As women age, their bodies produce less estrogen and progesterone, the main hormones involved in female reproduction. When these hormones reach a low enough level, a woman will permanently stop having a menstrual cycle.
Menopause officially begins 12 months after a woman’s last period. Most women begin menopause between the ages of 45 and 55, with an average age of 51 in the United States. But for some women, menopause comes early.
If you’re between the ages of 35 and 45 and have missed your period for three months or more, you may be going through menopause earlier than normal. Read on to learn why this happens and what treatments are available.
Early menopause is menopause that begins between the ages of 40 and 45.
Premature menopause starts even earlier, before age 40. Many doctors now refer to premature menopause as “premature ovarian failure” or “primary ovarian insufficiency.” These terms reduce some of the stigma for younger women going through menopause.
Early menopause is relatively uncommon. Premature menopause is even less common, with only about of women going through menopause before age 40.
The symptoms of early menopause are similar to regular menopause. Some common symptoms include:
- irregular periods
- absence of periods (amenorrhea)
- hot flashes
- night sweats
- vaginal dryness
- mental fogginess
- decreased sex drive
If you haven’t had your period in three or more months, you should see your doctor. There are many reasons why you might not get your period besides menopause, such as:
- change in diet or exercise
- response to a medication or contraceptive
The low estrogen levels associated with missed periods can lead to bone loss. Early treatment can help prevent bone damage.
Early or premature menopause can happen for two reasons: follicle depletion or follicle dysfunction.
When these occur, eggs don’t mature or get released, causing a woman’s period to stop. These processes are considered normal when they occur later in life. If they occur early, your doctor will likely check for an underlying cause.
Follicle depletion and dysfunction can happen for a variety of reasons:
- Aging. The risks of early menopause rise after age 35.
- Family history. Being related to women who have a history of early or premature menopause may raise your risk.
- Genetic disorders. Having abnormal chromosomes or genes, as occurs in Turner syndrome or Fragile X syndrome.
- Toxins. Exposure to chemotherapy drugs and radiation therapy used to treat cancer can affect onset of menopause.
- Autoimmune conditions. When the immune system mistakenly attacks the body’s hormone-producing organs, it can sometimes affect the ovaries.
- Infection. Having certain infections such as the mumps virus.
- Surgery. Procedures to remove the ovaries (bilateral oophorectomy) or uterus (hysterectomy) may cause early menopause.
Your doctor will ask you about your symptoms and your menstrual cycle.
They may also:
- ask about your history of exposure to toxins, such as chemotherapy and radiation treatments
- conduct a physical exam (including a pelvic exam)
- perform a pregnancy test
- test your blood for certain hormones, including: follicle-stimulating hormone (FSH), estradiol, prolactin, and anti-Mullerian hormone (AMH)
- test your DNA for the genetic causes of early or premature menopause
Early and premature menopause can increase your chance of developing other conditions. These include:
- Infertility. Most women going through early or premature menopause cannot get pregnant.
- Stress, anxiety, and depression. These mood changes often result from infertility and other early menopause health issues.
- Bone loss (osteoporosis): Osteoporosis is caused by low estrogen levels and leaves women more at-risk of bone fractures.
- Heart disease. Heart disease can also result from low estrogen levels.
Your doctor will recommend a treatment based on your individual situation. Some common treatments for early or premature menopause include:
Supplemental estrogen and progestin can help replace some of the reproductive hormones your body can no longer make on its own. They’re often taken until the average age of menopause (about 50) to manage the uncomfortable symptoms of early menopause.
The treatment also helps prevent bone loss and supports heart health.
This treatment is not recommended for all women because it can increase the risk of:
It’s important to discuss the risks and benefits of treatment options with your doctor.
Supplemental calcium and vitamin D
Supplementary calcium and vitamin D can help prevent osteoporosis if you aren’t getting enough of these nutrients from your diet.
Women ages 19 to 50 should get 1,000 milligrams of calcium per day through food or supplements. Women over age 51 should get 1,200 milligrams per day.
A recommended daily amount of vitamin D is around 600 IU/day. For adult women, most doctors recommend 600-800 IU through food or supplements.
Strategies to deal with infertility
Some women with premature menopause can still get pregnant without any treatment.
Women who want to have children but become infertile after early or premature menopause should consider in-vitro fertilization using donor eggs or pursuing adoption.
Many women find talking to a therapist helpful to cope with their stress.
Going through early or premature menopause can be challenging. Consider joining local support groups and talk to your doctor about any concerns you have.
Learning more about your condition can arm you with the knowledge you need to make informed decisions about your treatment.