The following symptoms can all be indicators that you may be entering or experiencing POI:
- Irregular periods or periods stopping – this is the most common reason for recognising that something is not right
- Hot flushes and night sweats
- Insomnia/disrupted sleep
- Weight gain (especially around waist and abdomen)
- Skin and hair changes (dryness, thinning)
- Breast tenderness
- Mood swings and irritability
- Anxiety/panic attacks
- Loss of self-esteem
- Lowered libido
- Difficulty concentrating and memory lapses
- Fatigue/low energy levels
- Joint/muscle pain
- Vaginal dryness and urinary infections
The difficulty is that many of these are common complaints and can be attributed to life events, stress or other factors. This can lead to frustrating delays in diagnosis and also mean that not every symptom experienced is a direct result of POI. However, many women do look back after being diagnosed and realise that certain complaints probably were due to an early menopause.
If you have not already been diagnosed and are concerned, your GP can offer a blood tests to measure your level of Follicle Stimulating Hormone (FSH). FSH levels above 30 iu/l (international units per litre of blood) are an indicator that the ovaries are failing and menopause is approaching or has happened. However, levels can fluctuate significantly in the early stages of POI. It is also important to ensure that the blood tests are correctly timed – during day 2-5 of your period if you are still having cycles or any time if you do not have any periods. Measuring the estrogen level at the same time can aid interpretation of the FSH result – very high estrogen will suppress the FSH and make it appear normal when it may in fact have been raised if the estrogen was not so high.
There is no universally agreed threshold for the diagnosis of POI but most experts would agree that two correctly timed FSH levels of over 30 at least 4 weeks apart in combination with either absent or irregular periods provides the diagnosis.
The usual level of day 2-5 FSH for a woman who is premenopausal is 10 iu/l or less. Levels between 11 – 29 (and even levels approaching 10 in very young women) while not diagnostic of POI are not normal This generally means that the ovaries are not functioning properly and POI will happen. The term incipient ovarian failure is sometimes used for than FSH of 11-29 or fluctuating levels.
Read the latest NICE guidelines here.