Menopause marks a transition point when a woman's period stops, and she can no longer become pregnant naturally. While most women enter menopause in their early 50s, approximately 1% of women begin menopause before turning 40.
Approximately 1% of women experience early or premature menopause. Women may experience premature menopause before turning 40 and early menopause before age 45.
Naturally occurring early and premature menopause are uncommon, occurring among only 5% of cases.
Ask your healthcare professional about techniques and tests to evaluate early and premature menopause.
Hormone replacement therapy (HRT) is often used to help manage early and premature menopause symptoms.
When does menopause typically start?
A woman is said to have started menopause when at least twelve months have passed since her last period. The transition into menopause is not a sudden change. The years leading up to the onset of menopause, referred to as perimenopause, are marked by various changes.
Perimenopause, which can last for over a decade in some cases, is characterized by symptoms such as:
- Problems with sleep;
- Hot flashes;
- Reduced fertility;
- Change in sexual function and desire;
- Irregular periods.
For many women, the onset of menopause often occurs between ages 45 and 55, but this is not the case for everyone. Some women may experience premature menopause or early menopause.
What is the difference between premature menopause and early menopause?
The terms premature menopause and early menopause are often used interchangeably, but there is a difference between them.
A woman with premature menopause meets all the criteria for menopause before the age of 40.
While a woman experiences early menopause when she enters menopause after age 40 yet before age 45.
Both premature and early menopause occur when periods stop, and hormone production declines at an earlier age than usual for traditional menopause. This can occur due to surgical procedures affecting the ovaries, such as a hysterectomy with oophorectomy (removal of the ovaries) or various medical conditions.
A hysterectomy that does not remove the ovaries will not trigger early or premature menopause. Statistics suggest early and premature menopause that occur naturally are uncommon, occurring in only about 5% of women.
What is premature ovarian failure?
Premature ovarian failure and premature menopause describe different conditions but are sometimes used interchangeably. Premature ovarian failure (primary ovarian insufficiency, POI) is the reduction of ovarian reserve. Like premature menopause, POI can involve an interruption of the menstrual cycle.
However, where POI and premature menopause differ is that with POI, there is a possibility your period could return. Women diagnosed with POI may still ovulate each month. They may also continue to have monthly cycles and can naturally conceive. With premature menopause, ovulation and menstruation do not occur, so natural pregnancy is impossible.
How can I determine if I experience early or premature menopause?
While some women with premature and early menopause may not initially experience signs or symptoms, other women may experience menopause signs and symptoms such as mood swings, night sweats, and hot flashes. It is possible for a woman to have early or premature menopause and not know until her periods stop.
If you experience irregular periods or other menopause-related signs and symptoms, contact your healthcare provider. Also, ask your healthcare provider about tests to assess your hormone levels and identify the causes of your signs and symptoms. Your healthcare provider can also evaluate if you show indicators for the onset of menopause and rule out other potential health concerns that share similar signs and symptoms.
- A pregnancy test. The first test usually performed when evaluating an individual for premature, or early menopause is a pregnancy test. Some pregnancy signs and symptoms closely resemble menopause, such as irregular and absent periods, hot flashes, night sweats, weight gain, and headaches. It is crucial to rule out natural pregnancy before recommending treatments to address menopausal signs and symptoms.
- Tests to measure hormone levels. In addition to a pregnancy test, your provider may conduct blood tests to measure follicle-stimulating hormone (FSH), estradiol (a form of estrogen), and other hormone levels. FSH is the hormone that triggers the ovaries to produce estrogen. Multiple measurements are generally taken several weeks apart. Two abnormal FSH readings taken four to six weeks apart may suggest you are in menopause.
- Other potential tests. Depending on your symptoms and the results of the above tests, your provider may recommend other assessments to evaluate the cause of early or premature menopause. These tests can also help gauge a woman's risk of other health conditions related to the early onset of menopause, such as osteoporosis, coronary artery disease, mood disorders, and dementia.
What triggers early and premature menopause?
Natural menopause occurs when levels of various hormones in the female body decline sufficiently to stop ovulation and monthly menstruation. The average age for natural menopause is around 51 years of age, although this can vary from woman to woman based on several factors unique to their body and body chemistry.
A woman experiences early or premature menopause when her symptoms – specifically the end of the regular monthly menstrual cycle – occur before the age of 40 (premature menopause) or 45 (early menopause).
The causes of premature and early menopause are generally similar. Any injury, illness, or procedure that damages the ovaries or stops the production of estrogen can trigger menopause. Sometimes the cause is related to disease or medical treatments, but other times the cause of early onset menopause is unknown. Premature or early menopause may occur in association with:
- Chromosomal abnormalities;
- Chronic fatigue syndrome;
- Autoimmune diseases, including thyroid disease, rheumatoid arthritis, and Crohn's disease;
- Family history or early onset menopause;
- Starting your period before the age of 11;
- Chemotherapy and radiation treatments;
- Surgical procedures that remove the ovaries or the uterus.
Are there specific treatments for early or premature menopause?
Treatment for premature or early menopause may vary depending on the underlying cause of early menopause. There are some health risks with early menopause. For this reason, providers may recommend hormone replacement therapy (HRT) unless these treatments may be unsafe for the individual due to another medical condition.
HRT replaces hormones that are lost during menopause. It can help reduce the symptoms of menopause and reduce the risk of certain health conditions associated with it. Yet another way is probiotics for menopause, helping to reduce the symptoms. Although natural formulations, the use of probiotics should also be consulted with a doctor.
When HRT is used to treat premature and early menopause, it is generally recommended until the person turns 51 (the age when menopause usually begins). Because women who experience early or premature menopause spend more years with reduced estrogen levels, they are at an elevated risk for certain medical conditions.
Reducing the risk of these illnesses is a benefit of HRT, as treatments help to replace lost estrogen. Although HRT has benefits, it is essential to discuss the potential positive and negative side effects with your provider.
In addition to menopausal symptoms, reduced fertility is a common concern for women in their 30s and 40s with POI. Unfortunately, there are no proven treatments to restore normal ovarian function; however, options are available if you experience early menopause yet still wish to get pregnant.
A small percentage of women may conceive naturally. Sometimes referred to as “spontaneous remission” of POI, this can occur when the ovaries begin to function again on their own, restoring fertility.
HRT is another widely used
treatment option for POI. As noted above, HRT can help reduce many symptoms of
premature menopause, and for women with POI, it may trigger regular periods to
resume. In addition to HRT, fertility treatments are also options for some
women. Your health provider can help you determine the best course of treatment to
meet your needs and family planning goals.
- The Annals of Medical and Health Science Research. Premature Menopause.
- NIH National Institutes on Aging. What Is Menopause?
- The North American Menopause Society. The North American Menopause Society Recommendations for Clinical Care of Midlife Women.
- Merk Manual Consumer Version. Premature Menopause.
- Mayo Clinic. Perimenopause.