Signs of early menopause like missed periods, hot flashes, night sweats, pain during sex, vaginal dryness, irritability, and brain fog could indicate your body has entered early menopause or premature menopause. Early menopause is when a woman hits this stage between ages 40 and 45, while premature menopause means she’s in menopause before age 40. This health change can happen naturally or it might be the result of another health condition.
If you’re in your 30s and noticing signs of early menopause, know that true premature menopause is still uncommon. Only about 1% of people who menstruate experience menopause before 40, while about 5% experience early menopause in their early 40s. That said, your symptoms are real and worth taking seriously.
The most common sign of early menopause is that a woman’s period stops before age 45. In some cases, it’s due to primary ovarian insufficiency (POI), when the woman’s ovaries stop working before age 40. She might still experience the occasional period with POI and there’s a chance she could even conceive with POI. This condition causes one to have lower levels of other hormones, and the symptoms mimic those of menopause. A doctor can diagnose POI through a physical exam, blood tests, and a pelvic exam.
Find out why early menopause occurs, symptoms of premature menopause, how they differ from perimenopause and how to talk to your healthcare team about this stage, and take our premature menopause quiz to determine if you might be going through early menopause.
In this article, you’ll learn about:
- Key signs and symptoms of early and premature menopause in your 30s and early 40s
- How early menopause differs from perimenopause and primary ovarian insufficiency (POI)
- Common causes and risk factors, from genetics and autoimmune conditions to lifestyle and medical treatments
- Short- and long-term health effects on fertility, bone density, heart health, mood, sleep, and brain function
- How early menopause is diagnosed and treated, plus a self-assessment quiz and tips for talking to your healthcare team
What are the signs of early menopause?
The most common signs of early menopause include changes in menstrual cycles, sudden hot flashes, and emotional or energy fluctuations.
Know the symptoms of early menopause that occur before age 45:
- Irregular or missed periods
- Hot flashes or night sweats
- Mood changes, like low mood or anxiety
- Vaginal dryness and a low sex drive
- Vaginal atrophy
- Sleep disturbances, like insomnia and fatigue
- Incontinence
- Problems with memory or concentration
Early menopause symptoms differ from standard perimenopause onset in that the hormone changes can be dramatic in early menopause, particularly if her ovaries were removed surgically and she’s in early menopause due to surgery. Usually, perimenopause symptoms — which mimic those of early menopause — occur gradually over years. Early menopause signs to talk to your doctor about include hot flashes and mood swings.
Signs of premature menopause: how they differ
The most important sign of premature menopause is that it occurs before age 40. When you’re experiencing premature menopause symptoms — particularly menstrual changes, mood swings, and/or hot flashes — it’s important to make an appointment with your healthcare professional.
Common underlying causes of premature menopause are genetic causes or the results of a medical treatment or procedure, which include pelvic radiation for cancer, chemotherapy, removal of the uterus, or surgical removal of the ovaries. You might also be more likely to go through early menopause if you have specific genetic diseases, like Turner Syndrome, or rheumatoid arthritis, thyroid disease, or are living with HIV/AIDS.
Going through menopause early as a younger woman can be particularly challenging on one’s mental health and physical health. Early detection with your healthcare provider and blood and hormone testing can help with early menopause and premature menopause symptom relief. It can also help improve outcomes of conditions that might develop like osteoporosis and cardiovascular disease as well as dictate some of the important discussions to have with your healthcare team if you still want to have a baby.
A healthcare team might recommend low-dose hormone therapy depending on your health history and suggest lifestyle modifications to ease early menopause symptoms.
Risk factors for early menopause
The highest risk factors for early menopause include genetic predisposition, autoimmune disease, and lifestyle influences such as smoking. Here are some of the major influences identified in research:
Genetics and family history
If other women in your family experienced early menopause or premature menopause, you’re at an increased risk of experiencing this reproductive aging issue. Having a genetic predisposition to early menopause could also ramp up the risk of other associated health problems, like an increased risk of cardiovascular disease. Researchers continue to study how a shared genetic background influences the mean age of menopause in women. Someone with Turner Syndrome is at a higher risk of ovarian dysfunction and could develop POI due to those ovarian problems.
Autoimmune disorders
Someone who has been diagnosed with an autoimmune disease might be more likely to find themselves in early menopause or POI. That’s because the ovaries tend to be a common place of autoimmune attacks, causing future dysfunction. Research has also shown associations between the onset of menopause and autoimmune diseases, including rheumatic diseases. One study found that early menopause and hormone replacement therapy were associated with a heightened rheumatoid arthritis risk.
Smoking and environmental toxins
Being a smoker has shown to negatively impact one’s reproductive health, in particular the age of natural menopause. Smoking can damage the ovaries, possibly leading to early menopause. It’s also important to be aware of the products you use, eat from, drink from, and apply to your body, as endocrine-disrupting chemicals (EDCs) can impact reproductive aging, causing early menopause.
Chemotherapy or ovarian surgery
It’s been shown that chemotherapy in particular the alkylating agents, or radiation treatments (especially pelvic radiation), as well as an oophorectomy (surgery to remove one or both ovaries) can cause premature menopause or early menopause in women under age 45. A unilateral oophorectomy was shown in some studies to reduce the age of menopause by almost two years.
Low BMI, chronic stress, and depression
While there are plenty of associations (and articles) about menopause and weight gain, it’s interesting to note that having a body mass index (BMI) that’s too low can be one of the risk factors of early menopause. Women with a high BMI were more likely to have late menopause. Excess chronic stress can also do a number on one’s hormones, negatively impacting reproductive ability and possibly being a risk factor of early menopause. One study found that women between the ages of 40 and 70 who reported high stress levels tended to have a lower average age of menopause by five months than women who reportedly felt little stress. That being said, other studies have shown strong associations between early menopause or premature menopause in women with severe depression.
The premature menopause quiz
Could you be experiencing early menopause or premature menopause? Take this quiz to find out if the signs of premature menopause are showing up in your life.
1: How old are you?
- 45 or older (A)
- 40-44 (B)
- 35-39 (C)
- Under 35 (D)
2: How often are your periods becoming irregular?
- Never. My periods are regular (A)
- Occasionally irregular (B)
- Often irregular (C)
- Very frequently or they stopped (D)
3: Are you experiencing hot flashes or night sweats?
- No (A)
- Occasionally (B)
- Often (C)
- Very frequently (D)
4: Have you noticed changes in your mood?
- No (A)
- Occasionally (B)
- Often, more than usual irritability (C)
- Frequently (D)
5: Are you experiencing vaginal dryness or discomfort during sex?
- No (A)
- Occasionally (B)
- Often (C)
- Yes, significant changes (3)
6: Do you have a family history of early menopause or have you had treatments affecting your ovaries?
- No (A)
- Not sure (B)
- Yes, family history (2)
- Yes, both family history and/or medical treatments (3)
What your premature menopause quiz score may mean:
- Mostly A’s: Your symptoms suggest you're likely not experiencing early menopause. Particularly if you’re in your mid-40s, it could be perimenopause symptoms.
- Mostly B’s: You have some symptoms that could indicate early menopause or they are signs of premature menopause. Talk to a healthcare provider to learn more and discuss hormone testing or screening.
Mostly C’s and D’s: Based on your responses, your symptoms align with perimenopause. Consider hormone testing if you’re under age 45. Schedule a consultation with your healthcare provider or look into integrated support for hormones to discuss testing and treatment options.
Health effects of early and premature menopause
When someone faces early menopause (before 45) or premature menopause (before 40), it means estrogen levels drop sooner than the body expects, and that impacts everything from fertility to heart health to mental health. Having an understanding of the long-term health repercussions and consulting with a healthcare team about what you can do to prevent or prepare for them can go a long way in setting you up for a healthy future.
Fertility changes
Once ovulation slows or stops, getting pregnant naturally becomes more difficult. If you’re diagnosed with early menopause, premature menopause, or POI, your doctor can discuss fertility options like egg freezing or IVF or other explorations of parenthood.
Bone density loss
There’s a reason why women who go through early menopause are considered at higher risk for bone-related health diseases, like osteoporosis. Estrogen protects bones, so early depletion can speed up bone loss and increase the risk of osteoporosis or fractures later in life.
Heart health risks
Estrogen helps maintain healthy blood-vessel function and can contribute to favorable cholesterol/lipid profiles (lower LDL, higher HDL) under many conditions. When estrogen levels drop, the risk of developing heart disease increases and some studies have shown associations in an increased risk of heart failure in women who went through early menopause or premature menopause. Research shows that women who experience menopause before age 40 have a higher chance of coronary heart disease compared to those who reach menopause later in life.
Mood, sleep, and brain changes
It seems safe to assume that when your hormones are out of whack in early menopause, it can impact your mood, but it also takes a toll on your sleep quality and your ability to concentrate. (Fun.) Hot flashes throughout the day, night sweats, and poor sleep can affect mood and focus. Dropping estrogen levels can impact memory and performance, mood, and cause brain fog.
Because women who experience early menopause live with lower estrogen levels for longer, their lifetime risks for bone loss and heart disease are higher. Early diagnosis helps you understand what’s happening and allows your care team to create a personalized plan for relief.
Treatment may include hormone therapy, nutrition changes, exercise, stress management, and mental health support to ease symptoms and lower long-term risks.
Be proactive about your health. Move regularly to strengthen bones, quit smoking, eat well, get quality sleep, and manage stress to support hormones and heart health. Hormone therapy can ease symptoms and protect long-term health, while non-hormonal options help with hot flashes, mood changes, and vaginal symptoms.
Medical evaluation and treatment options
If you’re concerned about the signs of premature menopause or early menopause symptoms, make an appointment with your healthcare team or talk to a professional through Carrot’s network to learn more about an early menopause diagnosis and treatment.
Menopause might be diagnosed through blood tests or urine tests that can include Anti-Müllerian Hormone (AMH) test, Human Chorionic Gonadotropin (hCG), Follicle-Stimulating Hormone (FSH)/Estradiol blood level test, thyroid-stimulating hormone (TSH) blood level test, or a prolactin blood level test.
Treatment for early menopause may include:
Hormone replacement therapy (HRT)
Whether a doctor suggests this depends on if you had a hysterectomy, your health history, including cancer, and your risk for other health problems, like osteoporosis or heart health concerns.
Non-hormone interventions for early menopause
There are a number of non-hormonal treatments available for menopause symptoms, particularly if you’re experiencing the vasomotor discomforts of menopause like hot flashes and night sweats. In some studies, women taking selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors had significant reductions in either the frequency and/or severity of hot flashes. Prescription gabapentin was shown in some studies to reduce the frequency of hot flashes. Some research has shown that individuals using cognitive behavioral therapy might have some improvements on hot flash symptoms.
Supplements, nutrition, and mental health
Talk to your healthcare professional about alternative treatments for early menopause since natural products like black cohosh and increasing soy intake might be beneficial for symptoms, but it depends on the individual’s health history. Talking with a mental health professional about early menopause can help if you’ve been diagnosed. Individuals with early menopause and premature menopause have shown higher instances of anxiety and depression.
Fertility preservation or egg freezing options
You may have heard rumors that egg freezing causes early menopause, but that’s not true. While a premature menopause diagnosis or early menopause diagnosis can seem devastating if you still want to have a family, there are options available. Discussing all of your fertility options with a reproductive professional can help younger individuals who are facing premature menopause or early menopause explore what’s available based on their health history. There are still plenty of options for creating a family.
FAQ
What are the signs of early menopause?
The signs of early menopause for a woman aged 45 and under are hot flashes, irregular periods or stopped periods, pain during sex, night sweats, insomnia, and mood swings.
What causes premature menopause?
A number of factors can cause premature menopause, in particular, surgical removal of the ovaries, pelvic radiation for cancer, chemotherapy, removal of the uterus, or genetic conditions.
What are the risk factors for early menopause?
Risk factors for early menopause are a genetic predisposition based on family history, autoimmune disorders, reproductive surgeries, smoking, low BMI, and possibly chronic high stress levels.
How can I know if I’m experiencing premature menopause?
One of the best ways to know if you’re in premature menopause is to get testing done if you’re age 40 or younger.
Recognizing and managing early menopause
Early detection of premature menopause and early menopause symptoms can go a long way in getting relief and reducing long-term health risks like cardiovascular disease and osteoporosis. Seek professional care from a trusted menopause medical expert and talk to them about testing for hormone evaluation to determine if you’re in early menopause or to rule out other potential health issues.
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