When the actor Naomi Watts started experiencing menopause symptoms, she says she “felt like I was losing my mind, and I was definitely losing what it felt like to be ‘myself’”. Then consider the fact that this was all happening when Watts was 36 – at least a decade earlier than expected, “a time when [she] was more focused on starting a family” and well before any of her peers had gone through the same experience. No wonder the star describes it as “incredibly isolating”.
Typically, as a woman enters her forties, her ovaries will produce less of the hormones oestrogen and progesterone; during the years that follow, known as perimenopause, her periods will start to become unpredictable, eventually stopping altogether. Twelve months after her final period, she is said to have reached menopause. According to the NHS, the average age for this is 51 years old. But for one per cent of women, it occurs before the age of 40, and is defined as “premature” menopause. For 0.1 per cent, it happens pre-30. As many as 5 per cent of women will also experience “early” menopause, between the ages of 40 and 45.
The physical and emotional ramifications can be huge, affecting everything from your career to your personal life (including plans to start a family). As 44-year-old menopause coach Louisa Hussey puts it, learning that you are undergoing this process prematurely can mean having to grapple with “the trauma of being told that your body is 20 years older than it should be”. Like Watts, she started to experience symptoms in her thirties. “The menopause really knocked me in so many different ways,” she says. “My confidence was in the bin, and I was generally, physically, feeling completely alien to myself.”
Hussey says she started to notice thinning hair and shorter periods around the age of 32, but she wasn’t diagnosed until she went to a doctor four years later in order to discuss her fertility and take some tests. “At that point, it was like in the movies: everything stopped and slowed down,” she says. Other classic symptoms include “low mood, anxiety, poor sleep, reduced motivation and concentration, low stamina, then muscle and joint pains,” says Dr Louise Newson, founder of the Newson Health Menopause and Wellbeing Centre in Stratford-upon-Avon.
Menopause coach Sarah Shah was also diagnosed at 36, and found the brain fog and anxiety overwhelming. “I got to the point where I couldn’t drive a car, especially at night,” she says. She even “thought [she] had early-onset Alzheimer’s at one point” – and she’s not alone.
Lauren Chiren is now the director of Women of a Certain Stage, a consultancy specialising in training employers about the menopause. But in her early forties, she ended up leaving a high-powered job, believing she had early-onset dementia. She had gone from being “the type of person who could go into a meeting [and] always remember all the actions, what everyone was doing, what the follow-up was” to “taking copious notes, because I was struggling to recall that information” and having difficulty remembering colleagues’ names. At first, her doctor thought she just “needed a break”, but during her third appointment, she was told that she was postmenopausal. Her response was an unusual one: she ended up “punching the air with joy” when she learnt that she didn’t have dementia.
It can take a while for these symptoms to be diagnosed as menopause-related at an earlier age. “It can be so easily bundled into ‘Well, you’re just a mum’ or ‘You’re just busy at work’ or ‘Everyone gets PMT,’” Hussey notes. If you’re taking hormonal contraception that affects your periods, you might not even notice any disruption to your menstrual cycle. Shah, meanwhile, had been trying for another child around the time of her diagnosis, and had reasoned that her late periods and night sweats might be pregnancy-related. “All the symptoms I was getting were actually menopausal symptoms.” Her diagnosis was relayed over the phone, when she was home alone one evening.
It can be so easily bundled into ‘Well, you’re just a mum’ or ‘You’re just busy at work’ or ‘Everyone gets PMT’— Louisa Hussey, menopause coach
Corinna Bordoli, meanwhile, started experiencing symptoms at around 10 years old. “I had heart palpitations, I had a lot of anxiety, and I kept getting injured in sports,” the 28-year-old explains. She ended up “constantly on crutches”, having thrown herself into physical activity after she’d had to stop singing “because my vocal cords were so damaged – now I know I was lacking oestrogen”. When she hadn’t started menstruating by 15, she went to a specialist. “No one ever mentioned the menopause. They just told me, ‘Your ovaries don’t work, it’s really, really rare and we don’t know why.’” She was placed on the birth control pill, but continued to struggle with her mood – and even broke a foot doing pilates, “just by standing on my tiptoes”.
What actually causes premature menopause? Sometimes the ovaries stop producing typical levels of oestrogen and progesterone at an earlier age, a condition known as primary ovarian insufficiency (POI); in 90 per cent of cases, the cause is unknown. It was only through “some independent googling” that Bordoli discovered the Daisy Network, the charity for women with POI, and started to learn more about her condition; now, she organises meet-ups in London for women with similar experiences. “Sometimes,” Newson notes, “[POI] can run in families – so if you’ve got a mother, sister or auntie who had menopause at an early age, then you’re more likely to, but it doesn’t mean that it will happen”.
Hormone replacement therapy (HRT) can help with the symptoms of menopause and perimenopause— (Getty)
There are other risk factors. “Some studies have shown that alcohol and smoking might have an effect,” Newson says. Chemotherapy and radiotherapy for cancer can also lead to premature or early menopause. And if a woman has her womb removed in a hysterectomy, even if her ovaries are conserved “they are more likely to fail earlier”, she notes. “That’s partly because the blood supply to the ovaries can be disrupted, but also [because] the ovaries work closely with the womb, and without [it], they fail.”
She points to some striking research by neurologist Dr Walter Rocca, which explores what happens to women under 40 who have their ovaries removed. “They have a markedly increased risk of all the diseases associated with the menopause: cardiovascular disease, osteoporosis, type 2 diabetes and clinical depression,” she says. So the bigger picture goes beyond the classic menopause symptoms. “As a physician, of course I worry that women have the symptoms [of premature or early menopause], but a lot of women who might not have symptoms have still got this increased risk of disease.”
It’s because of these potential risks associated with a lack of oestrogen and progesterone, Newson says, that hormone replacement therapy (HRT) is so important (for young, otherwise healthy women, it is now thought that the benefits usually outweigh the risks, such as breast cancer and blood clots). But getting hold of HRT is not always easy. “Some professionals don’t even know how to prescribe HRT safely,” she explains. “So it’s a lot easier for them to say no.” Bordoli says she “got a lot of pushback” initially when requesting HRT. And when Hussey was prescribed it, her initial dosage had little effect – she was told she could take more, but was given “no information about what would happen if [I] took more”.
A lot of women who might not have symptoms have still got this increased risk of disease— Dr Louise Newson
Many women will have to go “back and forth to different doctors” in order to receive a proper diagnosis for premature or early menopause, Newson says. “This is where women have just been gaslit for years.” During the time it took to get diagnosed, Bordoli ended up questioning herself, “feeling like [I was] going crazy ... I just thought, ‘Oh, that’s me. I’m very anxious as a person, I guess I’m unlucky and I keep forgetting things.’ But that wasn’t the case, and it’s just a shame that doctors hadn’t picked up on it.” She implores young women in a similar situation to “listen to their body” – and to keep advocating for themselves.
Menopause coach Shah, meanwhile, thinks that better education is crucial. “I’m a big advocate of getting information out there and empowering women to take back control and not be fobbed off,” she says. “Fifty per cent of the population are going to go through it. And we really deserve to be armed with the facts as soon as possible.”
The Daisy Network provides information and support for women with primary ovarian insufficiency
