Vaginal dryness, four other warning signs of early menopause

Menopause is a natural biological process marking the end of a woman’s reproductive years, typically around age 51.

However, some women experience menopause much earlier, in their 30s or even 20s—a condition known as early or premature menopause.

Early menopause is defined as the onset of menopause before age 40, while perimenopause—the transitional phase leading up to menopause—can start in the early 40s. Though relatively rare, early menopause affects approximately one per cent of women under 40 and five per cent of women under 45, according to the Mayo Clinic, an online health repository.

The causes of early menopause are varied, ranging from genetics and lifestyle factors to autoimmune diseases and medical treatments such as chemotherapy. Understanding the warning signs of early menopause is essential for women’s health, as early menopause can carry unique risks, such as increased susceptibility to osteoporosis, cardiovascular disease, and mental health issues like depression.

This article delves into five warning signs of early menopause, helping women recognise the symptoms and seek medical guidance promptly:

Irregular, missed periods

The first and most noticeable sign of early menopause is an irregular menstrual cycle.

For women approaching natural menopause, periods often become unpredictable as the ovaries gradually decrease hormone production. This pattern, however, may start much earlier in women experiencing early menopause.

According to a senior gynaecologist, Dr Amanda Kolawole, irregular or missed periods are often the first sign of a hormonal imbalance. She notes that if a woman under 40 starts experiencing irregular cycles for three months or more, she should consult a gynaecologist.

“Typically, a menstrual cycle lasts between 21 and 35 days, with bleeding lasting between two and seven days. Women experiencing early menopause might skip several cycles, notice heavier or lighter bleeding, or experience more prolonged periods. While occasional irregularity is normal, persistently irregular cycles in women under 40 should not be ignored, as they could signal the onset of early menopause,” Kolawole noted.

Scientific Insight: A study published in The Journal of Clinical Endocrinology & Metabolism indicates that hormonal fluctuations in oestrogen and progesterone contribute to these menstrual irregularities.

A significant drop in these hormone levels affects the regularity and consistency of periods, which can be an early warning of ovarian decline.

Hot flashes, night sweats

Medical experts note that hot flashes are a common symptom of menopause, but experiencing them before age 40 could indicate early menopause. Hot flashes involve sudden feelings of intense heat, usually in the upper body, which can last from a few seconds to several minutes. Night sweats are similar episodes occurring during sleep, often leading to discomfort and disrupted rest.

A Europe-based Nigerian endocrinologist, who specialises in women’s hormonal health, Dr Tim Banes-Wale, explains that hot flashes and night sweats occur because oestrogen plays a crucial role in regulating body temperature.

He added, “A sudden drop in oestrogen levels affects the brain’s hypothalamus, the region that controls body temperature, causing sensations of extreme heat.”

Banes-Wale also noted that hot flashes can significantly impact a woman’s quality of life, particularly when they occur frequently or disrupt sleep.

Mood swings, emotional changes

Hormones such as oestrogen and progesterone don’t just regulate the menstrual cycle; they also influence mood, cognitive function, and mental health.

Women going through early menopause often report feeling more anxious, irritable, or depressed, says women’s health researcher and psychologist Tanko Sule.

Sule said that oestrogen, in particular, affects the production of serotonin, a neurotransmitter associated with mood regulation.

“Women who experience early menopause often feel emotional distress, not only due to hormonal fluctuations but also because of the unexpected changes in their life trajectory,” he said.

“Many women feel a sense of loss, especially if they were planning to have children, which can exacerbate feelings of anxiety and depression.”

Anxiety, irritability, and mood swings are common during perimenopause, but these symptoms may be more intense or prolonged in cases of early menopause. Studies in Psychosomatic Medicine journal indicate that women experiencing early menopause have a higher risk of depression than those undergoing natural menopause. Recognising and addressing these emotional changes is crucial, as mental health support can play a key role in managing the transition.

Vaginal dryness, discomfort

One lesser-discussed but equally important symptom of early menopause is vaginal dryness, which can lead to discomfort, pain during intercourse, and even recurrent urinary tract infections.

Vaginal tissues are highly sensitive to oestrogen, which helps maintain lubrication and elasticity. When oestrogen levels decline, the vaginal lining becomes thinner, drier, and more susceptible to irritation.

According to a gynaecologist based in Boston, U.S., Dr Amanda Langton, “Women in early menopause may notice increased vaginal dryness or experience pain during sex, which is directly linked to the reduced oestrogen levels. It’s a common but under-reported symptom, as many women feel embarrassed to discuss it.”

A study published in Menopause, the journal of the North American Menopause Society, highlights that vaginal dryness affects nearly half of all women going through menopause, with those experiencing early menopause particularly at risk. Another doctor based in Lagos, Dr Suleiman Alade, said over-the-counter lubricants or oestrogen creams could help alleviate vaginal dryness, but consulting a healthcare provider was advisable for personalised treatment. “Early intervention can help maintain sexual health, improve comfort, and reduce the risk of recurrent infections,” he said.

Decreased fertility and libido

For women in their reproductive years, a sudden decline in fertility can be distressing. Dr Alade noted that early menopause often leads to reduced fertility due to the depletion of ovarian follicles, necessary for ovulation.

“Women may notice it becomes more challenging to conceive or may be diagnosed with diminished ovarian reserve, a condition that signals a decline in the quantity and quality of eggs,” he explained.

A fertility expert and CEO of EEK Fertility Centre, Abuja, Dr Destiny Ekinyi-Ochete, added, “Many women seeking fertility treatments are unaware that their struggles may be due to early menopause.

Reduced libido is also common, as hormonal imbalances impact sexual desire, which can further affect intimacy in relationships. The drop in oestrogen and testosterone—both of which play a role in libido—can reduce sexual interest and satisfaction.”

For younger women, decreased fertility and libido can be unexpected and emotionally challenging. They may feel a sense of urgency about their reproductive choices, particularly if they had planned to have children later in life.

Research Insight: Studies in the Human Reproduction journal show that ovarian reserve diminishes rapidly in early menopause, with significant implications for fertility and sexual health. Addressing this concern early can help women make informed choices, whether considering fertility preservation options or lifestyle adjustments.

Understanding the impact, seeking support

The onset of early menopause carries both physical and emotional challenges, impacting a woman’s overall health, fertility, and quality of life. While the symptoms may be similar to natural menopause, the experience is often more abrupt and unexpected. Early menopause increases the risk of conditions like osteoporosis, heart disease, and depression, making it critical for women to seek medical advice if they experience symptoms.

Sule advises that if one is under 40 and notices any of the symptoms above, consulting a healthcare provider is essential.

He said, “Blood tests can check hormone levels, and a gynaecologist or endocrinologist can guide you through treatment options, such as hormone replacement therapy, lifestyle changes, or fertility advice.”

Early awareness is key

Early menopause is a challenging condition that can affect a woman’s physical, emotional, and reproductive health. By recognising and understanding the warning signs, women can seek medical guidance and take steps to manage their health effectively. Early diagnosis and intervention are key and can help to mitigate health risks, providing women with the support they need to navigate this life stage.

For women facing early menopause, resources and support groups are available. Speaking with a gynaecologist, endocrinologist, or mental health professional can provide tailored advice, ensuring women don’t have to face early menopause alone.

Kolawole emphasises that, as with all health matters, awareness and early action are vital.