Maria was going about her regular day, doing her job at a food company when she felt a hot flush come on. 'It started on my knees then spread up my legs,’ she says. ‘I felt really warm and went bright red and ended up having to run across the shop floor and getting into the industrial fridge to try and cool down'. At her worst, she says, she was having 30 hot flushes a day, lasting anything from 30 seconds to four minutes.
Hot flushes are one of the first things that you'd associate with the menopause. Although you wouldn't expect them to affect a 25-year-old woman, Maria – who is now 31 – was one of the 1 in 1000 women who go through the menopause before the age of 30.
Early menopause, also known as premature ovarian failure, can have many causes, from endometriosis to polycystic ovaries or as the result of medical treatment. Maria's was caused by chemotherapy and radiotherapy as part of cervical cancer treatment in February 2011, which she says 'effectively killed my ovaries and sent me straight into the menopause'.
However in most cases there appears to be no cause, according to Consultant Gynaecologist and Clinical Lead for the Menopause Service at King's College Hospital, Mr Haitham Hamoda. ‘A lot of the tests come back normal,’ he says. ‘Around 10-20% of young women who go through the menopause early will do so due to a genetic condition, or another illness, but a lot of the time there’s seemingly no reason for it to happen.’
Music promoter Samantha’s periods suddenly stopped when she was 23. ‘I had no idea what was happening,’ she says. She was also experiencing hot flushes, and terrible mood swings. ‘I felt completely paranoid and anxious, kept bursting into tears and just felt uncomfortable all the time. I kept going to the doctor’s, but they just told me to lose weight.’ Eventually, at the age of 26, a blood test to measure the amount of follicle stimulating hormone (FSH) – the hormone that helps control the menstrual cycle and the production of eggs by the ovaries – showed she was going through the menopause. ‘I completely fell to pieces,’ she says. ‘My body effectively thought I was in my 50s. It was very difficult to hear.’
Though Mr Hamoda says around 10-15% of women who go through early menopause will experience no symptoms, due to a lack of oestrogen the majority will experience the aforementioned hot flushes and mood swings, as well as vaginal dryness, sleep problems and loss of libido. If you’re experiencing these symptoms, it’s important to push for a blood test and a diagnosis early on. ‘I often think “what if I’d been taken more seriously by the doctors?”,’ Samantha says. ‘Maybe if I’d been diagnosed earlier, I could have saved some of my eggs. It does upset me still and it can be difficult to hear people talk about their children knowing I’ll never be able to have them.’
In a world where it feels like we're constantly bombarded with headlines about leaving it too late to have children and the need to pre-emptively freeze your eggs, it can be especially hard for young women who've had the choice taken away from them so early on in their lives. Mr Hamoda says young women whose ovaries aren’t completely depleted of eggs, there’s a 5-10% chance they can have children themselves. Egg donation and adoption are other options.
‘It’s ridiculous, but there’s still a feeling that you’re not considered a “real woman” if you can’t have children,’ Rachel, a 27-year-old writer from Sunderland, says. She has elected to have a hysterectomy following six years of unexplained chronic pelvic and crippling period pains, and is currently going through a medically induced menopause to prepare her for the major surgery, which is expected to happen early next year. 'I've had every test going, for basically every condition you’d think would cause these problems, and I've been on every type of birth control I can take to help my periods. I could barely sit up at times, so couldn't hold down a job. The pain caused mental health issues and all this basically ruined my last relationship.'
Rachel says doctors constantly told her that she was too young to have a hysterectomy – and asked her to ‘consider a fictional partner before the needs of herself.’
‘I’m currently single, which made the decision to have this treatment easier, but having to constantly struggle to get taken seriously really affected me,’ she admits.
For those in a relationship, it can be hard being honest about going through the menopause so young, so having an understanding partner is important. ‘I am currently in a relationship and the only way I could tell him “by the way I can’t have children and I’m going through the menopause and have HRT patches stuck to my bum” was to do it in jokey sort of way and make light of it,’ Maria says, ‘but that is very much who I am anyway. Luckily, he’s been brilliant about it all and very supportive’.
Building good support networks is key too. Given that the average age women in the UK go through the menopause is 51, it can feel strange for those experiencing it in their 20s to have more in common with their mums than their own friends. ‘When I had my first hot flush, I felt like I was having a panic attack and about to pass out at the same time. I genuinely felt I was dying,’ Rachel says. ‘I called for my mum and she told me what I was really experiencing. We do swap tips for dealing with the symptoms, as she’s going through the menopause too.’ Rachel says. She’s also a sub-editor for a site called Ask Me About My Uterus and through this has met other young women going through the menopause too, which she says has been really helpful.
For those young women going through premature ovarian failure, the main treatment is hormone replacement therapy. Though this is linked to breast cancer in older women, Mr Hamoda says the risk doesn’t apply to those in their 20s. He advises the women he sees to either go on that or take the combined pill in order to increase oestrogen levels and in turn reduce the menopausal symptoms. ‘I’ve been on HRT for about four years, and since then everything has calmed down quite a bit,’ Maria says. ‘I haven’t really noticed any side effects from it [the HRT]. I can only praise it to be honest.’
HRT also helps to reduce the risk of osteoporosis - a condition where bone density reduces, causing them to become more fragile. Oestrogen is essential for healthy bones, so women who go through early menopause are more likely to develop the condition. Samantha now suffers from the condition, which causes her daily agony. ‘The pain can bring me to my knees, but I take painkillers and supplements for it and stay active. Still, it’s hard when your body thinks you’re older than you actually are.’
Of course, the psychological impact of going through the menopause in your 20s can be intense. ‘CBT can really help, but the problem is it’s just not readily available,’ Mr Hamoda says. ‘Counselling is useful too. It’s essential for us medical practitioners to give young women going through POF the chance to raise their concerns and make sure they are supported.’ However, this doesn’t always happen. ‘I wasn’t offered counselling or anything like that when I was going through the menopause at 25,’ Maria says. ‘I’d been through all that cancer treatment, then was told I was going to be going through the menopause for almost a third of my life. It was really disheartening.’ However, she came across Jo’s Cervical Cancer Trust, which provided her with information, and she now fundraises for them. Another helpful organisation is The Daisy Network, but most other places are still geared towards women who go through the menopause at 45+.
‘I do think there needs to be more support for those of us who’ve been through the menopause young,’ Samantha says. ‘I keep busy and carry on, but when I stop I get depressed. I do feel like I’m forever running away from the shadow of early menopause, but I don’t know any other way.’
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This article originally appeared on The Debrief.