Premature menopause: Why some women in their 20s and 30s will experience hot flashes, night sweats and infertility

The hot flashes began just as she was finishing college. An intolerable heat crept over her face and neck, her complexion flushed and beads of sweat rolled down her skin, sometimes during a final exam or at a hair appointment for graduation photos.

"It feels like I'm sitting, like, right in front of a fire ... that feeling when you're burning up," said Mackenzie Brody, who grew up in Jericho and is now in law school in Atlanta.

Brody was diagnosed with premature ovarian insufficiency, or POI, a condition in which the ovaries stop functioning before age 40. She was 22.

Natural menopause occurs at age 52 on average in the United States, but some women experience hot flashes, sleepless nights and other symptoms decades earlier. POI and cancer treatments are two reasons. The symptoms can disrupt work and life and leave a woman wondering if she will be able to conceive.

A premature transition

About 4% of women worldwide are impacted by POI, which can lead to premature menopause symptoms such as hot flashes, night sweats and brain fog. But it can also manifest in osteoporosis, heart disease and infertility — a psychologically devastating development for many women who envisioned themselves as mothers.

"It can feel incredibly isolating when a person gets that diagnosis," said Dr. Randi Goldman, program director for the reproductive endocrinology and infertility fellowship program and an attending physician at Northwell Fertility, which has offices on Long Island. "Oftentimes, if they were thinking about potentially having a biological child ... it can feel like they are never going to reach a goal that they might have had their entire life, which is to be a parent." 

For women with POI, hormone therapy is a scientifically proven way to protect bone and cardiovascular health, while alleviating hot flashes, vaginal dryness and other symptoms, experts said. Research shows that hormone therapy does not raise cancer risk for a woman until she reaches the age of natural menopause

Brody’s POI diagnosis came after mentioning hot flashes during a routine annual gynecologic appointment. The doctor ordered a hormone blood panel, which showed low levels of estrogen and high levels of Follicle-Stimulating Hormone. A bone density scan revealed osteopenia, precursor to osteoporosis. The cause of her POI remains unknown.

The hot flashes, osteopenia and other menopausal symptoms dissipated with hormone treatment, but she still wondered if she could conceive. 

She has pursued egg freezing, and remains unsure about using a donor egg to carry a child to term. Brody, now 26, said she has spent more than $50,000 to freeze eggs — an amount paid with the help of her parents and infertility coverage from her health insurance. She noted she may only get one or two eggs per cycle while other women might get 15 to 20. 

"In one life, I was just a typical 22-year-old who's graduating college, living in New York City with all my best friends," she said. "Then the other side of that was that I'm constantly thinking about my fertility and ... if I go out with friends, I don't want to drink too much because I don't want to hurt my chance of conceiving."

About 5%-10% of women with POI will be able to have children without the use of fertility treatment, research shows.

Grief and acceptance

Lauren Donato, a licensed mental health counselor who works with women who are experiencing infertility, said part of her work deals with grief and acceptance. Often, she said, she helps women untangle their childlessness from their femininity by asking how they view womanhood outside of having children.

Acceptance, she said, comes with being OK with not knowing.

There's nothing that they could control when our bodies are acting like this, and people want answers, and people feel like maybe they did something wrong, or God is punishing them, or karma.

- Lauren Donato, licensed mental health counselor

Cerene Prince, a therapist and CEO of Orchard Blue Counseling in Queens, said acceptance takes time. She said she advises clients experiencing infertility to tap into the maternal side outside of motherhood, whether that is being an auntie or another role.

"I think sometimes people think that when women experience infertility, that maternal spirit ... just gets turned off, but it's still there. It's still dwelling inside one, and so I guide them to find a space to actualize that in a different way."

Freezing eggs

Young women can also experience medically induced menopause due to breast cancer treatment in which ovarian suppression is used to prevent production of estrogen, which can fuel cancer.

The treatment helps avoid the DNA-damaging effect of chemotherapy on the reproductive organs, researchers said. And the medication can be used to stop menstruation from happening during chemotherapy, when the risk of bleeding is already high. 

But the result can be abrupt — women may quickly feel the onset of hot flashes or other menopause symptoms. 

Many describe the menopausal symptoms as disruptive — the tossing and turning at night, perhaps on top of a desperate and expensive rush to freeze their eggs. Meanwhile, they are seeing friends live more carefree lifestyles or having baby showers while they struggle with the prospect of infertility.

Cancer diagnosis 

Gina Rooney was 32 and breastfeeding her 1-year-old son when she felt a lump that turned out to be cancer. The Town of Islip mother of two received menopause-inducing injections to protect her ovarian function so that she may be able to one day expand her family.

Within hours of her first injection, the hot flashes started. Then came the insomnia and emotional upheaval. 

"I truly had no control over my emotions throughout this process, and it was due to the menopause part of it," she said.

At night, she dealt with insomnia as well as vomiting and dizziness from chemotherapy. She also experienced hair loss, including her eyebrows and eye lashes.

"I feel like it was almost like I was watching myself from afar," she said. "Like it wasn't my body that was experiencing this, you know." 

Her menstrual cycle took months to return after she finished chemotherapy in January. Now, she’s deciding whether she wants to return to the classroom as a teacher.

"I'm starting to find a balance in my life again," she said, noting, "Trying to figure out what my new normal looks like while raising two small children."

Dr. Kristen Kelley, a clinical assistant professor at the Huntsman Cancer Institute at the University of Utah, stressed that the sudden drop in estrogen can be severe for younger women.

For hot flashes, she advises them to avoid alcohol and caffeine and to sleep with a fan or wear moisture-wicking fabrics.

But often, those interventions are not enough. So for mood swings, she might recommend a mental health therapist who might prescribe antidepressants or anxiety medications, vaginal moisturizers for dryness or pelvic floor physical therapy for painful intercourse.

"It's a lot of different approaches to address all of these different elements of menopause, whether it's natural or medically induced," Kelley said.

Returning from menopause

When Meagan Pettit was 29, she found a lump under her arm. It was a triple-negative breast cancer that had spread to her lymph nodes.

"I felt like my life was potentially over," she recalled. "I did not know what to expect at the time. I did not know anyone else who had been diagnosed with cancer at such a young age."

The cancer treatment was grueling. Chemotherapy first claimed her hair. A mastectomy left her with a reconstructed breast that looked uneven due to radiation treatment. Lymphedema, a condition that causes chronic swelling, made her right arm larger than the other.

Of all the treatments, the shot that induced menopause was among the hardest to endure, she said. The symptoms left her with a debilitating mix of hot flashes and night sweats. She would rip off the blankets and turn on a fan only to turn off the fan and pull on the covers again when she got too cold.

"Getting chemo, you need to rest, and I was exhausted," she said, "so not being able to sleep really took a toll."

Her friends and family rallied around her, but she said the experience was isolating. She didn't have friends her age who could relate or whom she could ask for advice on alleviating symptoms.

Pettit, now a 34-year-old mother of a baby and a toddler, is cancer-free. But within the next five years, she plans to get both ovaries removed, placing her in surgical menopause to lower the risk of the return of cancer and increase her chances of survival. She worries about how the surgery recovery will impact her ability to hold her children; about how the return of menopause will impact her lifestyle, mental health and "my overall functioning." 

"It feels unfair that I am going to have to make that decision of when to go into menopause for myself rather than allowing my body to naturally go into menopause when it is ready to in the way that my peers will get to experience." 

Still, her experiences, she said, have left her believing that growing older "is such a gift."

"I'm so hopeful that I'll be able to make it to be able to have wrinkles and go gray," she said.