What Is Premature Menopause?

Premature menopause affects women before the age of 40. This type of menopause is either induced or natural. Menopause means you have not had a menstrual period for 12 straight months, and you are not pregnant or sick.

Menopause is a natural and normal part of aging that occurs when female sex hormones go down naturally, the ovaries stop releasing eggs, and the person no longer gets periods and is unable to get pregnant. The average person enters natural menopause in their early 50s.

Here is what you need to know about premature menopause including symptoms, causes, and risk factors, diagnosis, and more.

Premature vs. Early Menopause

Premature menopause affects 1% of women under the age of 40. The only difference between premature menopause and early menopause is the timing.

Premature menopause occurs before age 40 and early menopause happens after age 40 but before age 45. Many of the same causes of premature menopause also cause early menopause. Both conditions cause similar symptoms.

Premature Menopause Symptoms

You may start to notice changes months or years before you actually hit menopause. That period of change is called perimenopause. No one knows when they will hit menopause; all they can do is pay attention to how they are feeling and the changes they are experiencing.

Symptoms of menopause will vary from person to person. For example, some people will experience harsh symptoms, while others will have milder symptoms, and some may not have any symptoms at all.

Common signs of menopause include the following:

• Mood swings: Some people will find that hormone fluctuations can create feelings of irritability, anxiety, fatigue, and depressed mood.
• Hot flashes: Hot flashes make you feel warm or hot quickly and for no reason. The skin may feel flush and appear red. Your heart may beat faster, and you may feel suddenly cold. Research shows up to 80% of people going through menopause will experience hot flashes.
• Night sweats: Night sweats are hot flashes that occur during sleep. They are so intense they can wake you from your sleep.
• Sleep disturbances: Sleep problems are common during the menopause transition, including problems falling asleep, early awakening, and interrupted sleep. Sleep problems are often associated with other symptoms of perimenopause like night sweats.
• Vaginal and sexual symptoms: The loss of estrogen and testosterone in menopause can affect vaginal health and sexual drive. During the transition to menopause, you may notice you are not as easily aroused or less sensitive to stroking or touching. Lower estrogen can affect vaginal lubrication, causing the vagina to be too dry for comfortable sex.
• Irregular periods: Irregular periods are classic signs you are on the way to menopause. Periods may become more or less frequent, become heavier or lighter, or last longer or shorter than before. Menstrual changes can start up to 10 years before periods stop completely.
• Urinary incontinence: This includes persistent and involuntary loss of urine. 
• Changes to cognition and memory: Research shows up to 60% of middle-aged women report problems with concentrating and cognition. These issues tend to spike during perimenopause. Cognitive problems associated with perimenopause include problems with verbal learning (memorization and retention), memory, motor function, and attention.
• Decreased bone density: When a person transitions to menopause, their estrogen levels drop and this lead to bone loss. Estrogen acts as a protector of bone strength and the lack of it contributes to the development of osteopenia and osteopenia, two bone diseases that make bones weaker.

Symptoms of Induced Menopause

People who experience induced menopause do not go through natural menopause where there is a gradual transition of many years before the final menstrual period occurs. The term induced describes menopause caused by medical treatment.

The most common type of induced menopause is surgical. With surgical menopause, menopause is abrupt­—usually on the day of surgery. With menopause induced by medication, there might be a short transition before the damaged ovaries shut down completely.

Symptoms of induced menopause may include:

• Hot flashes
• Vulvovaginal atrophy (thinning, drying and inflammation of the vaginal walls)
• Drastic mood changes
• Sleep problems
• Severe headaches
• Joint pain
• Sexual problems, including pain with intercourse

Induced menopause can occur at any age after puberty and at an age before natural, spontaneous menopause would occur. The abrupt loss of ovarian hormones with induced menopause will be more drastic than what is experienced with natural menopause. Symptoms will be more intense and will have a rapid onset.

Associated Risks

Premature menopause and early menopause are associated with a higher long-term risk for several serious health conditions especially in comparison to people who reach menopause later.

Health risks associated with early and premature menopause include risks for cardiovascular disease, neurologic disease, osteoporosis, mood disorders, and psychosexual dysfunction (inability to experience sexual arousal or achieve sexual satisfaction), and premature death.

You will want to make regular appointments with your healthcare provider or another specialist to:

• Monitor and treat symptoms of perimenopause
• Look for vaginal changes       
• Monitor for heart problems
• Check bone density
• Check for the development of other health conditions, including diabetes and thyroid disease

Causes

Premature menopause has numerous causes and risk factors. Premature menopause can happen naturally for no clear reason, or it can occur because of surgeries, medications, or diseases. 

Known causes of premature menopause include:

• Primary ovarian insufficiency (POI): POI affects 1% of women ages 15 to 29. This condition causes the ovaries to stop working early. POI can stop periods prematurely or early, but there are rare instances where the ovarian function may resume spontaneously.
• Medication-induced menopause: Sometimes, menopause can be induced by medication causing the ovaries to stop functioning. This is often seen after chemotherapy and radiotherapy treatments for treating cancer.
• Surgical menopause: Surgical removal of the ovaries leads to menopause. Women at risk for surgical menopause are those treating cancer and other diseases requiring surgical removal of the female reproductive organs to treat their conditions.

Several diseases cans contribute to premature menopause. These may include:

• Genetic abnormality: Females need two functioning X chromosomes for normal ovarian functions. Conditions like Turner syndrome and fragile X syndrome involve problems with X chromosomes and can result in POI.
• Autoimmune diseases: Premature menopause can be induced by autoimmune disorders, such as thyroid disease and rheumatoid arthritis. Inflammation caused by autoimmune diseases can affect the ovaries.
• Metabolic disorders: While rare, some metabolic disorders that cause problems with converting the hormone androgen to estrogen can induce menopause.
• Infection: Mumps can cause an oophoritis infection cause can cause the ovaries to become chronically inflamed and stop functioning.

Risk Factors

A risk factor is something that can increase your risk of getting a disease or health problem. Some people have risk factors specific to premature menopause, and the more risk factors a person has the greater chance they have for developing premature menopause.

Of course, a person can still experience premature menopause without any risk factors. The disease causes noted above are also considered risk factors. Additional risk factors for premature menopause are:

• Early periods: If you start periods before age 11, you may have premature menopause. A 2017 study of 50,000 postmenopausal women found those who had periods before age 11 had a higher risk for natural premature menopause and increased risk for early menopause compared to those who had their first period at ages 12 and 13.
• Genetics: In some instances, premature menopause can be related to genes. If your mother started menopause early, it is more likely that you may as well.
• Smoking: Smoking has been known to induce premature menopause. Researchers don’t know the exact reasons for this, but they think that smoking can destroy ovarian cells and affect the way a woman’s body responds to estrogen.
• Epilepsy: Epilepsy is a seizure disorder of the brain. Research shows women with epilepsy have an increased risk for premature ovarian failure, which can eventually lead to premature menopause.

Sometimes, the cause of premature menopause is idiopathic or unknown. Although, researchers believe idiopathic causes are often related to other diseases and genetic causes.

Diagnosis

Testing isn’t needed to diagnose menopause. Most people can self-diagnose perimenopause based on their symptoms. However, if you are under age 40 and think you may be experiencing premature menopause, you will want to see a healthcare provider to be certain.

Hormone testing can determine whether symptoms experienced are signs of perimenopause or another condition.

Hormone testing includes:

• Anti-Mullerian hormone (AMH): This test uses the anti-Mullerian hormone to determine if a person is experiencing perimenopause or has reached their last menstrual cycle.
• Follicle-stimulating hormone (FSH): If FSH levels are consistently above 30 milli-international units per milliliter (mIU/mL) and you have not had a period for at least 12 months, this test can confirm menopause. An elevated FSH alone usually doesn’t confirm menopause.
• Estrogen: Your healthcare provider will check your estrogen levels, as these decrease with menopause.
• Thyroid-stimulating hormone (TSH). Your healthcare provider will want to check your TSH levels because symptoms caused by an underactive thyroid are similar to symptoms of perimenopause.

Treatment

Premature menopause doesn’t usually require treatment. However, there are treatment options to help manage symptoms and conditions related to it.

Your healthcare provider may suggest hormone replacement therapy (HRT) to support your body with the hormones it needs until an age where most people achieve natural menopause. HRT can help to manage symptoms of perimenopause and reduce the risks associated with estrogen deficiency, including for conditions affecting bone, heart, and emotional health.

Research shows HRT has a high success rate for improving health and quality of life in people with primary ovarian insufficiency and premature menopause.

A Word From Verywell

A person who goes through premature menopause will experience perimenopause symptoms at an earlier age, which may affect their emotional and physical health.

Talk to your healthcare provider if you think you are experiencing premature menopause. It is possible signs and symptoms may be the result of an underlying condition and treating that condition could potentially relieve symptoms and reduce the risk for premature menopause.

If your healthcare provider has diagnosed you with premature menopause, it is important to be aware of risk factors for conditions affecting your heart, bone, and emotional health. That risk can be offset with lifestyle changes, including diet and exercise, HRT treatments, and preventive screenings.

Talk to your healthcare provider about the best choices you can make to live a full and healthy life through your transition and after menopause.