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Menopause starts for most people in their late 40s or early 50s. But in early or premature menopause, the drop in estrogen production and the end of menstrual periods comes much earlier. Premature menopause begins before the age of 40, and can sometimes happen in your 20s.

If you’re in your 20s and in premature menopause, you may have questions and concerns about its effects on your health. In this article, you can read about the symptoms of early or premature menopause, what can cause it, and what can be done to treat its symptoms. You’ll also learn about the effects premature menopause can have on your health.

Menopause is premature when it occurs before age 40. Premature menopause is sometimes called primary ovarian insufficiency because the ovaries stop producing estrogen the way they should. If you’re in your 20s and going through menopause, you’re going through premature menopause.

Premature menopause is different from early menopause, which refers to menopause that happens before you’re 45 years old. The average age for menopause in the United States is 51 years old. A 2019 research review showed that around 3.7 percent of women experience either primary ovarian insufficiency or early menopause.

The symptoms of premature menopause are the same as those you’d experience if you started menopause later. But it’s important to note that menopause symptoms can vary from one person to another. Some of those symptoms include:

  • hot flashes
  • night sweats
  • trouble sleeping
  • lower sex drive
  • body aches and headaches
  • trouble concentrating or focusing
  • trouble remembering things
  • vaginal dryness
  • painful sex
  • weight gain
  • bone loss
  • changes in your cholesterol levels
  • mood changes

It isn’t always possible to determine exactly what has caused premature menopause. Here are some of the known causes and risk factors.

Family history

Premature menopause can run in families. If it feels appropriate, you may want to speak with your biological relatives about the age at which they stopped having periods. Knowing about their symptoms could help you get a sense of what to expect.


Smoking is associated with an earlier menopause. 2018 research shows that the more someone smokes, the higher their risk of premature menopause. A research review from 2020 including some mouse studies shows that e-cigarette vapors also affect reproduction. But scientists don’t yet know how smoking e-cigarettes affects menopause.

Ovarian surgery

Pelvic or ovarian surgery is sometimes the cause of premature menopause. You may have had a surgery called an oophorectomy to remove your ovaries because of cancer, endometriosis, or another condition. If surgery has caused you to go into menopause, your symptoms may be more severe than if you started menopause more gradually, according to 2019 research.

Exposure to toxins

People who have had chemotherapy or radiation therapy to treat cancer have a higher risk of premature menopause.

A 2015 study also looked at exposure to certain estrogen-disrupting chemicals. It found that exposure to substances found in some pesticides and phthalates also gives you a higher risk of earlier menopause.

Viral infections

Some viruses have been linked in a 2015 research review to premature menopause, though their role isn’t clear. HIV, mumps, cytomegalovirus, tuberculosis, malaria, and other viruses may potentially cause ovarian changes and premature menopause.

Autoimmune disorders

Autoimmune disorders can sometimes damage the ovaries, bringing about premature menopause. Some conditions associated with premature menopause include:

Genetic differences

2019 research found that more than 75 different genes can contribute to primary ovarian insufficiency and premature menopause. Most are genes that influence how ovaries develop and function, how cells divide, or how DNA is repaired in the body. Turner syndrome and fragile X syndrome are genetic conditions that can cause premature menopause.

Premature menopause poses some health risks. It’s a good idea to talk with a healthcare professional about these risks so that you can take steps to protect your physical and emotional health going forward. Here are some potential health issues that can arise:

  • Heart disease. Lower estrogen levels can cause changes in your blood vessels and your heart, possibly leading to a higher risk of heart problems.
  • Anxiety, depression, and other mood changes. Hormone changes can also cause some significant emotional shifts. Anxiety, depression, and lower self-esteem are not uncommon.
  • Eye conditions. Around 79 percent of menopausal women in a 2021 study developed dry eye disease and other conditions that can affect the surface of the eye. It’s worth noting that symptoms are generally worse in older adults.
  • Infertility. It’s harder for people in premature menopause to become pregnant naturally. Working with a fertility specialist may help.
  • Hypothyroidism. For some people, hormones produced by the thyroid gland drop after menopause, which can cause changes in metabolism and energy levels.
  • Osteoporosis. Lower estrogen levels can sometimes weaken bones and make them more susceptible to fractures.

Primary ovarian insufficiency is often diagnosed when someone talks to a healthcare professional about missing several periods. If you have missed three or more periods in a row, it’s a good idea to talk to a doctor. Here’s what to expect during the diagnosis:

If your doctor thinks you may have primary ovarian insufficiency, you may have a pelvic ultrasound to see if a cause can be determined.

Premature menopause cannot yet be reversed, but researchers are trying to improve the outlook. Treatments have different goals, such as:

  • reducing your menopause symptoms
  • protecting your heart, bone, and sexual health
  • providing emotional support
  • connecting you with fertility specialists if you want to become pregnant

Your treatments options could include:

What about children?

Permanent premature menopause may affect your ability to have children. Be sure to discuss with your doctor all available options, including:

Was this helpful?

It can be a shock to experience menopause in your 20s. In fact, for many, premature menopause comes with mixed emotions, including sadness, anxiety, and frustration. This change can be especially hard if your plans include pregnancy and childbirth, since premature menopause can make it harder to have children.”

Whether you’re experiencing physical, psychological, or emotional symptoms, it’s important to take good care of yourself during this transition. Think about whether a therapist, a nutritionist, a support group, or other specialists could benefit you.

Here are some places where you may be able to find support:

Premature menopause, sometimes called primary ovarian insufficiency, happens when your ovaries stop producing as much estrogen, your periods stop, and it becomes more difficult to become pregnant naturally.

Premature menopause brings on all the symptoms usually associated with menopause — hot flashes, night sweats, mood changes, concentration difficulties, lower libido, and more. And because premature menopause can alter your life plans and your sense of self, it’s not uncommon to experience depression and anxiety along with the other symptoms.

Treatment may help with your symptoms. Hormone replacement therapy, while not right for everyone, may also prevent bone loss and heart problems down the road. A healthcare professional can help you decide what treatments are right for you.

Menopause in your 20s can be unexpected. Though you may feel isolated by the diagnosis, you are not alone in dealing with it. As soon as you are ready to reach out, you can find the professional guidance and personal support you need.