Premature and early menopause: causes, symptoms & how to test

What is early menopause?

Early menopause means that you reach menopause before the age of 45 [1, 2], which is outside the age range of 45-55 when it typically happens. Menopause is diagnosed retroactively once 12 months have passed since your last period, and typically, you’ll also experience some perimenopause symptoms in the months or years leading up to it [3]. However, since missing periods can have other causes, such as PCOS and some thyroid conditions, it’s important to rule these out with the help of a healthcare professional if your periods become irregular or stop earlier than expected.

Early menopause vs. premature menopause

The difference between premature and early menopause comes down to the timing of when it happens. Early menopause means that you have your last period before the age of 45, while those with periods ending before the age of 40 are considered to be in premature menopause [1, 2]. 

It’s worth keeping in mind that perimenopause (when we start to get the typical menopause symptoms) can begin long before we actually reach menopause. It can last for months or even several years before periods stop completely.

Premature menopause or primary ovarian insufficiency?

Depending on where you look, the term premature menopause overlaps with primary ovarian insufficiency (POI). However, while the two are similar, they aren’t the exact same thing. 

POI is a condition where the ovaries stop working normally before the age of 40, which can lead to irregular cycles, missing periods and also cause menopause-like symptoms. It can also lead to premature menopause, when periods stop entirely. However, those with POI can still ovulate occasionally, and it’s possible, although not very common, to become pregnant or regain function in the ovaries [5]. 

What causes early menopause?

Early or premature menopause can happen naturally without any known cause, but there are a few things that can make it more likely. It’s also possible to be put into early menopause because of medical treatments, so-called “induced menopause”.

• Family history: Some people are genetically predisposed to early menopause. If you have family members who went through menopause early, you’re more likely to do so as well [1].
• Genetic conditions: Early or premature menopause is more common for those with certain genetic conditions, such as ovarian dysgenesis (where the ovaries haven’t developed as they should), or chromosomal abnormalities [6].
• Smoking: Research shows that people who currently smoke have up to an 80% higher risk of early menopause compared to those who have never smoked, and the risk increases the more you smoke [7].
• Autoimmune disorders: These are conditions that affect how the immune system functions, causing it to react to the body’s own tissues. Some autoimmune disorders are associated with an increased risk of early menopause, for example, those affecting the thyroid and Addison’s disease [6].
• Infections: Mumps, genital tuberculosis, and HIV have also been linked with a higher likelihood of early or premature menopause [6, 8]. 
• Cancer treatments: Some types of chemotherapy or radiation treatments can damage the ovaries and cause premature menopause. However, in some cases, it’s possible to regain fertility after the treatment. You may also get the option to freeze your eggs before the treatment so you can conceive with IVF later on [6].
• Surgery: If the ovaries are surgically removed, you’ll go into early menopause due to the drop in sex hormones, estrogen and progesterone, that are produced in the ovaries. In some cases, a hysterectomy (removal of the uterus) can also lead to early menopause even if the ovaries are left intact [6].   

If you suspect you may be approaching early menopause, make sure to reach out to your healthcare provider. They’ll be able to look at your symptoms in the context of your wider health history and can help you determine your next steps and what treatment options would work best for you.

Early menopause symptoms

Symptoms of premature or early menopause are the same as those that typically appear during “regular” perimenopause. Everyone has their own unique experience, but for many, the first thing they notice is changes to their period. This might start with different bleeding patterns than you’re used to, or cycles becoming longer or shorter than usual. Common symptoms of early menopause (and perimenopause) are:

• Irregular periods
• Heavier or lighter bleeding
• Shorter or longer periods
• Spotting
• Hot flashes and/or night sweats
• Vaginal dryness
• Brain fog
• Low libido
• Mood changes, such as irritability or low mood
• Anxiety
• Joint pain
• Fatigue
• Frequent urination [1, 3, 9]

You’ll usually start to notice these several months or even years before your periods stop completely at menopause. Tracking your menstrual cycle and symptoms, for example, by using Natural Cycles, can help you spot changes early. It’s also worth noting that many of these symptoms can be caused by other conditions, which is why it’s important to consult with your doctor to rule out other potential causes. 

How common is early menopause? 

Around 8% of women go through early menopause, meaning that periods stop before the age of 45 [7, 10]. Premature menopause (before the age of 40) happens to roughly 1% of women [6, 11].

What are the risks of early menopause?

While menopause is a natural part of aging, there are a few risks related to premature and early menopause. 

• Difficulties conceiving: When menopause approaches, fertility will decline as the number and quality of the eggs decrease, which can make it more difficult to become pregnant. If you’re planning to conceive and suspect you might be going through early menopause, it’s best to reach out to your doctor to evaluate your symptoms and see if any fertility treatment would be needed [1].
• Loss of bone density: Early menopause, and premature menopause in particular, is linked to a higher risk of developing osteoporosis, a condition where the bones become more fragile. This is because the levels of estrogen drop to lower levels earlier than usual, and estrogen is important for bone health [7]. 
• Cardiovascular issues: Estrogen also plays an important role in our cardiovascular system and heart health, so the risk of developing cardiovascular issues increases with early menopause [7].  
• More severe vasomotor symptoms: Symptoms like hot flashes or night sweats can be more severe for those who go through menopause early or prematurely. This is especially common if menopause is medically induced (by medication or surgery), since hormone levels then drop quite quickly [7].
• Mental health: Going through menopause earlier than expected can also affect mental health. It’s normal to experience sadness, anxiety, or feelings of loss, and there is an increased risk of depression in early menopause [7]. If you’re struggling, know you’re not alone, and there is help available — reach out to a healthcare provider for support.  

When to see a doctor

You should reach out to your doctor if you experience perimenopause-like symptoms, such as irregular periods, bleeding changes, or hot flashes, and suspect you may be approaching early menopause. Keep in mind that these symptoms don’t always mean you’re in perimenopause — other conditions, including PCOS, thyroid disorders, or vitamin deficiencies, can cause similar symptoms. A doctor can help identify the cause and guide the next steps for you.

Aside from the risks associated with going into menopause earlier than usual, the symptoms can also be disruptive in their own right — whether you have mental or physical symptoms (or both). The good thing is that they largely are treatable, and you don’t have to tough it out if you’re struggling. 

How to test for early menopause

There’s no single test to detect early menopause, so the diagnosis will be made based on several criteria. Your doctor will look at your menstrual cycle history, for example, how often you get your period and how much it varies from cycle to cycle. Keep in mind that tracking your cycle can help you spot these chances more easily. They will also evaluate any other symptoms you experience that can indicate you’re going through perimenopause [7].  

Your doctor will likely ask about your own medical history and lifestyle to get a full picture and rule out other potential causes for your symptoms, as well as ask about your family history to understand if you have family members who have gone through early menopause [7]. 

In some cases, your doctor may do a physical exam or take blood tests. For example, they may check your thyroid levels or test your levels of follicle-stimulating hormone (FSH), which can give an indication of how your ovaries are functioning [7, 12].

How is early menopause managed?

The management of early and premature menopause is essentially the same as for “regular” perimenopause and menopause, with hormonal and non-hormonal treatment options. Lifestyle changes can also play a big role in managing symptoms. 

It’s also important to tailor the treatment to each individual depending on symptoms and medical history, so your doctor will work with you to make a plan to best fit your needs.

Hormonal treatments for premature and early menopause

Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), works by adding hormones that drop to lower levels when we go through menopause, mainly estrogen and progesterone (alone or together, depending on the situation). HRT comes in many different forms — both as medications that you either take orally or that you put on your skin. Hormonal birth control, such as the pill, IUD, or implant, can also be used to treat menopause symptoms [7, 12].

HRT is often prescribed for premature and early menopause to prevent the risks related to declining estrogen. However, not everyone can use hormonal medications. For example, estrogen might not be suitable if you have a history of certain types of cancer.

Non-hormonal treatments

There are a number of non-hormonal options available to manage symptoms in early menopause. Antidepressants, such as SSRIs or SNRIs, as well as gabapentin (an anti-seizure medication), can be used to treat vasomotor symptoms like hot flashes and night sweats. There are also newer options like neurokinin receptor antagonists, which work by affecting the temperature regulation center in the brain [7].

In addition to treating the physical symptoms, it’s important to focus on mental health. Early menopause can be especially challenging since it may come with more stigma, anxiety, or feelings of sadness than going through menopause later in life. Cognitive behavior therapy or other types of psychological support are helpful tools for navigating this transition [7, 12].

Lifestyle changes

There are a number of lifestyle adjustments you can make to support your body through perimenopause and menopause, such as eating a nutritious diet, regular exercise, prioritizing sleep, and practicing mindfulness.

For premature and early menopause, recommendations around lifestyle are usually focused on supporting your heart and bone health, since these are the main risk factors associated with early menopause [7].

• Stop or limit smoking: Smoking increases the risk of early menopause, and it also has a negative impact on cardiovascular health, so try to stop smoking or cut back if you can.
• Include calcium in your diet: Calcium helps support bone health, which is especially important for those going through premature or early menopause. Foods that are rich in calcium include dairy products, leafy vegetables, and fish, such as salmon and sardines.
• Exercise regularly: Cardio activities, such as running, cycling, or swimming, are important for our cardiovascular health, while weight-bearing exercise is a great way to promote bone health. Try to include both in your routine and find ways of exercising that you enjoy, as this will help you maintain the habit.

Understand the menopausal shift with Natural Cycles

Here at Natural Cycles, we believe in empowering you with the knowledge to understand your own body — especially when it comes to reproductive health. Regardless of when it happens, menopause comes with a lot of uncertainty, and it’s easy to feel overwhelmed and out of control during this transition. NC° Perimenopause is designed to help you understand your body’s changes through science and data — always with you in focus. 

NC° Perimenopause provides an assessment of what stage of perimenopause you might be in, allows you to track symptom trends, and spot potential links to lifestyle factors. The app is packed with expert-backed guidance to help you along the way. You can also download a PDF report of your cycles and symptoms to support productive conversations with your doctor. Why not see if Natural Cycles might be right for you?