Early or premature menopause

Early or premature menopause happens when ovaries stop making hormones and periods stop at a younger age than usual (the average age for menopause in the United States is 52). This can happen naturally or for a medical reason, such as when both ovaries are removed in a hysterectomy.

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.

Early or premature menopause can happen on its own for no clear reason, or it 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 much as two years before nonsmokers. They may also get more severe menopause symptoms.² Research suggests that women who have early or premature menopause and smoke die about two years earlier than nonsmoking women.³
• 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. Surgical removal of both ovaries, called a bilateral oophorectomy (OH-fuh-REK-tuh-mee), 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, which removes the uterus, can keep their ovaries. If this happens, you will no longer have periods, and you cannot get pregnant. But 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.⁴ Women with HIV may also have more severe hot flashes than women without HIV.⁵
  • Missing chromosomes. Women born with missing chromosomes or problems with chromosomes can go through menopause early. For example, women with the condition called Turner’s 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 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.⁶

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 doctor or nurse.

• Your doctor or nurse will ask you about your symptoms, such as hot flashes, irregular periods, sleep problems, and vaginal dryness.
• Your doctor or nurse may give you a blood test to measure estrogen and related hormones, like follicle-stimulating hormone (FSH). You may choose to get tested if you want to know whether you can still get pregnant. Your doctor or nurse will test your hormone levels in the first few days of your menstrual cycle (when bleeding begins).

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 doctor or nurse about steps to lower your risk for these health problems.
• More severe menopause symptoms. Talk to your doctor or nurse 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 doctor 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. Your doctor or nurse can recommend specialists who can help you deal with your feelings. Your doctor or nurse can also discuss options, such as adoption or donor egg programs, if you want to have children.

For more information about early or premature menopause, call the OWH Helpline at 1-800-994-9662 or check out the following resources from other organizations:

• Premature Ovarian Failure: Premature Menopause – Information from the American Pregnancy Association.
• Primary Ovarian Insufficiency (POI) – Information from the Eunice Kennedy Shriver National Institute of Child Health and Human Development

1. Shifren, J.L., Gass, M.L.S., for the NAMS Recommendations for Clinical Care of Midlife Women Working Group. (2014). The North American Menopause Society Recommendations for Clinical Care of Midlife Women. Menopause; 21(10): 1038–1062.
2. Women.Smokefree.gov. (n.d.). 11 Harmful Effects of Smoking on Women’s Health.
3. Bellavia, A., Wolk, A., Orsini, N. (2016);23: Differences in age at death according to smoking and age at menopause. Menopause, 108–110.
4. Imai, K., Sutton, M.Y., Mdodo, R., del Rio, C. (2013). HIV and menopause: A systematic review of the effects of HIV infection on age at menopause and the effects of menopause on response to antiretroviral therapy. Obstetrics and Gynecology International, 2013:340309 (Epub 2013 Dec 19).
5. Looby, S.E., Shifren, J., Corless, I., Rope, A., Pedersen, M.C., Joffe, H., et al. (2014). Increased hot flash severity and related interference in perimenopausal human immunodeficiency virus-infected women. Menopause; 21: 403–409.
6. Boneva, R.S., Lin, J.M., Unger, E.R. (2015). Early menopause and other gynecologic risk indicators for chronic fatigue syndrome in women. Menopause; 22:#826–834.