Most women begin menopause between the ages of 45 and 55. The average age for menopause onset in the United States is 51 years old.
Early menopause usually refers to onset before age 45. Premature menopause or premature ovarian insufficiency occurs before age 40.
Menopause occurs when your ovaries stop producing eggs, resulting in low estrogen levels. Estrogen is the hormone that controls the reproductive cycle.
Someone is in menopause when they haven’t had a period for more than 12 months. But associated symptoms, such as hot flashes, start long before menopause during a phase called perimenopause.
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 your body can also start menopause early even if your ovaries are still inside you.
Language matters
Sex and gender exist on spectrums. We use “women” in this article to refer to sex assigned at birth.
Early menopause can begin as soon as you start having irregular periods or periods that are noticeably longer or shorter than your typical cycle.
Other symptoms of early menopause include:
- heavy bleeding
- spotting
- periods that last longer than a week
- a longer amount of time inbetween periods
In these cases, contact your doctor to check for any other issues that might be causing these symptoms.
Other common symptoms of menopause include:
There are several known causes of early menopause, but sometimes the cause cannot 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 parent started menopause can provide clues about when you’ll start your own. If your parent started menopause early, you’re more likely than average to do the same.
However, genes tell only half the story.
Lifestyle factors
Some lifestyle factors may have an impact on when you begin menopause. Smoking affects estrogen and can contribute to early menopause.
Some
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 also suggests that a vegetarian diet, lack of exercise, and lack of sun exposure throughout your life can all cause an early onset of menopause.
Chromosome issues
Some chromosomal issues can lead to early menopause. For example, Turner syndrome (also called monosomy X and gonadal dysgenesis) involves being born with an incomplete chromosome.
Women with Turner syndrome have ovaries that don’t function as expected. This often causes them to enter menopause prematurely.
Other chromosomal issues can cause early menopause, too. This includes pure gonadal dysgenesis, a variation on Turner syndrome.
In this condition, the ovaries don’t function. Instead, periods and secondary sex characteristics must be brought about by hormone replacement therapy, usually during adolescence.
Women with Fragile X syndrome, or who are genetic carriers of the disease, may also have early menopause. This syndrome is passed down in families.
You can discuss genetic testing options with your doctor if you have premature menopause or if you have family members who had premature menopause.
Autoimmune diseases
Premature menopause can be a symptom of an autoimmune disease, such as thyroid disease or 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. Someone with epilepsy is more likely to experience primary ovarian insufficiency, which leads to menopause. Changing hormone levels due to menopause can affect seizures in people with epilepsy.
An
The time leading into menopause is called perimenopause. During this time, you may have irregular periods and other symptoms that come and go.
You’re generally considered to be in menopause if you go 12 months without menstrual bleeding, and you don’t have another medical condition to explain your symptoms. This may be an indicator of early menopause.
Tests aren’t usually needed to diagnose menopause. Most people can self-diagnose menopause based on their symptoms. But if you think you’re experiencing early menopause, you may want to contact your doctor to be sure.
Your doctor can order hormone tests to help determine whether your symptoms are due to perimenopause or another condition. These are the most common hormones to check:
- Anti-Müllerian hormone (AMH). The
PicoAMH Elisa test uses this hormone to help determine whether you’re approaching menopause or have already reached your last menstrual cycle. - Estrogen. Your doctor may check your levels of estrogen, also called estradiol. In menopause, estrogen levels decrease.
- Follicle-stimulating hormone (FSH). If your FSH levels are consistently above 30 milli-international units per milliliter (mIU/mL), and you haven’t menstruated for a year, it’s likely that you’ve reached menopause. However, a single elevated FSH test can’t confirm menopause on its own.
- Thyroid-stimulating hormone (TSH). Your doctor may check your levels of TSH to confirm diagnosis. If you have an underactive thyroid (hypothyroidism), you’ll have TSH levels that are too high. Symptoms of the condition are similar to the symptoms of menopause.
The North American Menopause Society (NAMS) reports that hormone tests are sometimes unhelpful because hormone levels still change and fluctuate during perimenopause.
Even so, if you’re concerned about signs of menopause, NAMS suggests requesting a full checkup with your doctor.
Early menopause generally doesn’t require treatment.
However, there are treatment options 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.
Premature menopause is often treated because it occurs at such an early age. This helps support your body with the hormones it would typically make until you reach the age of natural menopause.
The most common treatment includes 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.
HRT does have risks though. It can increase your chances of:
- heart disease
- stroke
- breast cancer
Talk with your doctor about the risks and benefits of your individual care before starting HRT. Lower doses of hormones may decrease your risk of experiencing these conditions.
Although you can’t prevent menopause from happening, you can take action to help your symptoms.
Eating a healthy diet and exercising regularly can help manage menopause symptoms. If you smoke, consider quitting to manage your symptoms as well.
There is mixed evidence on using natural products to manage menopause symptoms. Some people prefer vitamins and herbal supplements over conventional medication. Check with your doctor about which treatment is right for you.
For now, available treatment can help delay or reduce the symptoms of menopause, but there is no sure way to reverse early menopause.
However, researchers are investigating new ways to help people in menopause have children.
In 2016, scientists in Greece announced a new treatment that enabled them to restore menstruation and retrieve eggs from a small group of women who were in perimenopause.
This treatment made headlines as a way to “reverse” menopause, but little is known about how well it works.
The scientists reported treating more than 30 women, ages 46 to 49, by injecting platelet-rich plasma (PRP) into their ovaries. PRP is sometimes used to promote tissue healing, but the treatment hasn’t been proven to be effective for any purpose.
The scientists claimed the treatment worked for two-thirds of the women treated. However, the research has been criticized for its small size and lack of control groups.
Though the research might have potential for the future, it’s not a realistic treatment option right now.
Infertility is often a big 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 typical can increase your risk of:
- heart disease
- osteoporosis
- depression
- dementia
- premature death
If you have concerns about these symptoms, speak with your doctor. Because of these risks, people who enter menopause early are often prescribed HRT.
Starting menopause early can actually protect you from other diseases. These include estrogen-sensitive cancers such as breast cancer.
People 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.
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.
Contact your doctor for regular checkups, and try to 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
- receiving an egg donation
- having a surrogate carry your child
A fertility specialist may also suggest procedures that can help you have children. Talk with your doctor about the options available to you for becoming a parent. Their risks and successes can be affected by many factors, including your age and overall health.