Reasons, Risks, and Treatment for Premature or Early Menopause

Maybe you wake up at night drenched in sweat. Or you're struggling to concentrate, and your period has been irregular for the last couple of months. Those are the hallmark symptoms of menopause, which mark the end of your reproductive years and happen 12 months after your last period. Menopause typically occurs around age 52. So, it may be a bit concerning if those symptoms begin in your 30s. Here's what you should know about some of the causes of premature and early menopause, as well as risks, diagnosis, and treatment. 

What Is Early Menopause?

Premature menopause happens when the ovaries stop functioning normally before age 40, Shawn Tassone, MD, an OB-GYN specializing in integrative medicine in Austin, Texas, told Health. Early menopause happens when menopause happens between ages 40 to 45.

About 5% of people who get their period experience early menopause. Although premature and early menopause often happens without an apparent cause, a few risk factors may increase your risk.

With premature and early menopause, your ovaries gradually make less of the hormones estrogen and progesterone at a younger age than average.

While people typically experience menopause, which typically happens around age 52, premature and early menopause occurs before age 45. Specifically, premature menopause happens before age 40, and early menopause occurs before age 45.

Premature and early menopause share similarities with primary ovarian insufficiency (POI). POI is a condition where the ovaries stop working, usually before you naturally reach menopause.

However, POI is distinct from any form of menopause. Although irregular, people with POI may still get periods and have the ability to become pregnant. In contrast, people who experience premature and early menopause have no periods and cannot become pregnant.

Potential Risks

In general, menopause that occurs at any age poses complications. The natural decline in estrogen puts many people at a higher risk of the following health conditions:

• Mood changes
• Low libido
• Depression and anxiety
• Osteoporosis
• Heart disease
• Infertility

Specifically, research has found that estrogen helps protect your heart and bones against disease. Therefore, when your body makes less of the hormone, your risk of heart disease and osteoporosis increases.

Also, in addition to general depression and anxiety, people who experience premature or early menopause may experience adverse mental health in response to infertility.

If you experience menopause early and wish to become pregnant, you can talk to your healthcare provider about in vitro fertilization (IVF). With IVF, donor egg cell or embryo options may be available.

Causes of Early Menopause

Premature and early menopause may happen for no apparent reason. But in some cases, certain factors may increase your risk. Specifically, some surgeries, medicines, or health conditions may cause the onset of menopause to occur earlier than average.

Autoimmune Diseases

With autoimmune diseases, your immune system may attack your ovarian follicles and small sacs in your ovaries. Ovarian follicles are where egg cells mature and grow. So, although rare, an abnormal immune response may interfere with the function of your ovarian follicles.

For example, in one study published in 2022 in Crohn’s & Colitis 360, researchers found that the mean age of menopause among people with irritable bowel disease (IBD) was 50. That age is slightly lower than the average age of menopause. IBD, which includes Crohn’s disease and ulcerative colitis, causes gastrointestinal (GI) inflammation.

Still, the researchers noted that earlier evidence suggested that IBD increases the risk of POI four-fold. Therefore, they indicated that healthcare providers should continuously check in with patients with chronic inflammatory conditions, like IBD, for symptoms of premature or early menopause.

Likewise, research has found that thyroid disease occurs among 30% to 40% of cases of POI. Thyroid disease occurs when the thyroid gland does not function properly. Auto-antibodies found in people with thyroid disease may impair reproduction, decreasing egg cell reserves.

Still, IBD and thyroid disease are commonly linked to POI. Therefore, more research is needed to determine whether those autoimmune diseases have a similar effect on the onset of menopause.

Certain Health Conditions

Some health conditions may increase your risk of premature or early menopause. For example, if untreated, human immunodeficiency virus (HIV), which is a sexually transmitted infection, may bring about menopause earlier than expected.

Specifically, some evidence suggests that low CD4 cell counts raise the risk of early menopause. CD4 cells are white blood cells that help fight infections. HIV kills CD4 cells, which makes people who are HIV-positive vulnerable to severe illnesses.

However, treatment can decrease the amount of HIV in the body and keep CD4 cell levels steady. Therefore, early diagnosis and treatment of HIV are essential.

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis, may also increase the risk of premature or early menopause. CFS causes symptoms like:

• Extreme fatigue
• Muscle and joint aches
• Memory loss
• Headaches
• Trouble sleeping

One study published in 2015 in the journal Menopause, found that people with CFS reported premature menopause at a mean age of 38.5 more often than people without the health condition. However, more research is needed to establish the link between CFS and premature menopause.

Chemotherapy or Radiation Treatments

Cancer treatments, like chemotherapy and radiation, may damage the genetic material in your egg cells. That damage depends on various factors, including:

• The type of drug
• Radiation dose
• Your age at the time of treatment
• The area of your body receiving the treatment 

Some people may not notice symptoms of premature or early menopause until years after undergoing cancer treatment. At the same time, others may never see any changes.

Chromosomal Abnormalities

People who are born with missing, extra, or atypical chromosomes may experience menopause earlier than average. For example, FMR1 is a gene that may cause Fragile X syndrome (FXS). FXS is one of the most common forms of inherited intellectual disabilities. 

Other mutations on the FMRI gene may cause problems with the ovaries. Fragile X-associated primary ovarian insufficiency (FXPOI). People with FXPOI may have irregular periods, infertility, and early menopause.

FXPOI may also increase the risk of heart disease and osteoporosis. Those complications are common during menopause when your body produces less estrogen than average. 

Some evidence suggests that estrogen has protective effects on your heart. So, when levels of the hormone decrease during menopause, your risk of heart disease may increase.

Additionally, Turner’s syndrome, a genetic disorder causing people assigned as females at birth to be born with only one X chromosome, is another cause of premature or early menopause. People with Turner’s syndrome may have underdeveloped ovaries and irregular menstrual cycles.

Early Age at First Period

In one study published in 2017 in Human Reproduction, researchers found that early age at first period—before age 11—and never being pregnant are risk factors of early menopause. The researchers noted that early age at the first period also links to several other factors impacting reproduction, like:

• Irregular periods
• Polycystic ovary syndrome (PCOS)
• Endometriosis

According to the researchers, more studies are needed to establish the relationship between age at first period and early menopause. However, the study's results should influence clinical surveillance of people who had their first period before age 11.

Family History

If your mother went through menopause earlier than average, your chances of premature or early menopause might increase.

"You tend to see it run in families," noted Dr. Tassone. "It can come from either side." 

Smoking

Research has found that people who smoke are more likely to experience menopause nearly two years earlier than others.

"Some toxins can bring on premature ovarian failure," explained Dr. Tassone. "[This includes] things like cigarettes and pesticides." 

Typically, people are born with all their primordial follicles, which eventually become ovarian follicles and contain immature egg cells. But some evidence suggests that exposure to harmful chemicals may cause a person to run out of ovarian follicles sooner than they naturally would.

Surgery

Surgical removal of the ovaries or uterus brings about menopause earlier than normal. For example, a bilateral oophorectomy, which removes the ovaries, will cause your periods to stop. And without ovaries, your body will naturally produce less estrogen than normal. After having a bilateral oophorectomy, you may notice symptoms that mimic menopause, like hot flashes and low libido.

In contrast, a hysterectomy removes the uterus so you will no longer have a period. However, some people may still experience some menstrual cycle-type symptoms (like sore breasts or PMS) even if they no longer actively get a period.

A hysterectomy will not bring about menopause as quickly as a bilateral oophorectomy since your ovaries will continue to produce estrogen. Still, some evidence suggests that you may go through menopause a couple of years earlier than normal.

Early Menopause Diagnoses and Treatment

In general, menopause happens if you’ve not had a period for 12 consecutive months. If you’ve stopped having your period, consult your healthcare provider.

Your healthcare provider may be able to diagnose premature or early menopause depending on your age and if you’ve experience other symptoms, like:

• Hot flashes or night sweats
• Irregular menstrual bleeding
• Sleep disturbances
• Vaginal dryness

Additionally, your healthcare provider may order blood tests. Your healthcare provider can tell how much estrogen and follicle-stimulating hormone (FSH) your body produces.

FSH is a hormone that plays an essential role in the menstrual cycle. For example, levels of FSH rise right before ovulation. Ovulation happens when an egg cell matures and releases from one of your ovaries.

But as you age, your ovaries carry fewer egg cells, and your body makes decreased amounts of estrogen. Usually, estrogen “tells” your brain to stop producing FSH. So, when there is insufficient estrogen, your brain doesn’t get that signal. Therefore, FSH levels may drastically increase.

If your blood test signals high levels of FSH, your healthcare provider may be able to diagnose premature or early menopause.

Your healthcare provider may recommend hormone therapy, a treatment option for menopause, if you’re experiencing symptoms earlier than average. There are different types of hormone therapy, such as estrogen-only or combined estrogen-progesterone. Hormone therapy comes in the form of pills, creams, vaginal inserts, patches, and sprays. 

It would be best to consult your healthcare provider about what type and dose of hormone therapy would work best for you.

Additionally, if you wish to become pregnant, you can discuss IVF using a donor egg cell or embryo with your healthcare provider.

A Quick Review

Premature and early menopause happen if you begin experiencing menopause symptoms and stop having a period before age 45.

There are many reasons why people experience menopause earlier than expected, including autoimmune diseases, certain health conditions like HIV and chronic fatigue syndrome, and surgery, among others.

The risks of premature and early menopause are similar to those associated with natural menopause, like bone, heart, and mental health changes. Therefore, it's essential to consult your healthcare provider if you're experiencing hot flashes and night sweats, irregular menstrual bleeding, or mood changes. Hormone therapy may alleviate your symptoms and stave off any complications.