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What Causes Early Menopause?

What is menopause?

The average age for menopause in the United States is 51 years old, according to the National Institute on Aging. Most women begin menopause between the ages of 40 and 58. Early menopause usually refers to onset before age 40.

Menopause occurs when your ovaries stop producing estrogen, the hormone that controls the reproductive cycle. Anything that damages your ovaries or stops estrogen production can cause early menopause. This includes chemotherapy for cancer or an oophorectomy (removal of the ovaries). In these cases, your doctor will help prepare you for early menopause. But you can go into menopause early even if your ovaries are still intact.

Causes

Causes

There are several known causes of early menopause, although sometimes the cause can’t be determined.

Genetics

If there’s no obvious medical reason for early menopause, the cause is likely genetic. Your age at menopause onset is likely inherited. Knowing when your mother started menopause can provide clues about when you’ll start your own. If your mother started menopause early, you’re more likely than average to do the same. However, genes tell only half the story.

Lifestyle factors

Smoking has antiestrogen effects that can contribute to early menopause. An analysis of several studies shows that long-term or regular smokers are likely to experience menopause sooner. According to the Mayo Clinic, women who smoke may start menopause one to two years earlier than women who don’t smoke.

Body mass index (BMI) can also factor into early menopause. Estrogen is stored in fat tissue. Women who are very thin have fewer estrogen stores, which can be depleted sooner.

Some research suggests that a vegetarian diet, lack of exercise, and lack of sun exposure throughout your life can all cause the early onset of menopause.

Chromosome defects

Some chromosomal defects can lead to early menopause. For example, Turner syndrome involves being born with an incomplete chromosome. Women with Turner syndrome have ovaries that don’t function properly. This often causes them to enter menopause prematurely.

Other chromosomal defects can cause early menopause, too. These include pure gonadal dysgenesis. In this condition, the ovaries don’t function. Instead, periods and secondary sex characteristics must be brought about by hormone replacement therapy (HRT), usually during adolescence. Trisomy 13 and 18 are conditions in which the 13th or 18th pair of chromosomes has an extra chromosome. These conditions can also lead to early menopause. They usually cause severe developmental issues in addition to infertility.

Autoimmune diseases

Premature ovarian failure
Premature ovarian failure occurs when your ovaries stop functioning normally before you turn 40. It’s similar to early menopause, but you can still have periods or get pregnant (though very irregularly). The causes, symptoms, and complications of this condition are similar to early menopause. Your body produces less estrogen and fewer eggs due to chromosome defects, toxins, or autoimmune disorders.

Premature menopause can be a symptom of an autoimmune disease such as thyroid disease and rheumatoid arthritis. In autoimmune diseases, the immune system mistakes a part of the body for an invader and attacks it. Inflammation caused by some of these diseases can affect the ovaries. Menopause begins when the ovaries stop working.

Epilepsy

Epilepsy is a seizure disorder that stems from the brain. Women with epilepsy are more likely to experience premature ovarian failure, which leads to menopause. One study in the journal Epilepsia found that in a group of women with epilepsy, about 14 percent had premature menopause, as opposed to 1 percent of the general population.

What are the symptoms of early menopause?

Symptoms

Early menopause can begin as soon as you start having irregular periods or periods that are noticeably longer or shorter than normal. Other symptoms of early menopause include:

  • heavy bleeding
  • spotting
  • periods that last longer than a week
  • a period after a year of no bleeding

In these cases, see your doctor to check for any other issues that might be causing these symptoms.

Other common symptoms of menopause include:

  • moodiness
  • changes in sexual feelings or desire
  • vaginal dryness
  • trouble sleeping
  • hot flashes
  • night sweats
  • loss of bladder control

Can early menopause contribute to other conditions?

Complications

Infertility is often the most obvious concern when you start menopause 10 or more years early. Yet, there are other health concerns. A steady stream of estrogen to your tissues has many uses. Estrogen increases “good” HDL cholesterol and decreases “bad” LDL cholesterol. It also relaxes blood vessels and prevents bones from thinning.

Losing estrogen earlier than normal can increase your risk of:

  • heart disease
  • osteoporosis
  • Parkinson’s-like symptoms
  • depression
  • dementia
  • premature death

Discuss your concerns about these symptoms with your doctor. Because of these risks, women who enter menopause early are often prescribed hormone replacement therapy.

Managing early menopause

Treatment

Treatments are available to help manage the symptoms of menopause or conditions related to it. They can help you deal with changes in your body or lifestyle more easily. Some common treatments include:

Hormone replacement therapy (HRT): Systemic hormone therapy can prevent many common menopausal symptoms. Or you may take vaginal hormone products, usually in low doses, to help with vaginal symptoms of menopause.

Menopausal hormone therapy (MHT): The estrogen and progesterone supplements can help reduce menopause symptoms and bone loss.

These therapies can increase your chances of heart disease, stroke, or breast cancer. Talk to your doctor about these risks before undergoing HRT or MHT. Lower doses of hormones may decrease your risk.

Learn more: Hormone replacement therapy (HRT): Is it right for you? »

Can early menopause protect me from other conditions?

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Starting menopause early can actually protect you from other diseases. These include estrogen-sensitive cancers such as breast cancer. Women who enter menopause late (after age 55) are at greater risk of breast cancer than those who enter the transition earlier. This is because their breast tissue is exposed to estrogen for a longer time.

Easing the transition to menopause

Coping

A genetic test may one day determine a person’s likelihood of early menopause. For now, though, only time will tell when you’ll start your transition. See your doctor for regular checkups, and be proactive about your reproductive health. Doing so can help your doctor ease the symptoms or decrease your risk factors for early menopause.

Seeing a therapist can also help you cope with any pain or anxiety you may feel during menopause.

Fertility and your options

If you’re interested in having children, you still have a few options for growing your family. These include:

  • adoption
  • egg donation
  • having a surrogate mother carry your child

A fertility specialist may also suggest procedures that can help you bear children. In vitro fertilization (IVF) is one procedure that allows you to have children even after the onset of menopause. Talk to your doctor before attempting IVF. Its risks and success can be affected by many factors, including your age and overall health.

You asked, we answered

  • What are the symptoms of early menopause?
  • Symptoms of early menopause are the same as traditional menopause, only they begin earlier, in women who are younger than 40 years. Symptoms include irregular or missed menstrual periods, hot flashes, vaginal dryness, emotional irritability and mood swings, and decreased sex drive. Some women may experience just a few of these symptoms, and others may experience more symptoms.

    - Katie Mena, MD Internal Medicine
  • Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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