Perimenopause: but aren’t I too young?
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I don't think people really truly understand how disturbing it is to be diagnosed with POI or premature menopause.

The level of understanding, even around like women approaching their 40s, around menopause and what it does, is still really, really lacking. And I'm kind of like, guys, do you want a preview? Rather than my hormones look like they belong to a 24-year-old girl, they now look like someone who is, you know, 10, 20 years my senior.

I had no awareness that this could happen to younger women. Menopause was just not on my radar. I was just thinking about having children and that next stage in my life.

When we're younger, we think that we're invincible, that our bodies will withstand the thrashing we give it through alcohol and terrible dancing or whatever, and we are utterly unquestioningly sure we'll continue on our regular menstrual cycle until the distant future. When our hair has started to turn grey and our boobs are facing down to our toes, and only then, and probably about time, will our periods stop.

But for some women, this change comes much earlier than expected. And no, it is not a welcome bloody blessing. A diagnosis of premature menopause might mean a woman's infertile before she's even thought of starting a family. And it can lead to serious long-term health problems. So what is it like to have the hormones of a much older woman but be living inside the body of a young woman?

And how do you know if you might be going through premature menopause? I'm Yumi Steins. Ladies, we need to talk about going through perimenopause way too young. Music

Premature ovarian insufficiency, or POI, is the name given to the condition that causes a woman to go into menopause before she's 40. If we're talking about it in the context of our rock band Ovarian Retirement, which will make sense if you've listened to our other episodes in this miniseries, well, imagine the band never even gets to tour. They maybe write and record one album and then that's it. They never board the jet.

forced into early retirement.

I want to get a bit technical here for a minute because premature ovarian insufficiency and premature menopause are terms that are often used interchangeably, but there are differences. Premature menopause refers to menopause occurring before the age of 40. Done, finito, no more ovulating, finished. While POI is where the ovaries stop functioning normally before 40. They're not doing what they were hired for, but they ain't retired just yet.

Women might go through premature menopause because of medical treatment. With POI, it can be genetic, but most women will just never know why they were unlucky enough to be singled out for POI in a lottery of life. OK, picture this. You're in your late 20s, your career is on the up, and you can finally afford to upgrade from no-brand cheese to a whole wheel of fancy brie. And you're shacked up with a man that you hope will be your baby daddy.

This was the scene for Sarah. I was very much in love and thinking about, you know, all the classic heteronormative things like marriage and kids. But at the age of 31, when Sarah thought she had it sorted, things came crashing down. Her periods had become erratic. She was having hectic abdominal pain and was eventually diagnosed with endometriosis.

Oh, and her boyfriend? The guy she thought she was going to have the house and the babies with? Yeah, he dumped her. Broken-hearted and broken-bodied, Sarah had surgery to treat her endo. She hoped that her period would go back to normal afterwards. I didn't actually get my period back at all. Sarah's period was AWOL for a whole year. And I went to see the specialist surgeon...

And they recommended that I should see a fertility specialist because it just wasn't quite normal. Sarah booked in with a fertility specialist and got some tests done. By this stage, she was 32. When she went in to get her results, she could tell from the doctor's face that something was up. She was just looking down at her desk and she was kind of averting her gaze. So it was just immediately obvious to me that

The news wasn't good. The doctor showed Sarah a chart comparing her egg reserves to those of other 32-year-olds. And my egg reserves were that of a 47-year-old woman. So a woman typically in, like, perimenopause, yeah. Are you OK? Um, yeah, I'm all right. I can see you've got a lot of emotion around this. Yeah, it's all right, though. It's just...

Doesn't make it less awful. So you got the results. Yeah. How did you process it? What were your first thoughts when you heard that? I think I was in shock, honestly. Sarah was diagnosed with premature ovarian insufficiency or POI. Looking back, Sarah says things had been skew-iff with her body for a few years before her diagnosis.

I was having insomnia. I was having mood swings and I had weird symptoms like tingling in my extremities and my bones were cracking. I felt horrible but I put it all down to being depressed because of everything that had happened to me. When Sarah was diagnosed with POI, she saw her chances of having a baby, something that she'd assumed was in her future, slipping away.

Sarah's specialist told her they could give egg freezing a shot, but because she had so few eggs in reserve, she shouldn't get her hopes up. Basically, my estrogen levels at that time were the level of a woman in her 60s or 70s. So here's Sarah. She's a babe in her early 30s. Not a grey hair on her head nor a worry line on her face, but inside her body, it was telling a different story.

Her hormones and her egg reserves were those of a much older woman. Her mum went through menopause earlier than most at 40, but Sarah was almost 10 years younger than that. It just felt like it was too hard to explain the complexity to everyone I knew. So you were pretty alone in all of this. Yeah, I'd say so.

Most women will go through menopause when their ovaries retire and they have their last menstrual cycle sometime between 45 and 55 years of age. I want you to meet Dr Natasha Vavrek. Dr Vavrek is a Women's Health Specialist GP and in her clinic she regularly treats women going through what Sarah experienced, premature menopause or POI.

For some women, their ovaries decide to retire a little earlier and that's before the age of 40. Can you just help me understand what you mean by your ovaries decide to retire? I'm getting such a visual of them just packing up their desk. Yeah.

into a box and then walking out of the building. But I'm guessing that's not quite what I need to picture. Essentially, it's a really great way of thinking about it. Each month, as you already probably know, our ovaries are going to work and they're ovulating for us and producing that egg that may or may not result in a pregnancy.

Now, when we go through menopause, what happens is those eggs slowly start to dwindle and our ovaries decide, okay, this is going to be the last one and then I'm going to retire. So they're no longer producing that egg anymore and no longer ovulating. Just a reminder, when we're talking premature menopause, we're talking before the age of 40, whereas early menopause is between the ages of 40 and 45.

What we do know is that for women going through premature menopause is that their symptoms will sometimes be far more severe than a woman going through perimenopause at the normal age. Oh, is that right? So a woman will probably have hot flushes, night sweats, mood changes, brain fog, urinary symptoms, dry vagina, loss of libido, you know, the list goes on.

Dry vagina and no libido in your 20s is a pretty rough deal. If we were going to do a song about this, it would involve a fair bit of screaming. I always feel for these women because they should be having the best sex of their lives and they want to be having the best sex of their lives and they're often stuck wondering why is this happening to me? What are the long-term effects of going through this hormonal shift so young?

Long-term health implications can be quite serious for women going through POI rather than later. The risks of cardiovascular disease is great. And so this can put them at a risk of things like heart attacks and strokes. And also because of the decline in estrogen, it can affect a woman's bones greatly. And so there's that increased risk of osteoporosis.

For women going through premature menopause, because they're losing estrogen sometimes decades earlier than most women, they lose out on bone density. That's where hormone replacement therapy can help. So we're replacing those hormones that they should ideally be having in their 20s or 30s?

Dr. Tash, do we know why some women will have POI and others won't? What factors are at play? Are they genetic? Are they lifestyle? For the majority of women that go through POI, we actually don't know why they go through it. And so that is still a mystery for a lot of patients.

There are factors, however, that can increase their chances of having an earlier age of menopause, and that can include things like smoking, as well as a family history of early menopause. And there are a few other factors that could be at play, and these are genetic factors and two conditions in particular, Turner syndrome and fragile X mutation, which can be tested for and confirmed.

There are medical reasons why women go through perimenopause prematurely. One of those is surgical menopause, where the ovaries are removed altogether because of something like cancer or endometriosis. So that sudden removal of ovaries will put a woman straight into menopause and those symptoms will quite often be quite severe. I wanted to ask you a bit more about that because when I've heard that described, I've often pictured it being a little bit like when you are induced to give birth.

And it means you don't sort of get a slow walk up towards labour pains. You just go straight into cracking great big pains. It's described as really, really intense. Is it a bit the same having that sudden POI?

Yeah, it certainly can be for women that have had surgical menopause and it can be that zero to 100 and, you know, within a few weeks women can be experiencing those symptoms. Other women might enter what is called chemical menopause. If we have a patient going through chemotherapy, those medications can be quite toxic and in some situations they can be toxic enough to the ovaries that it can shut down function of that ovary.

Some women undergoing chemotherapy will be prescribed a drug to shut down the function of the ovaries. This is an attempt to protect the ovaries from the onslaught that's to come. It's like closing up shop and boarding the windows before the cyclone arrives. This is what happened to Maddie.

The treatment that I ended up going with was extremely intense just because my cancer was so advanced. When Maddie was just 19, she was diagnosed with stage 4 Hodgkin's lymphoma. Maddie didn't even have time to really process her diagnosis before doctors started talking to her about treatment.

There were two options. The first was less effective in terms of the cancer, but better for her fertility. And the second was more intense, but there was an 80% chance Maddie would be infertile at the end of it. And that was enough for me to say, well, I will take the 80% risk of infertility at the cost of saving my life, which I believe was the right decision.

During her chemotherapy, Maddie was put on a drug to protect her ovaries. This drug put her into chemical menopause for the almost two years she was receiving treatment. After her treatment finished, Maddie was put on menopausal hormone therapy, or MHT, to try and bring her hormones back online.

She started having some full-on symptoms. For me, the worst one was the hot flashes. I would feel the heat kind of start and rush right up to my face. I would go completely red. If I was asleep in my bed, it was throwing the covers completely off like a full body sweat. Then my body going cold and you having to put that back on again. Emotional instability from that hormone imbalance when your body was so used to having the hormones of a teenager that

was really, really drastic. And like my hair has stayed really, really thin, which they think is hormonally driven. My skin's been breaking out more than it ever has. Like the list goes on. Maddie's doctors hoped that after her recovery from the cancer treatment and with the help of MHT, her hormones would go back to normal.

Once Maddie's period returned, she went off MHT, but the effects of her cancer treatment still linger. Rather than my hormones look like they belong to a 24-year-old girl, they now look like someone who is, you know, 10, 20 years my senior on the brink of perimenopause. Right. So they're kind of like, you're in this perimenopause state indefinitely. So now, five years cancer-free, Maddie's dealing with a perimenopausal body and brain at age 24.

The hardest thing to deal with, though, is this idea that she may not ever be a mum.

I've wanted it since I was a little girl and I really can't imagine a world where I kind of look back on my life and feel like I've experienced everything unless I've had kids. Teenage Maddie never imagined she'd find herself in this situation. I think for me, losing your sense of feminine identity as a young person is really hard.

because there's this naivety that you have when you're in your youth, that you've got your life ahead of you and all these exciting things to look forward to, like motherhood, like travelling. It's like starry-eyed, rose-coloured glasses on. When she was diagnosed with cancer, Maddy's doctors recommended she freeze her eggs before the storm of chemo hit her body. So the next week I started an emergency IVF egg freezing cycle. Wow. Wow.

Yeah, so you get this diagnosis of stage four cancer and then three days later it's like needle in the belly, here we go. So I did that and we got some eggs on ice and then the week after that it was straight into chemo. Women with POI have a 5% chance of falling pregnant spontaneously in their lifetime. At 32, Sarah, the first woman we met on this episode, was newly diagnosed, newly single and back on the dating scene.

After diving in for some meat and potatoes, Sarah wanted to be upfront with him about her fertility. I sat on the couch with him and I just kind of said...

I have something I need to tell you. I don't know if it's possible for me to have children. Most 32-year-old women don't expect to be disclosing private medical information about their ovaries on the second date. But in accepting the reality of her own body, Sarah, there on the couch, was quite courageous. It was a hard discussion to have and I think he was quite taken aback by it, you know.

At first, he got spooked and Sarah thought that might be the end of the fledgling romance. But they kept hanging out, doing couple-y things like going away for a dirty weekend. Sorry, I meant a romantic getaway. I think there was perhaps one episode of unprotected sex. And then the next day we were like, oh shit, that happened. Well, you know, the chances are so minor, it's not going to happen, you know. Yeah.

Unprotected sex, probably not the best. Wouldn't have done it so bad, did it all over. But baby, I was fanging. Hungry, hungry, hungry for those meats and potatoes. And then I don't know how, but I fell pregnant. Wow. There's a twist in the tale. There is a twist in the tale. Okay. And so what happened? How did you feel? I mean...

I was just in shock but also elated. Sarah and her very new love decided to go ahead with the relationship and with the baby. Not only was Sarah over the moon that she was pregnant, she was also feeling brilliant. I actually felt great because when my hormones elevated, I had more estrogen in my body than I'd had for years. Yeah.

I felt so calm and relaxed and just unflappable. While Sarah was pregnant and later breastfeeding, the boost in hormones from having a child masked her perimenopause. But once she stopped breastfeeding, she noticed a shift.

I remember walking my son in the pram to get my daily coffee. I felt this sudden, like irregular kind of heart palpitations and I felt dizzy and I sort of clutched my chest and I was like, oh shit, am I having a heart attack?

It wasn't a heart attack. It was Sarah's perimenopause symptoms back with a vengeance at the age of 33. I could not remember my name. I could not remember the date my son was born on. I couldn't remember what street I was on. I honestly felt like I had early onset dementia. It was horrifying.

And it would have been weird for your partner. Were you still together then? Still together now? Because he would have seen a whole different side of you. Oh, absolutely, yeah. Who is this crazy bitch? Unleash the dragon. Totally. I was so angry as well. Oh, gosh. Yeah. That sounds like so much to deal with. It's a lot.

Sarah's now 36 and based on her hormone levels, it's likely she's perimenopausal. She often feels like she's living in a different world to her friends. We're all, I suppose, like mid to late 30s. Some of them are just having their first children now and that conversation is just not there yet. And to the friends I have divulged, if they have older sisters, they get it.

But I would say that the level of understanding, even around women approaching their 40s, around menopause as a concept and what it does, is still really, really lacking. And I'm kind of like, guys, do you want a preview? After Sarah gave birth, doctors put her on MHT to try and manage her perimenopausal symptoms. Over the years, she's tried it all. Patches, creams, pills, gels.

I'll be in a regime and it will work for a time and then it will stop. And then I will start getting heart palpitations, vertigo, insomnia, mood swings. They'll all come in back. So then I'll go back to my specialist and they'll either increase the dosage or swap me onto something else. It feels like in my experience in being on HRT for a while now,

I've never feel like I'm completely covered symptom wise. Yeah. Can I ask you about your vagina? Sure. Okay. How is it going down there? Sometimes it's great. Yeah. And other times it's not. Sometimes I just notice that everything down there is dry. There's no discharge. There's nothing, nothing good happening basically. And I just have no sex drive because why would I?

I don't want to be flippant, but if our band Ovarian Retirement wants to write another banger, Dry Vagina could be our next hit. Woo!

Changes in hormones during perimenopause can wreak havoc on a woman's sex life. Loss of estrogen can lead to a thinning of the skin of the vaginal walls and clitoris, plus it can be tricky to get lubricated. Quick aside, we get deeper into the science of sex and perimenopause and what you can do to get your horn back in episode three of this mini-series. Check it out if you haven't already.

OK, back to our girls. Like Sarah, Maddie's sex life has changed since perimenopause. I'm a lot more sensitive to the variations in hormones I've found in perimenopause than I ever was before. Maddie lives with her partner, who she met last year. He's very understanding, but Maddie's perimenopause means that their relationship is not always like that of a typical 20-something couple. My libido has definitely gone down since I was younger and...

having to say that nicely without making them feel rejected. And it's just generally making sure that you're still trying to bring your best self to the relationship when sometimes you do feel really crabby or

I get like really bad anxiety sometimes where I'll just sit for days and just stress about relapsing and infertility. And it's like all of the weight of cancer and menopause just falls on me at once. And he kind of has to tenderly like hold and navigate me through that, which can be really hard. I love the way you use the word crabby. Because it's so, it's very vivid. I can see it, but it's also not so, it's not so horrible. You're just snappy. Yeah, you're a bit crabby. Yeah. Yeah.

So when you get night sweats, how do you deal with that when you're in the same bed with your partner? We do, I think it's called the Scandinavian sleeping method. You have separate blankets. Oh. Yeah, and he also runs really hot, so that's also the main reason for that as well, but separate blankets. And I honestly think every couple should do it because then you're not stealing sheets off each other. Like, it's so good. Yeah, highly recommend. Okay, I'm adding that to a list. LAUGHTER

While most of her friends are trying not to get pregnant and are busy enjoying their supple, collagen-rich skin, Maddie feels very distant from the person she was before she got sick.

There's always that past version of myself that I'm trying to compare myself to. Now, every time I'm in front of camera, I'm looking at things like, how do I look now versus how I looked back then? And having that comparison is really hard. When that person that you're comparing to is yourself five or six years ago, that can be a really confusing headspace because it feels like it's just far enough away, but I know that I'll never be able to get that back.

Talking to Maddy and Sarah has made me realise how resilient they are. Dr Vavrek sees patients like them every day. I don't think people really truly understand how disturbing it is to be diagnosed with POI.

or premature menopause, I think patients themselves don't realise until they're in the thick of it. I'm just thinking of some of my own patients and like it actually gets me quite emotional. You know, I hate giving that information to a patient because you know it's about to change their whole trajectory in life and those decisions that they make. And it also makes patients have to think about things like family, family planning earlier on than they wanted to.

Dr. Tash also sees patients who have been struggling with symptoms for years but have fallen through the cracks. Because it's not well known, it's even not very well known amongst GPs and it is often missed, that can add to the stress that comes with the diagnosis because a lot of women will say, well, I've had these symptoms for two or three years and why is it only being addressed now? What's a common reaction for women facing early menopause?

Absolute devastation. You can see it on their face. As soon as you bring up the subject, you can see it on their face. And it's really important to be able to give that patient space to be able to think about it and to put them in touch with the right specialists and the right mental health support in order to navigate that journey because it's something that's going to affect the rest of their lives. Mm-hmm.

Five years on from her diagnosis, Sarah has some advice for other women. I had no awareness that...

this could happen to younger women. Menopause was just not on my radar. I was just thinking about having children and that next stage in my life. And I want every woman out there to advocate for their own health, not just to have children, but also to know that if you don't feel right in your body, get it checked out. Mm-hmm.

Did you hear that? We're not doing the suffering in silence thing anymore. Menopause is coming for us all and it's better to be armed with information and talk openly about it so that we can all go through the process together and shoulder some of the discomfort collectively. Maddy, still so young at 24, has some advice for women going through this.

Just be gentle on yourself. It's so hard. And I think that there's so much that goes with it emotionally that no blood work or scan or anything will ever show you. And I empathize with all of the days where you just feel really bogged down by it and it feels like there's this dark cloud over your head, but

you've also gone through enough of those days that you know it gets better. Can we have a little moment to celebrate you, though? Like, 24, survived cancer, gone through all this stuff. Sounds like you've got a beautiful relationship. Yeah. And you've got a cool job in marketing and you just went to New York City. Yeah. How dare you? It was very cold. I was there for a month, living out of a hotel, eating bagels. Oh, my. Are you Emily in Paris? I mean, maybe.

That's so good, so good.

Meeting these two awesome powerhouses, I'm just in awe. Both Maddie and Sarah have dealt with massive health shocks at a young age. It's hard enough not to compare yourself to smiley-faced, peachy and perky-bummed 20-somethings, especially if those are your friends. Imagine comparing not just how you look in a bikini, but your egg count. So many of our mothers went through menopause in silence. It just wasn't talked about.

But that's definitely changing. So let's make a pact to share this stuff with our doctors, with that random guy who walks their dog past our house, with our favourite rock bands. Shout out ovarian retirement! And of course, especially with each other. In taking you on this perimenopause world tour around our bodies, our brains, our sex lives, and just now to the island of premature menopause, I've learnt a few things myself.

The changes in our hormones can have huge impacts, from heavy bleeding to night sweats, mood swings to infertility, not to mention vaginal dryness and loss of libido. But I've also learnt that no matter what kind of fuckery perimenopause is up to in our bodies, there are treatment options available. If I were to make some band merch for this ovarian retirement tour, I reckon the t-shirts would say something like...

Get a GP you can trust. Ovarian retirement, yeah. No. What is that? What kind of band merch is that? What are you going to need to workshop this? Oh, yeah, it's terrible. Okay. What about this one? Get a GP for your pee-pee. No. You did not run this by your producers. Okay, okay. What about this one? Okay, I've got the best one. Doctor, doctor, give me the news. I've got a bad case of hormonal blues. No!

Boo! Not approved. So harsh!

Whether perimenopause gets you in your 20s or in the decades after, whether you blink and it's over or it lurks around following you for many years, the dozens of women I've spoken to for this podcast, whether it be in the studio or as background research or just friends of mine, they all wanted to share some part of their story with you.

An offering of sorts to say, you're not alone, girl. It's sort of like the podcast equivalent of passing a tampon or a pad under the toilet stall to some random sister next to you who needs it. I hope it helps.

This podcast was produced on the lands of the Gundungurra and Gadigal peoples. Ladies is mixed by Anne-Marie de Bettencourt. It's produced by Elsa Silberstein. Supervising producer is Tamar Kranswick. Our executive producer is Alex Lolbach. This series was created by Claudine Ryan. Hey, before we go, I want to share a podcast we've been really loving here at Ladies at the moment, The Hookup with Dee Salmon and Pip Rasmussen. The Hookup with Dee Salmon and Pip Rasmussen.

The pod is all about unpacking their listeners' dating and sex lives. And what I love is how they normalise the most taboo topics. Like, is it okay to fantasise about someone else while you're in a relationship? A lot of the time people might just be fantasising about people that are unobtainable, like a celebrity or maybe an ex from 10 years ago if the sex was really good.

In most cases, I just don't think it's that deep. It's like pissing in pools, you know. Some people will deny it, but I think everyone's done it. Ah!

They debate the big questions. Once a cheater, always a cheater? And they deep dive into dating trends online like micro-cheating. We asked you, what are your examples? Like, what do you consider micro-cheating? People were saying that liking someone's story, micro-cheating. Someone was saying going out to lunch, micro-cheating. If you're still in contact with your ex, he reckons that's micro-cheating. Getting dressed up and looking good. Who for?

These are examples of what people are saying. That is insane. If it's not for me, then who's it for? Plus, each week, Dee calls on an expert to get the best advice on things like breakups, increasing your intimacy and libido, dating with neurodivergence, performance anxiety, and so much more. Listen to The Hookup every Tuesday and Thursday wherever you get your podcasts and catch the full vodcast on the Triple J YouTube channel.