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Early menopause symptoms
Early menopause is menopause before 45; before 40 it's called premature menopause or premature ovarian insufficiency (POI). The symptoms are the same as at any age: irregular or stopped periods, hot flashes, night sweats, vaginal dryness, poor sleep, low mood and brain fog. About 7.3% of women reach menopause at 40 to 44, and POI affects about 3.5%. Hormone treatment until at least the usual age of menopause is recommended.
Menopause before 45 is early; before 40 it's premature (POI). Signs to watch, causes, tests, and why HRT until about 51 is usually recommended.
Early menopause: expectation vs reality
What people often expect
“Menopause in your 30s or early 40s is so rare it can't be what's happening”
What the evidence shows
It's more common than most people think. The 2024 international guideline on premature ovarian insufficiency puts it at 3.5% of women, higher than earlier estimates, and a meta-analysis of thirty-one studies found early menopause before 45 in 12.2% of women. Because missing hormones for years raises the risk of osteoporosis and heart disease, recognizing early menopause matters for your long-term health, not just your symptoms.
Early menopause: signs, causes and diagnosis
What is considered early menopause?
Menopause before 45 is called early menopause, and before 40 it's premature menopause, medically called premature ovarian insufficiency or POI. The only difference between them is the age at which it happens; the causes are the same. It can happen naturally or because of treatment for another condition. After early or premature menopause, you can't get pregnant using your own eggs, although with POI the ovaries can occasionally start working again.
Early menopause signs and symptoms
The main sign is periods becoming irregular or stopping completely before 45. Other symptoms are the same as for menopause at the usual age: hot flashes and night sweats, vaginal dryness, trouble sleeping, low mood or anxiety, a lower sex drive, and problems with memory or concentration. When menopause is caused by surgery, symptoms can start suddenly and be more severe, because hormone levels drop quickly.
Learn more →What causes early menopause?
Often no clear cause is found. It's more likely if it runs in your family, if you smoke, started your periods early or are underweight. Autoimmune diseases such as thyroid disease and rheumatoid arthritis, poorly controlled HIV, chronic fatigue syndrome and chromosome conditions such as Turner syndrome can all bring it on. So can treatments: chemotherapy, pelvic radiotherapy, certain hormone medicines and surgery to remove the ovaries. In many women, though, no cause is ever identified.
Is early menopause genetic?
Genes play a big part. In a study of 275 identical and 353 non-identical twin pairs, genes explained 63% of the variation in age at menopause, and both early and late menopause ran in families. Women whose mother or sister had early or premature menopause are more likely to have it too. The 2024 international guideline on POI updated its recommendations on genetic testing, and a family history of POI is worth telling your doctor about.
Smoking and early menopause
Smoking is the clearest cause you can change. In a pooled analysis of 17 studies, current smokers had about twice the risk of premature menopause (relative risk 2.05) and early menopause (1.80). The longer women had smoked, the higher the risk. Smokers can reach menopause as many as two years earlier and may have more severe symptoms. Women who had quit more than 10 years earlier had the same risk as those who had never smoked.
Learn more →Early menopause after chemotherapy or radiotherapy
Chemotherapy and pelvic radiotherapy can damage the ovaries and stop periods, permanently or for a while. Age matters most: the younger you are, the less likely treatment is to cause menopause. In a study of 102 premenopausal women having chemotherapy for breast cancer, 77.9% had no periods 12 months after treatment, and only 24.6% of those whose periods stopped got them back. Hormone-blocking treatment for breast cancer can also bring on menopause.
Premature and early menopause from surgery
Removing both ovaries causes menopause immediately, whatever your age, and symptoms are usually severe. A hysterectomy that keeps the ovaries doesn't cause menopause straight away, but it can bring natural menopause earlier. In the Nurses' Health Study, removing both ovaries before 50 was linked with higher death rates in women who never used estrogen, which is why HRT is advised until the natural age of menopause after this surgery.
Learn more →How early menopause is diagnosed
Under 40, NICE advises diagnosing POI from your symptoms plus raised FSH levels on 2 blood samples taken 4 to 6 weeks apart, not from a single test, and not routinely using AMH. The 2024 international guideline says one raised FSH above 25 IU/L is enough, with AMH or a repeat FSH when there's doubt. Between 40 and 45, an FSH test may be used to confirm menopause if you have symptoms and cycle changes.
Learn more →Why early menopause matters for your health
Losing estrogen years early affects bone, heart, brain, mood and sexual health, and is linked with earlier death. In a pooled analysis of 301,438 women, the risk of heart disease or stroke was 1.55 times higher after menopause before 40 and 1.30 times higher after menopause at 40 to 44, compared with menopause at 50 to 51. Osteoporosis is also more likely. Hormone therapy reduces some, but not all, of these risks.
Early menopause and fertility
Early or premature menopause makes it harder to get pregnant, but not always impossible. In a French study of 358 women with unexplained POI, 24% showed signs of their ovaries working again, and 4.4% got pregnant without treatment. So contraception may still be needed if you want to avoid pregnancy, and HRT isn't a contraceptive. If you want children, options include IVF with your own frozen eggs or donor eggs, surrogacy and adoption.
Early menopause by the numbers
From the studies on this page
of women have premature ovarian insufficiency, menopause before 40
3.5%
of women had early menopause, before 45, in a global meta-analysis
12.2%
the risk of premature menopause in current smokers compared with never smokers
2x
Relative odds vs comparison group (1× = same odds)
the risk of heart disease or stroke after menopause before 40, compared with menopause at 50 to 51
1.55x
Relative odds vs comparison group (1× = same odds)
Estimates vary with how studies define menopause and which women they include. POI was more common among women with autoimmune disease (10.5%) or a medical treatment as the cause (11.2%) in one review.
Early menopause or something else?
Missed periods before 45 aren't always early menopause. These are the other common causes, and most are easy to rule out.
Pregnancy
Check →A missed period, sometimes with breast tenderness, nausea or tiredness. Pregnancy is possible in early menopause and POI.
Test: Pregnancy test
Thyroid problems
Check →Missed or irregular periods with tiredness, weight change, feeling hot or cold, or a racing heart.
Test: TSH blood test
Polycystic ovary syndrome (PCOS)
Missed or irregular periods with weight gain, hair growth on the face, and oily skin, usually long-standing.
Test: Hormone blood tests, sometimes an ultrasound scan
Stress, weight loss or over-exercising
Periods stop after sudden weight loss, heavy training or a stressful time, without hot flashes.
Test: Your history and blood tests
Hormonal contraception or breastfeeding
Check →Periods stop or become rare on the pill, injection or hormonal IUS, or while breastfeeding.
Test: Review of your contraception
Early menopause treatment: what works
HRT for early menopause
Strong evidenceReplacing the missing hormones is the main treatment. NICE advises HRT or a combined hormonal contraceptive for POI, continued until at least the age of natural menopause, unless there's a reason you can't take it, such as a hormone-sensitive cancer. It relieves symptoms and protects bones and heart. Younger women may need higher doses to match their natural hormone levels. For women under 40, the baseline risk of breast cancer and heart disease is very low.
Related guide →The combined pill as early menopause treatment
Strong evidenceThe combined contraceptive pill is an alternative to HRT for women with early menopause or POI. Both protect bones. The pill also works as contraception, which HRT doesn't, which matters because a small number of women with POI get pregnant without treatment. NICE notes that HRT may be better for blood pressure than the combined pill, so the choice depends on your priorities.
Related guide →Protecting your bones after early menopause
First stepBecause bone loss starts years early, bone health needs attention. Exercise regularly, including weight-bearing and muscle-strengthening activity, and eat calcium-rich foods such as yogurt. Women 51 and older need 1,200 milligrams of calcium a day. US guidelines recommend a bone density scan before 65 for postmenopausal women at higher risk of fracture, which includes early menopause.
Related guide →Fertility options with premature menopause
If this is the causeIf you want children, ask for a referral to a fertility specialist. Options include IVF using your own frozen eggs, if they were stored before treatment, or donor eggs, as well as surrogacy and adoption. If you're about to have cancer treatment or surgery that could cause menopause, ask about fertility preservation first.
Emotional support for early menopause
First stepEarly menopause can be hard to come to terms with, especially if you'd planned a pregnancy. Talking therapies for anxiety and depression can help, and support groups for women with premature menopause exist. Reviews of early menopause stress that the psychological impact should be addressed alongside hormone treatment.
Non-hormonal treatment if you can't take HRT
Strong evidenceIf hormones aren't safe for you, for example after a hormone-sensitive breast cancer, SSRIs, SNRIs and gabapentin cut hot flash frequency by about 40% to 65%, and fezolinetant and CBT are other options with good evidence. They don't protect bone, so bone health needs separate attention.
Related guide →
When early menopause symptoms need a doctor
Periods stopped or irregular before 45
See a doctor, especially if you've missed 3 periods in a row. Early menopause needs diagnosing because hormone treatment protects your bones and heart.
Menopause symptoms under 40
See a doctor. POI is diagnosed with FSH blood tests and a review of your history.
More →Periods stopped after cancer treatment
Talk to your cancer team or doctor about menopause symptoms, bone protection and fertility.
Urgent: Thoughts of self-harm or suicide
Get help now: call or text 988, or call 911 in an emergency. In the UK, call 111 (mental health option), Samaritans on 116 123, or 999.
Early menopause: questions women ask
What are the first signs of early menopause?
Usually periods becoming irregular or stopping before 45. Hot flashes, night sweats, trouble sleeping, vaginal dryness, low mood, a lower sex drive and problems with memory or concentration often come with it. If you have these symptoms under 45, see a doctor rather than waiting.
What is considered early menopause?
Menopause before 45 is early menopause. Before 40, it's premature menopause, also called premature ovarian insufficiency. Menopause at the usual age happens between 45 and 55, with an average of 52 in the United States.
How early can menopause start?
Premature ovarian insufficiency covers any age under 40, so it can happen in your 20s or 30s. Overall, about 3.5% of women develop POI before 40. In a pooled analysis of 17 studies, 1.9% of women had natural menopause before 40 and 7.3% between 40 and 44.
What causes early menopause?
Often no cause is found. Family history, smoking, starting periods early and being underweight make it more likely. It can also be caused by autoimmune diseases, chromosome conditions like Turner syndrome, chemotherapy, pelvic radiotherapy, some hormone medicines, and surgery to remove the ovaries.
Is early menopause genetic?
Partly. It's more likely if your mother or sister had it. In a twin study, genes explained 63% of the variation in age at menopause, including early menopause. Some women with premature ovarian insufficiency have a specific genetic cause, which genetic testing can find.
Can you have menopause symptoms at 38?
Yes. Menopause at 38 would be premature ovarian insufficiency, which affects about 3.5% of women. Irregular periods, hot flashes and night sweats at 38 should be checked by a doctor, who can test FSH levels, as well as look for other causes like thyroid problems or pregnancy.
Related →Is early menopause bad for your health?
It raises some risks: losing estrogen early is linked with osteoporosis, heart disease, effects on mood, memory and sexual health, and earlier death. That's why hormone treatment is recommended until at least the usual age of menopause. With treatment, many of these risks are reduced.
Are there any benefits of early menopause?
Few. It ends periods and period problems, and some studies link later menopause with a higher risk of uterine cancer. But the overall effect of losing hormones early is negative for bones and heart, which is why doctors recommend replacing them rather than seeing early menopause as an advantage.
How long should you take HRT for early menopause?
At least until the natural age of menopause, around 51. NICE and other medical societies recommend continuing hormone treatment until then unless there's a reason not to. After that, you and your doctor decide whether to continue based on your symptoms, like any woman going through menopause.
Related →Can you get pregnant with early menopause?
It's unlikely but possible. In a study of 358 women with premature ovarian insufficiency, 24% showed signs of ovarian function returning and 4.4% got pregnant without treatment. If you don't want to get pregnant, use contraception, since HRT doesn't prevent pregnancy. If you do, IVF with frozen or donor eggs is an option.
How can I prevent early menopause?
Mostly you can't, because genes play the biggest role. Not smoking is the main step you can take: women who had quit more than 10 years earlier had the same risk as never smokers. Keeping a healthy weight also helps, since being underweight is a risk factor.
Related →What are the best early menopause remedies?
HRT or the combined pill are the main treatments, because they relieve symptoms and protect bone and heart. Lifestyle helps too: regular exercise, calcium-rich food and not smoking. Herbal remedies aren't recommended for hot flashes, and they don't replace the hormones your body is missing.
Sources
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