Premature and Early Menopause

Overview

What is early menopause?

Premature menopause and early menopause are conditions where a woman or person assigned female at birth (AFAB) goes through menopause at an earlier age than is typically expected. Menopause is the point in a person’s life when their menstrual periods end. Natural menopause typically happens around age 51. Once you’ve gone 12 straight months without a period, you’ve gone through menopause.

What is the difference between premature menopause and early menopause?

The difference between premature menopause and early menopause is when it happens. Menopause isn’t a process, rather it’s a point in time where menstruation ends.

  • Early menopause is when menopause happens before age 45.
  • Premature menopause is when menopause happens before age 40.

What is the difference between premature menopause and premature ovarian failure?

Premature menopause isn’t the same as premature ovarian failure, although some people use the terms interchangeably. Healthcare providers now refer to premature ovarian failure as primary ovarian insufficiency (POI).

POI is a condition where your periods stop suddenly and spontaneously, either early or prematurely. POI isn’t the same as premature or early menopause, because with POI, there’s a chance your period will come back. People with POI may still ovulate, menstruate or become pregnant. With early or premature menopause, you don’t ovulate or menstruate, and you lose the ability to get pregnant.

What is the earliest age for menopause?

Menopause can happen when a person is in their 20s, 30s or 40s. Premature menopause describes menopause that occurs any time before age 40. It’s rare for menopause to happen before age 30.

Can you start menopause at 35?

Yes, starting menopause around age 35 is premature menopause.

How common are premature menopause and early menopause?

Early menopause (menopause before 45) occurs in about 5% of women or people AFAB. Premature menopause (menopause before 40) happens in about 1% of people AFAB. It’s rare to experience menopause in your 20s. This happens in about 0.1% of people AFAB.

Symptoms and Causes

What causes early and premature menopause?

Many of the causes of premature menopause can also be causes of early menopause. Some of these reasons include cancer treatment, surgery or certain health conditions. But, sometimes, the cause is unknown. Anything that damages your ovaries or stops your body from making estrogen can cause menopause. Early and premature menopause also share many of the same symptoms as menopause.

Some causes of early or premature menopause are:

Sometimes there’s no cause of early or premature menopause. This is the case in up to 50% of people.

How do you know if you are starting early or premature menopause?

You may start having irregular menstrual cycles for a few years prior to your last menstrual period. Longer or shorter menstrual cycles, spotting between periods or changes in vaginal bleeding are often some of the first signs of menopause. If you experience irregular periods, speak with a healthcare provider to look into possible causes.

The other signs of premature and early menopause include many of the typical menopause symptoms. You may experience:

  • Hot flashes (sudden warmth that spreads over your body).
  • Night sweats.
  • Vaginal dryness and discomfort during sex.
  • Frequent urge to pee.
  • More frequent urinary tract infections (UTIs).
  • Difficulty sleeping (insomnia).
  • Emotional changes (irritability, mood swings, depression or anxiety).
  • Dry skin, dry eyes or dry mouth.
  • Breast tenderness.
  • Racing heart.
  • Headaches.
  • Joint and muscle aches and pains.
  • Changes in your sex drive (libido).
  • Difficulty concentrating or being more forgetful.
  • Weight gain or weight loss.
  • Hair loss or thinning.

Can stress bring on early menopause?

Stress from your daily activities, work or other life events isn’t a reason you’ll go into early or premature menopause. If you feel stress that interferes with your daily life or happiness, talk to a healthcare provider about your symptoms. They can offer tips to help you manage your stress.

Diagnosis and Tests

How do doctors test for early menopause?

If you begin to have symptoms of menopause before age 45, your healthcare provider may perform several tests and ask questions to help diagnose premature or early menopause. Diagnosing early or premature menopause can include:

  • Asking about the regularity of your menstrual periods.
  • Discussing any family history of menopause at an early age.
  • A physical exam.
  • A blood test to look at your hormone levels.
  • Looking for other medical conditions that may be contributing to your symptoms such as a thyroid condition.

People who haven’t had a menstrual period for 12 straight months, and aren’t on any medication that could stop menstruation, may have reached menopause.

Management and Treatment

How is early menopause treated?

Treatment for early or premature menopause may vary depending on why menopause started earlier than normal. Given the health risks associated with early menopause, providers recommend hormone replacement therapy (HRT), unless there’s a reason hormone therapy is unsafe (like if you’ve had breast cancer).

HRT replaces some of the lost hormones in your body. This helps reduce the symptoms and side effects of menopause, and decreases your risk of health conditions caused by early or premature menopause. Providers typically prescribe HRT until a person turns 51 years old (the time when most people reach menopause).

It’s important to discuss the pros and cons of hormone therapy with your provider. If you have infertility as a result of early or premature menopause, discuss your options with a fertility specialist, who can help you achieve your goal of becoming a parent.

Can you reverse early menopause?

You can’t reverse menopause or make your ovaries function normally again. However, your provider can help reduce the symptoms and side effects of menopause. In the case of primary ovarian insufficiency (POI), there’s a small possibility you’ll regain ovarian function.

Prevention

How can I reduce my risk of early menopause?

Most causes of early menopause are beyond your control. Smoking cigarettes is the only lifestyle factor that may cause early menopause. You can reduce your risk of menopause by quitting smoking. The other causes of menopause like health conditions, surgeries or treatment for cancer are unpreventable in most cases.

What are the risks of premature or early menopause?

People who go through menopause early tend to have more severe symptoms of menopause. These symptoms can lead to sexual dysfunction or loss of intimacy.

Additionally, people who experience premature or early menopause spend more years without the benefits of estrogen. Without typical amounts of estrogen, you’re at greater risk for certain health conditions like:

Outlook / Prognosis

Can I still get pregnant after being diagnosed with premature menopause or early menopause?

Both early and premature menopause affect your ability to get pregnant because you’re not ovulating. However, unless you’ve gone 12 consecutive months without a menstrual period, you can still get pregnant. This is because in the years leading up to your final period, or if you have POI, there’s a chance ovulation (releasing an egg) still happens. If getting pregnant or having children is important to you, work with a fertility specialist to explore your options.

It’s possible to get pregnant through in vitro fertilization (IVF) after menopause. You can use eggs from a donor or your own eggs (if you froze your eggs prior to menopause). Any eggs that are left after menopause typically aren’t viable. Surrogacy and adoption are also options.

A note from Cleveland Clinic

Premature and early menopause describe menopause that happens before it’s expected. Most women or people assigned female at birth (AFAB) reach menopause around age 51. With premature menopause, this happens before age 40. Early menopause is reaching menopause before age 45. Talk to a healthcare provider if you’re under 45 and have signs of menopause like irregular periods, spotting between periods, hot flashes or vaginal dryness. Your provider can order blood work and discuss your health history to help diagnose these conditions. Treatment is available to give you relief from unpleasant symptoms of menopause.

Last reviewed by a Cleveland Clinic medical professional on 09/06/2022.

References

  • Jean Hailes for Women’s Health. Premature & early menopause. (https://www.jeanhailes.org.au/health-a-z/menopause/premature-early-menopause) Accessed 9/6/2022.
  • U.S. Department of Health and Human Services, Office of Women’s Health. Early or premature menopause. (https://www.womenshealth.gov/menopause/early-or-premature-menopause) Accessed 9/6/2022.
  • Okeke T, Anyaehie U, Ezenyeaku C. Premature menopause. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3634232/) Ann Med Health Sci Res. 2013 Jan;3(1):90-95. Accessed 9/6/2022.
  • National Cancer Institute. NCI Dictionary of Cancer Terms: Premature Menopause. (https://www.cancer.gov/publications/dictionaries/cancer-terms/def/premature-menopause) Accessed 9/6/2022.
  • National Health Service. Early menopause. (https://www.nhs.uk/conditions/early-menopause/) Accessed 9/6/2022.
  • The North American Menopause Society. Perimenopause & Premature Menopause FAQS. (https://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/perimenopause-premature-menopause-faqs) Accessed 9/6/2022.

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