol. None whatsoever. It’s been hard.

I am struggling with my health but then I have a lot of complex health issues; lots of people in the group “just” have Addisons and find they can manage okay. So don’t let me worry you, not many people have all the issues I do.

Huge hugs and sympathy to you. You sound like a complete warrior for navigating it all and enduring every day. I too was diagnosed with various anxiety/depression/panic disorders. Sometimes it is hard to know where the endocrine conditions stop and the mental health ones begin, or if it’s all the former masquerading as anxiety. Thanks for contributing to my post. I’m going to see if I can find someone who is an expert on autoimmunity and early menopause

It is.

The definitions are -
Early menopause is the end of periods before age 45.
Premature menopause is end of periods before 40.

Peri menopause which can last for years can start in the early 40s.

OP, if you find anyone would you let me have their details, please?

I'm 38 and under an endo for my thyroid and now on HRT after battling for years to be believed that something else was going on as well. Reckon the perimenopause started after my 2nd child was born. He's 6 now. So I'd bet I've been peri for about 4 years now.

I'd love to talk to someone who understood the autoimmunity aspect of an early/premature menopause.

I can't find the link now but read somewhere that 40% of women with thyroid autoimmunity would have an early menopause.

This is a different study of thyroid/menopause

https://pubmed.ncbi.nlm.nih.gov/33569594/

Study question: Is thyroid autoimmunity associated with a higher risk of low ovarian reserve and POI?

Summary answer: Thyroid autoimmunity significantly increases the risk of POI in women.

Thanks for posting and yes I am going to do some research into autoimmunity and menopause.

More generally - once FSH starts going up does it just go in one single direction? If my FSH has risen over the last six months does it basically mean I will be in full-scale meno by the end of the year? I still have periods every 25-27 days on average so it all seems to be happening quite quickly. As I said above, I wouldn’t actually have gone to doctor about all this had I not been under such intense endocrine supervision as don’t have hot flushes yet etc. I’m trying to work out what stage of meno I am actually in? Many thanks for any answers!

My FSH has come down in HRT but that's expected. I think if you're not on HRT, generally speaking, FSH won't come back to 'normal' ranges.

I had hot flushes and night sweats but I didn't realise! 😂

My night sweats were just waking up early feeling too hot, thinking we'd left the heating on overnight. There was no actual sweating happening!

Hot flushes, again, we're really mild. Just the skin on my throat tightening and feeling a bit warm and uncomfortable.

The other thing was vaginal dryness but it would come and go and I put it down to using scented pads. Switched to period pants and it helped. I stopped being able to use tampons but thought that was psychological birth trauma. Not physical! 'vaginal' dryness can also present as general itching, including the vulva. Again, had loads of that and thought it was washing powder or something.

None of my symptoms were obvious, at all.

My FSH was 18 age 30 it was 26 age 40, I've been in perimenopause all that time with symptoms getting worse. I'm now 42 on HRT but still get periods I also managed a second miracle baby age 39.

FSH= follicle stimulating hormone- is the amount needed to stimulate and ripen an egg.

As we get older, it takes more 'oomph' to do this which is why FSH rises.

There's no set pattern. Some women have a flurry of ovulation in their late 40s and even early 50s as their ovaries have one last 'Hurrah' (which is why some unexpected pregnancies occur.)

I'd not get too worked up over your FSH unless you are trying to conceive and then you'd need a AMH test for ovarian reserve.

All hormone tests vary. I had a single test at 51 and it showed a post meno FSH (over 30) but in fact I continued with normal periods for almost 2 more years.

Although I can understand how you feel emotionally, if you have an early menopause, HRT has improved so much now and can be very individualised (through an expert) that you should try not to worry.

If you need HRT it will most likely help your symptoms .

Another POI here. It's depressing isn't it.

Ah come on op menopausal women are not unattractive barren husks

i was 37 when i first missed a period and had panic attacks and the gp had me do blood tests and said the word menopause and I literally ran away 😂 I was in no way prepared for that. I was offered hrt there and then but I took until I was 42 ish to go on it. Turns out it runs in my family as well.

so yes it's a big shock but you will find your way

edited to say I had periods on and off until a year ago and still sometimes get pmt and sore boobs etc

IAmAnAdultHumanFemale - thanks for the pep talk! I need it…! The stupid thing is that I haven’t actually missed any periods (perhaps yet). I honestly wouldn’t have even gone to a doctor about it as didn’t think I had any symptoms until I had them lit up on technicolour by blood test monitoring…. Could I ask how old you are now? So did you just have increasingly irregular periods? Did they even check your FSH?

Kindly, OP, are you over-thinking this a little?

Many women with no other conditions reach post-menopause by 45. That's 'early-ish' but not a disaster. Now, they are advised to consider HRT to age 51/52 (age of average menopause.)

Even if you are in peri now, you could go another few years before you are post menopause. It's only because you're being monitored for other endocrine disorders that you are aware of the FSH levels.

HRT is available readily now (compared to a few generations back) and if you have to use it, you will be no worse off than women with a later menopause.

HRT now is body identical, so it's simply replacing your own hormones.
By 51-ish you could decide whether to continue with it or not.

I'd advise that you try to stop chewing it over , as the stress won't help. Focus on things in your life you can control not the things you can't.

All the best x

Early menopause runs in my family. I was completely finished by 45. GP didn't believe it was happening in my late 30s, but the blood test didn't lie! And I have NEVER felt like a barren husk.

Early meno kicked in for me at around 40 but took a couple of years to diagnose right because the doctors thought I was too young. I am now on HRT so don't know whether I would have fully finished my periods yet or not. I was really shocked and sad for a while because I don't have children and would have liked them. But now I am used to it (and on HRT!!) I feel better. Good, in fact. It's a new life stage and actually massively liberating in its own way. I particularly love not giving a fuck what others think / want from me anymore :)

You're 41, still having regular periods and haven't noticed any symptoms of perimenopause. That sounds like a pretty good place to be!

Don't get hung up on the numbers in your blood tests, FSH levels can vary wildly between people and during different parts of your cycle and on it's own a number that's in the 'normal' range doesn't mean very much and doesn't predict the future!

How you feel is what matters, track your periods and symptoms if it makes you feel better (Balance app is good for this) and use that to guide you rather than focusing on the numbers of your blood tests.