What You Need to Know About Premature and Early Menopause

early and premature menopause

Few women receive any education about perimenopause and menopause, and most think it’s an event that happens far into the future. The average age for reaching menopause is 51 years old, with perimenopause usually beginning in your late thirties and early forties. However, for about six percent of women in the U.S., early and premature menopause will occur.

What are Premature and Early Menopause? 

Perimenopause is the stage before menopause when you still have periods, although they may become irregular. You transition from perimenopause to menopause when you haven’t had a menstrual period for 12 consecutive months that is not due to another cause, signaling that you have reached the end of your fertile years and your ovaries are no longer producing viable eggs. Most women will make the transition to menopause between the ages of 45 and 55. After you make the transition, you are in the postmenopause stage, although many use the terms menopausal and postmenopausal interchangeably.

Early natural menopause occurs between the ages of 40-44 years and affects about five percent of women.

Premature menopause is defined as menopause occurring before age 40 and will occur in about one percent of women. Premature menopause is also referred to as Primary Ovarian Insufficiency (POI). POI is a condition in which a woman’s ovaries stop functioning normally before she turns 40. This doesn’t mean the ovaries will necessarily shut down completely, it just means they aren’t working as well. In POI, the ovaries will stop releasing eggs or only release them sometimes. They will also stop producing hormones or release them sometimes. The process becomes irregular. It’s important to differentiate that POI is not early menopause. Women who have POI can still become pregnant and may even have a period (though it can become sporadic). Women with POI can start experiencing symptoms as early as during their teenage years, but a critical factor in POI is that it can only happen to women under 40.

Keep in mind that the menopause transition can take years, with perimenopause lasting an average of four years. That means if you experience premature or early menopause, you might start experiencing symptoms like sleep disturbance, mood swings, hot flashes, and irregular periods much earlier than the late 30’s or early 40’s. 

If you think you might be experiencing premature or early menopause, make an appointment with your healthcare provider. Your clinician will complete an exam and run a few simple tests to determine if you no longer have periods due to menopause or something else. If your estrogen and progesterone are low and your FSH (follicle-stimulating hormone) is high, you have likely reached menopause. A gynecologist specializing in reproductive endocrinology is an excellent resource for women experiencing POI.

Symptoms of Premature and Early Menopause

The symptoms of premature and early menopause are the same as menopause experienced at the expected time. Some of the most common symptoms include:

  • Irregular periods
  • Hot flashes
  • Night sweats
  • Sleep difficulties
  • Mood changes
  • Vaginal dryness
  • Pain or discomfort during sex
  • Decreased libido
  • Headaches
  • Dry skin

Health Risks of Premature and Early Menopause

Not only do you have menopause symptoms for longer than others might, but there are also health risks associated with premature and early menopause. The low estrogen that comes with menopause increases your risk of osteoporosis and heart disease. The longer you live in low estrogen conditions, the greater your risk of developing these conditions.

In addition to cardiovascular and osteoporosis risks, people who experience early menopause report a lower general quality of life, lower sexual satisfaction, and a greater incidence of mood disorders such as anxiety and depression than their peers.

Premature menopause has also been linked to cognitive decline, increased incidence of glaucoma, and increased risk of developing Parkinson’s disease.

Women who experience premature menopause will often have menopausal hormone therapy (MHT) recommended due to the multiple health risks noted above. In addition, calcium and Vitamin D are often prescribed to help maintain bone strength. These nutrients can also be found in certain foods, like dairy products, fortified plant milks, dark green leafy vegetables, and oranges.

Causes of Premature and Early Menopause

What causes premature and early menopause? Like most complicated physical processes, many factors play a part.


You may have just drawn the short genetic straw. When did your mother reach menopause? There is a strong genetic component to age of menopause, and this is something you have no control over. Also, your risk for premature and early menopause increases if you had your first period before age eleven.

Genetics can also cause certain autoimmune diseases or chromosomal differences that can trigger premature and early menopause. Thyroid disorders, rheumatoid arthritis, and Sjogren’s syndrome are some examples of genetic diseases that can cause premature ovarian failure.

Medically Induced Menopause

A common cause of premature and early menopause is medically induced menopause. For example, radiation and chemotherapy for ovarian and uterine cancer can damage ovarian function and jumpstart menopause.

Having a hysterectomy (surgical removal of the uterus) or an oophorectomy (surgical removal of the ovaries) will also affect the timing of your menopause. Even if one or both of your ovaries are left intact after a hysterectomy, experts find that you are still at risk for experiencing ovarian failure and premature or early menopause.

If your ovaries are removed, you will instantly begin menopause. This is referred to as surgical menopause.

Lifestyle Factors

One major risk factor you do have control over is smoking. Research has consistently shown a dose-dependent correlation between smoking and early natural menopause. The longer and more you smoke, the likelier you are to start menopause earlier than expected. Quit smoking now, and your risk for early menopause (and cardiovascular disease) will diminish.

Other lifestyle factors are suspected to have some impact on early and premature menopause, but research has been inconsistent. Alcohol consumption and low physical activity might play a part in developing premature and early menopause, but more research is needed.

Interestingly, low body mass index (BMI) research shows a consistent relationship to developing early or premature menopause. Conversely, there’s a tendency for people with a high BMI to reach menopause later than average.

There may also be a link between low socioeconomic status and premature and early menopause. Again, the research to date has been inconsistent in its results, and more study is called for to explore this potential risk factor.

Premature and Early Menopause Prevention

You can’t change your genetics or certain health conditions you may have, but there are some things you can do to lessen your risk of developing premature or early menopause.

  • Quit smoking. This is one of the only risk factors that has been proven to impact the timing of menopause.
  • Maintain a healthy weight. If you are underweight, you are at risk of developing premature or early menopause.
  • Eat a nutritious, well-balanced diet. Not only does this support your overall health and body function, but there may be a protective effect against early menopause from certain nutrients. Research suggests that adequate vitamin D and calcium levels may lessen your risk of premature and early menopause.
  • Be mindful of alcohol consumption. Experts find that moderate alcohol intake might actually lessen your risk of premature and early menopause, but excessive alcohol consumption is not protective.

If you experience premature or early menopause, talk to your healthcare provider about ways to minimize your health risks. If you are a candidate for hormone therapy, it can minimize or eliminate many of the symptoms and risks associated with menopause.

Excellent diet, regular exercise, good sleep hygiene, and medical support are all strategies to help you stay healthy and happy even during premature and early menopause.

Looking for more expert support on menopause stages, symptoms, and how you can get relief? Download Midday from the App Store or visit us at Midday.Health.

Jennifer Turkyilmaz, RN, BSN, is a medical writer who worked for many years in women’s health as a high-risk pregnancy nurse. She is also a newly menopausal woman who wishes she had known more about what to expect before it happened to her.

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