Early Menopause

What counts as early menopause

Menopause is your last period, confirmed after 12 months without one. Doctors group the timing like this:

Premature ovarian insufficiency affects about 1 in 100 women under 40. Unlike menopause at a normal age, the ovaries in POI may still work now and then, so periods and even pregnancy can occasionally return. For more detail on that group, see our page on premature ovarian insufficiency.

Early menopause signs and symptoms

Symptoms are the same as at the usual age, but they can be more intense, especially after sudden surgical menopause:

• Periods becoming irregular, lighter or further apart, then stopping.
• Hot flashes and night sweats.
• Vaginal dryness and pain during sex.
• Trouble sleeping.
• Low mood, anxiety, irritability and "brain fog".
• Reduced sex drive.
• Joint aches.
• Needing to pass urine more often, or recurrent urine infections.

A gradual run-up of irregular cycles and symptoms is called perimenopause. In early menopause it can start in the late 30s.

Causes of early menopause

Natural (spontaneous)

• Unknown: most women with early menopause have no identifiable cause.
• Family history: if your mother or sister had early menopause, your chance is higher.
• Smoking: brings menopause forward by roughly 1 to 2 years on average.
• Genetic conditions: Turner syndrome and being a carrier of the fragile X premutation.
• Autoimmune disease: the immune system attacks the ovaries, often alongside thyroid disease, Addison's disease or type 1 diabetes.
• Some infections, such as mumps affecting the ovaries, rarely.

Medical (induced)

• Surgery: removing both ovaries causes immediate menopause. See surgical menopause. A hysterectomy that keeps the ovaries can still bring menopause forward by a few years.
• Chemotherapy: risk depends on the drug, dose and age. Periods may return after treatment in younger women.
• Radiotherapy to the pelvis.
• Hormone treatments for breast cancer or endometriosis can cause temporary menopause.

How early menopause is diagnosed

1. History: your periods, symptoms, family history, surgery and cancer treatment.
2. Pregnancy test, if periods have stopped.
3. FSH (follicle-stimulating hormone) blood test: a high FSH suggests the ovaries are failing. Under 40, two raised results 4 to 6 weeks apart are used to diagnose POI. Between 40 and 45, FSH may be checked if symptoms are unclear.
4. Other tests: estradiol, thyroid tests and prolactin to rule out other causes of missed periods. Anti-Müllerian hormone (AMH) estimates egg reserve but is not used alone to diagnose menopause.
5. For POI: chromosome testing, a fragile X test, and screening for autoimmune conditions.

Health risks of early menopause

Estrogen protects bones, blood vessels and the brain. Losing it years early increases the risk of:

• Osteoporosis and fractures. A bone density (DEXA) scan is often recommended at diagnosis.
• Heart disease and stroke.
• Possibly dementia and earlier death, according to observational studies, particularly after early removal of the ovaries without hormone replacement.
• Infertility, which can be a major emotional loss.

Most of these risks are reduced when estrogen is replaced until the usual age of menopause.

Treatment for early menopause

Hormone therapy

Unless there is a reason not to (such as some breast cancers), guidelines recommend hormone replacement therapy (HRT) or the combined contraceptive pill until at least the average age of menopause, about 51. In this group HRT replaces hormones you would naturally still have. The breast cancer risk linked to HRT in older women is not thought to apply in the same way before 51.

• Women with a uterus need estrogen plus a progestogen, to protect the womb lining.
• Women without a uterus usually take estrogen alone.
• Patches or gels carry a lower clot risk than tablets.
• Vaginal estrogen treats dryness and urinary symptoms directly.

Other options

• Non-hormonal medicines for hot flashes when HRT is not suitable.
• Cognitive behavioral therapy for hot flashes, sleep and mood.
• Weight-bearing exercise, calcium and vitamin D for bones.
• Stopping smoking and managing blood pressure and cholesterol.

Fertility

Natural pregnancy is unlikely after early menopause, but about 5 to 10 percent of women with POI conceive spontaneously. Egg donation and IVF give good pregnancy rates. Women facing cancer treatment can ask about freezing eggs, embryos or ovarian tissue beforehand.

Living with early menopause

Early menopause can bring grief, especially if you had not finished having children. Counseling and support groups help many women. Regular reviews of HRT, bone health and heart risk factors keep long-term risks low.

Frequently asked questions

What are the first signs of early menopause?

The first signs are usually changes in your periods: cycles becoming shorter, longer, lighter or skipped. Hot flashes, night sweats, poor sleep, mood changes and vaginal dryness often follow. If these start before 45, see a doctor so hormone levels and other causes can be checked.

What age is considered early menopause?

Menopause before 45 is called early menopause. Before 40 it is called premature menopause or premature ovarian insufficiency. The average age of natural menopause in the US is about 51 to 52.

What causes early menopause?

In many women no cause is found. Known causes include surgery to remove the ovaries, chemotherapy and pelvic radiotherapy, genetic conditions such as Turner syndrome and fragile X premutation, autoimmune disease, a family history of early menopause, and smoking.

Can you get pregnant with early menopause?

It is unlikely once periods have stopped for 12 months, but not impossible, especially with premature ovarian insufficiency, where the ovaries can occasionally release an egg. Use contraception if you do not want to conceive. If you do, ask a fertility specialist about egg donation and IVF.

Is HRT safe for early menopause?

For most women, yes. Taking HRT until about 51 replaces hormones your body would normally make and lowers the risk of osteoporosis and heart disease. The risks seen in older women on HRT are not thought to apply in the same way. A doctor will check for reasons it might not suit you.