Early menopause: what is it, signs, causes, risk factors

Menopause is a normal transition all women eventually face. Still, some people may start experiencing the symptoms of menopause earlier than expected. Keep reading to learn about early menopause, the causes, symptoms, and when to see a doctor.

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Menopause is a natural stage in life where women stop ovulating and menstruating. The average age for women to go through menopause is 51; most women experience it between ages 45 to 55 (Peacock, 2021). If a woman’s menstrual cycles stop before 45, it’s considered early menopause. In rare cases—about 1% of women—premature menopause can happen before age 40 (Okeke, 2013). 

The term menopause is commonly used as an umbrella term to reference the three  different stages of menopause, which include (Peacock, 2021):

• Perimenopause, also referred to as menopause transition, is the time when your body starts to transition towards menopause. Your hormones will fluctuate more during this time. You may experience symptoms like missed periods, hot flashes, vaginal dryness, and sleep problems. The time this stage lasts will vary from person to person. On average, people experience perimenopause for about four years. 

• Menopauseis reached after 12 months in a row since your last menstrual cycle.

• Postmenopauserefers to all of the years following menopause. Typically, menopausal symptoms decrease and go away completely. Some people may experience some symptoms for a few years after menopause.

Early and premature menopause have similar symptoms and causes. The main difference between the two is the age menopause is reached.

Early menopause may be caused by medical conditions, treatments, or unknown reasons. The possible causes of early menopause include:

Genetics and family history

Genetic abnormalities are a common cause of premature menopause, especially for cases that develop at a very young age. The genetic changes prevent the ovaries from functioning normally, impairing healthy ovulation. 

Genetic causes of premature menopause include (Okeke, 2013):

• Turner’s syndrome

• Familial

• Trisomy 18 and Trisomy 13

• Pure gonadal dysgenesis

If you have a known genetic disorder that could cause premature menopause, you may want to consider working with a fertility specialist to discuss fertility preservation or other options. 

Cigarette smoking

Smoking is a known cause of premature menopause. Research suggests the more cigarettes smoked, the more likely menopause will begin at an earlier age (Okeke, 2013). The good news is that many programs and medications are available to help you quit smoking. 

Autoimmune diseases

The ovaries are a common target for attacks from autoimmune diseases. It’s estimated that up to 30% of premature ovarian failure and primary ovarian insufficiency is caused by autoimmune conditions (Szeliga, 2021).

Autoimmune diseases that often occur alongside early menopause include (Szeliga, 2021):

• Hypothyroidism

• Hashimoto thyroiditis

• Grave’s disease 

• Rheumatoid arthritis

• Crohn’s disease

• Lupus

• Multiple sclerosis

Epilepsy

Epilepsy is a condition affecting the nerve cells in the brain resulting in seizures. Hormonal changes are common in people with epilepsy. Research suggests these hormonal changes can cause sexual dysfunction, decreased fertility, polycystic ovarian syndrome (PCOS), and early menopause (Pennell, 2009). There are excellent treatments for epilepsy available, so speak with your healthcare provider. 

Cancer and cancer treatments

Radiation and chemotherapy may result in ovarian failure and premature menopause. Sometimes the premature menopause caused by these medications is only temporary, but this depends on the type of treatment and your age (Okeke, 2013). If early menopause is an expected part of treatment, your healthcare provider will likely discuss fertility preservation options with you.

Hysterectomy

A hysterectomy is the surgical removal of the uterus, generally done for a medical reason. The ovaries, cervix, and/or fallopian tubes may also be removed. If the ovaries are removed, menopause will begin after the operation, a phenomenon sometimes referred to as surgical menopause (as opposed to natural menopause) (Okeke, 2013). 

Infections

Some types of infections may cause damage to the ovaries, ovarian failure, and premature menopause. Infections associated with early menopause include mumps and pelvic tuberculosis (Okeke, 2013).

The signs of early menopause are similar to the symptoms of perimenopause. You may experience symptoms like (Okeke, 2013):

• Irregular periods—changes in the time between periods

• Periods that are longer or short than usual

• Heavier than normal bleeding

• Spotting

• Mood swings

• Changes in libido

• Vaginal dryness

• Trouble sleeping

• Hot flashes

• Night sweats

• Joint pain

• Headaches

The risk factors for developing early menopause include (Arinkan, 2021; Okeke, 2013, Purdue-Smithe, 2017):

• Family history

• Smoking

• Oral contraceptive use

• First pregnancy at a younger age

• More than five pregnancies that lasted longer than 20 weeks

• Poor nutrition

• Poor health status

• Vitamin D deficiency 

Some of these factors are more within your control than others. Speak with your healthcare provider about your medical and social history if you think you may be at risk of early menopause. 

Early menopause may increase your risk of developing some health problems. This increased risk for complications is associated with changes in hormonal levels, such as estrogen. 

Here are the potential health complications following early menopause:

Osteoporosis

Osteoporosis is a condition where bones lose density, increasing the risk for broken bones. Research shows bone loss speeds up after menopause, leading experts to believe estrogen plays a role in bone density. 

Because of this likely link, premature and early menopause increase the chances of osteoporosis (Okeke, 2013).

Cardiovascular disease

Research shows the changes in estrogen levels also impact heart health. These changes may increase the risk of (Okeke, 2013):

• Heart disease

• High cholesterol levels

• Heart attack

• Stroke

Life expectancy

When compared with average or late menopause, early menopause is associated with a lower life expectancy by about three years (Asllanaj, 2019). It’s important to remember that many factors impact life expectancy, though. It’s possible to live a long and healthy life after going through early menopause. 

Typically, menopause isn’t diagnosed until 12 full months without a menstrual period. If you’re having irregular periods and symptoms that may indicate early menopause, your healthcare provider may recommend checking your hormone levels, including (Okeke, 2013):

• Estrogen: Declining estrogen levels may indicate perimenopause since levels decrease during menopause.

• Anti-mullerian hormone (AMH): This hormone is believed to mirror the number of inactive follicles (eggs in your ovaries). A low number indicates a low ovarian reserve and may be used to assess menopause status.

• Follicle-stimulating hormone (FSH): FSH stimulates the growth of eggs and helps control menstrual cycles.

• Thyroid-stimulating hormone (TSH): Thyroid conditions can mimic the symptoms of early menopause, so your healthcare provider will likely assess the health of your thyroid hormones when testing for early menopause. 

Testing hormone levels can help give you an idea if you may be approaching menopause. Still, it’s important to remember that it’s normal for hormone levels to fluctuate throughout your menstrual cycles. So, hormones may not be completely accurate for diagnosing early menopause, and you’ll likely need multiple tests to track levels over time. 

Once menopause is reached, it’s not likely it can be reversed. 

For some causes, you may be able to prevent and delay early menopause with healthy lifestyle changes. Some causes, such as genetics, cancer, and other medical conditions, likely can’t be prevented. Still, you could lower your risk for early menopause by:

• Avoiding or quitting smoking

• Eating a healthy diet

• Preventing vitamin deficiencies

• Exercising regularly

Some research suggests hormone replacement therapy (HRT) can help reduce symptoms and prevent complications that may develop after menopause (Okeke, 2013). Ask your healthcare provider if hormone therapy is right for you. 

If you’re experiencing the signs and symptoms of early menopause, it’s best to bring it up with your healthcare provider. The symptoms could be a sign of other problems, like a thyroid condition. 

But remember, menopause is a natural transition that all people with menstrual cycles eventually reach. If you have any questions or concerns about early menopause, talk with your healthcare provider.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

January 20, 2022

Written by

Ashley Braun, RD, MPH

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.