Menopause is your final menstrual period. As you approach menopause, your reproductive hormones (such as estrogen) drop. Most women reach menopause between the ages of 45 and 55, with the average being around 51 to 52 years of age.
Premature and early menopause#
Premature menopause is when you reach menopause before the age of 40. Early menopause is when you reach menopause between the ages of 40 and 45.
Up to 12% of women have their final period before they are 45. This figure is likely to be higher if we include menopause caused by surgery and cancer treatment.
Symptoms#
The symptoms of premature and early menopause are like those you would have if you reached menopause at the expected age. Symptoms can be more severe after surgery or cancer treatment, because of the sudden change in estrogen levels.
Common symptoms include:
- hot flushes
- night sweats
- sleep problems
- mood changes
- brain fog
- headaches or migraines
- sore breasts
- a dry vagina
- reduced sex drive (libido)
- itchy skin
- aches and pains
- weight gain
- tiredness
What causes premature and early menopause?#
Premature and early menopause may be caused by primary ovarian insufficiency (POI), cancer treatment or surgery.
Primary ovarian insufficiency (POI)#
POI is when periods stop suddenly at an earlier age than expected. It affects up to 1% of women. POI is associated with certain autoimmune diseases, but in about 60% of cases a cause cannot be found.
The first symptoms of POI may be:
- irregular periods
- no periods after stopping the oral contraceptive pill
- being unable to get pregnant
Cancer treatment#
Chemotherapy and radiotherapy can cause the ovaries to stop working, resulting in menopause. However, not all cancer treatments lead to menopause.
Surgical menopause#
Menopause also happens with removal of the ovaries, with or without the uterus being removed. This surgery may be necessary because of cancer or other health conditions such as severe endometriosis.
After a diagnosis#
Premature or early menopause can be very upsetting. It is normal to feel a sense of loss, sadness and grief. You may also have mixed feelings about your body image, fertility and sexuality.
If you feel very emotional, anxious or depressed after your diagnosis, it is important to talk to someone. You may find it helpful to have counselling or to join a support group. Your doctor can refer you to a psychologist if needed.
Managing premature and early menopause#
Depending on your situation, your doctor may refer you to a specialist, such as an endocrinologist, gynaecologist, fertility specialist, psychologist or psychiatrist.
People with premature or early menopause have lower levels of estrogen, which can increase the risk of health conditions such as osteoporosis and heart disease. Menopausal hormone therapy (MHT) or the oral contraceptive pill can help to reduce these risks. These treatments are generally taken until the expected age of menopause.
If you cannot take hormone therapy (for example, if you have a history of breast cancer), your doctor will discuss your situation and recommend other treatments.
Key points#
- Premature menopause occurs before age 40, and early menopause occurs between ages 40 and 45.
- Symptoms are like those of menopause at the expected age, but can be more severe after surgery or cancer treatment because of the sudden change in estrogen levels.
- POI is associated with certain autoimmune diseases, but in about 60% of cases a cause cannot be found.
- Lower estrogen levels can raise the risk of osteoporosis and heart disease, and treatments such as MHT or the oral contraceptive pill can help reduce these risks.
Where to get help#
Sources & further reading
For evidence-based global guidance on this topic, consult authoritative public-health bodies such as the World Health Organization (WHO), CDC, NHS, and ECDC.