Menopause that happens before age 40 is called premature menopause (which is also medically called primary ovarian insufficiency [POI]). Menopause that happens between 40 and 45 is called early menopause. About 5% of women naturally go through early menopause. Smoking and certain medicines or treatments can cause menopause to come earlier than usual.

What is the difference between early and premature menopause?

The average age for menopause in the United States is 52. Early and premature menopause happens when ovaries stop making hormones and periods stop at a younger age than usual. This can happen naturally or for a medical reason, such as when both ovaries are removed in a hysterectomy, also known as the removal of the uterus and bilateral oophorectomy (OH-fuh-REK-tuh-mee), or removal of both ovaries.

Early and premature menopause can have the same causes. The only difference is the age at which it happens. Menopause that happens before age 45 is called early menopause. Menopause that happens before age 40 is called premature menopause.

Women who have gone through early or premature menopause cannot get pregnant using their own eggs.

What causes early or premature menopause? 

Early or premature menopause can happen on their own for no clear reason, or they can happen because of certain surgeries, medicines, or health conditions.

Reasons for early or premature menopause can include:

• Family history. Women with a family history of early or premature menopause are more likely to have early or premature menopause.
• Smoking. Women who smoke may reach menopause as many as two years before nonsmokers. They may also get more severe menopause symptoms. Research suggests that women who have early or premature menopause and smoke may die earlier than nonsmoking women.
• Chemotherapy or pelvic radiation treatments for cancer. These treatments can damage your ovaries and cause your periods to stop forever or just for a while. You also may have trouble getting pregnant or not be able to get pregnant again. Not all women who have chemotherapy or radiation will go through menopause. The younger a woman is at the time of chemotherapy or radiation, the less likely she is to go through menopause.
• Surgery to remove the ovaries. A bilateral oophorectomy may cause menopausal symptoms right away. Your periods will stop after this surgery, and your hormone levels will drop quickly. You may have strong menopausal symptoms, like hot flashes and less sexual desire.
• Surgery to remove the uterus. Some women who have a hysterectomy can keep their ovaries. If this happens, you will no longer have periods, and you cannot get pregnant, but you are not menopausal. You will probably not go through menopause right away because your ovaries will continue to make hormones. Later on, you might have natural menopause a year or two earlier than expected.
• Certain health conditions:
  • Autoimmune diseases, such as thyroid disease and rheumatoid arthritis. Although rare, the body’s immune system, which normally fights off diseases, may mistakenly attack the ovaries and keep them from making hormones.
  • HIV and AIDS, Women with HIV whose infection is not well controlled with medicine may experience early menopause. Women with HIV may also have more severe hot flashes than women without HIV.
  • Missing chromosomes. Women born with missing chromosomes or problems with chromosomes can go through menopause early. For example, women with the condition called Turner syndrome are born without all or part of one X chromosome, so their ovaries do not form normally at birth and their menstrual cycles, including during the time around menopause, may not be normal.
  • Chronic fatigue syndrome. Women with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have extreme tiredness, weakness, muscle and joint pain, memory loss, headache, unrefreshing sleep, and other symptoms. Research has found that women with ME/CFS are more likely to have early or premature menopause.

How do I know if I am going through early or premature menopause? 

You know you have gone through menopause when you have not had your period for 12 months in a row. If you think you may be reaching menopause early, talk to your health care provider.

Your health care provider will ask you about your symptoms, such as hot flashes, irregular periods, sleep problems, and vaginal dryness.

Your health care provider may give you a blood test to measure estrogen and related hormones. You may choose to get tested if you want to know whether you can still get pregnant.

What are the effects of early or premature menopause? 

Women who go through menopause early may have symptoms or health problems similar to those of regular menopause.

But some women with early or premature menopause may also have:

• Higher risk of serious health problems, such as heart disease and osteoporosis, since women will live longer without the health benefits of higher estrogen levels. Talk to your health care provider about steps to lower your risk for these health problems.
• More severe menopause symptoms. Talk to your health care provider about treatments to help with symptoms if they affect your daily life.
• Sadness or depression over the early loss of fertility or the change in their bodies. Talk to your health care provider if you have symptoms of depression, including less energy or a lack of interest in things you once enjoyed that lasts longer than a few weeks. They can recommend specialists to help you understand and cope with your feelings. Your health care provider can also discuss options, such as adoption or donor egg programs, if you want to have children.