Natural menopause, the point in time when a woman hasn’t had a menstrual period for a year, usually occurs around age 51. Symptoms of perimenopause, the stage before menopause, can include irregular periods, hot flashes, difficulty sleeping, vaginal dryness, brain fog and mood changes, and for most women begin in the late 40s.
About 5 percent of women experience early menopause, defined as menopause before age 45, meaning that symptoms may start in the late 30s and early 40s. About 1 percent of women experience menopause before age 40.
Because some women don’t recognize these varied symptoms as signs of perimenopause, they may find themselves frustrated and seeking care from multiple providers to manage each individual symptom.
UNC Health reproductive endocrinologist Genevieve Neal-Perry, MD, PhD, explains what you need to know about early menopause.
Early Menopause Causes and Risk Factors
Early menopause has several known causes:
- Certain chemotherapy or radiation therapy in or near the ovaries
- Ovarian surgery or surgical removal of an ovary or the uterus
- Family history of early menopause
- Genetic disorders, including Turner syndrome and fragile X syndrome
- Autoimmune disorders, such as autoimmune polyglandular syndrome and celiac disease
- Smoking
Still, “about half the time, we don’t know why early menopause occurs,” Dr. Neal-Perry says. “There is likely a genetic basis or environmental factor.”
Early menarche (starting at age 10 or before) has been associated with an increased risk of early menopause, but more research is needed on a causal relation, Dr. Neal-Perry says.
There are also some racial and ethnic groups who may go through perimenopause and menopause earlier than others.
“Women who are Black, Hispanic and Native American tend to have earlier symptoms,” Dr. Neal-Perry says. “They may start experiencing symptoms in their early 40s as opposed to their late 40s.”
Early Menopause Symptoms and Treatment
Symptoms of early menopause are the same as symptoms of typical menopause, and they tend to vary from person to person. You or your doctor may not recognize them as menopause symptoms, however, particularly if you’re unaware of an underlying issue such as an autoimmune disorder.
“Early menopause can be misdiagnosed as polycystic ovary syndrome, or PCOS, because of irregular cycles,” Dr. Neal-Perry says. “Some people might also think they’re pregnant due to missed cycles.”
Menopause symptoms may be missed because they are believed to be related to another condition.
“Some people have anxiety or heart palpitations as a primary symptom of menopause, and there can be an assumption that it’s a thyroid issue or entirely attributed to mental health distress,” Dr. Neal-Perry says.
If you notice irregular menstrual periods with anxiety, sleep problems or hot flashes, talk to your doctor. Although there is no specific blood test to diagnose menopause, healthcare professionals may check your hormone levels via blood test or test for a condition associated with early menopause.
The ovarian changes associated with early menopause can’t be reversed or paused. However, you need to talk to your doctor about the long-term health concerns associated with the early loss of estrogen. Estrogen, the hormone that declines during menopause, has benefits for the bones, heart and brain, and early menopause means you have a premature withdrawal of estrogen and its beneficial effects.
“We recommend that someone with earlier menopause has hormone therapy until the age of typical menopause,” Dr. Neal-Perry says, noting that people who go through early menopause are at increased risk of osteoporosis, heart disease and dementia. You may need a bone density scan earlier than normal to check for osteoporosis.
Menopause hormone therapy may be recommended if your symptoms interfere with your quality of life. Dr. Neal-Perry says hormone therapy levels are lower than levels achieved in a normal menstrual cycle and considered safe in people who do not have a hormone-sensitive cancer, blood clotting disorder or another disorder adversely affected by ovarian hormones. It’s best to talk to your doctor to help you assess your personal risks and benefits.
“There is no need to suffer from symptoms with safe treatment options available,” she says.
The Emotional Impact of Early Menopause
Going through perimenopause and menopause earlier than expected can be hard, especially if you want to have a child.
“The emotional piece is significant, and depression and anxiety are common in this situation,” Dr. Neal-Perry says. “It can be very difficult for someone who did not begin or complete their family.”
Dr. Neal-Perry says that women who still want to get pregnant can pursue fertility treatments with donor eggs or donor embryos; besides pregnancy, foster parenting and adoption are options to build a family.
Regardless of your risk of experiencing menopause early, Dr. Neal-Perry recommends that you talk to your doctor about it.
“It’s important for every woman to have a conversation with their health care provider before menopause is anticipated,” she says. “Talk about when the process is likely to start and what to expect. The menopause experience may present in a variety of ways, and the experience is not monolithic.”
Dr. Neal-Perry says information and shared decision-making during this transition are important.
“Your doctor can empower you with knowledge and help identify your personal risks and what your experience could look like,” she says.
If you have questions about menopause, talk to your doctor. Need a doctor? Find one near you.