Premature & Early Menopause: Everything You Need to Know

In the United States, the average age of menopause is 51. Menopause that occurs between the ages of 40 and 45 is considered “early menopause,” and before 40 is called “premature menopause.” About 5% of women experience early menopause, and roughly 1% of women go through premature menopause. While the experience of menopause is unique for every woman, early or premature menopause can have specific health implications that require specialized care.

The Signs of Menopause: Perimenopause vs. Menopause

Menopause is not a sudden event, but rather a process that unfolds over time. The transition is often a gradual one, with fluctuating hormones and shifting symptoms. To better understand this journey, it’s helpful to distinguish between perimenopause and menopause.

  • Perimenopause: This is the transitional phase leading up to menopause. It can begin as early as your late 30s or 40s and can last anywhere from a few months to several years. During this time, your ovaries begin to produce less estrogen, leading to irregular periods and a host of other symptoms. While your periods may become lighter, heavier, or more sporadic, you can still get pregnant during perimenopause.
  • Menopause: While the menopausal transition may commonly be referred to as “menopause,” true menopause can’t be confirmed until one full year after a woman’s final menstrual period. At this point, your ovaries have stopped releasing eggs and producing most of their estrogen.

While irregular periods are often the first sign of perimenopause, other symptoms can be present and may fluctuate in severity. These include:

  • Hot flashes: A sudden feeling of intense heat that spreads through the body. It may cause flushing, sweating, and a rapid heartbeat.
  • Night sweats: Hot flashes that occur during the night, often disrupting sleep.
  • Vaginal dryness and discomfort during sex.
  • Sleep problems: Insomnia or difficulty staying asleep.
  • Mood changes: Increased irritability, anxiety, or depression.
  • Weight gain: A slowed metabolism can contribute to weight gain, particularly around the abdomen.
  • Loss of breast fullness.
  • Thinning hair and dry skin.
  • Changes in sex drive.
  • Joint and muscle aches.
  • Headaches.
  • Brain fog: Difficulty concentrating or memory problems.

The primary difference between early and premature menopause is simply the age at which it occurs. Early menopause is the cessation of periods between ages 40 and 45, while premature menopause is before age 40. The causes are often similar, but the long-term health implications are more significant the earlier a woman goes through it.

What Causes Early Menopause?

The cause of early or premature menopause is not always known. It can sometimes be a result of medical treatments, surgical procedures, or certain genetic conditions.

  • Genetic Factors: A family history of early menopause can increase your likelihood of experiencing it.
  • Medical Treatments: Chemotherapy and pelvic radiation for cancer can damage the ovaries.
  • Surgical Procedures: The surgical removal of the ovaries (oophorectomy) will immediately induce menopause. A hysterectomy (removal of the uterus) will end your periods, but if the ovaries are left intact, you will not enter menopause immediately.
  • Autoimmune Conditions: Diseases like thyroid disease, rheumatoid arthritis, or HIV/AIDS can sometimes cause the immune system to mistakenly attack the ovaries, leading to premature ovarian failure.

Can you get pregnant if you’re in early menopause? No. Once you have reached menopause, your ovaries are no longer releasing eggs, and you can no longer get pregnant using your own eggs.

Health Risks & Management

Going through menopause at a young age can have a more significant impact on a woman’s long-term health. The protective effects of estrogen are lost earlier, increasing the risk of certain conditions.

  • Osteoporosis: Estrogen plays a vital role in maintaining bone density. With the early loss of this hormone, the risk of developing osteoporosis and bone fractures increases significantly.
  • Heart Disease: Estrogen is also protective for the cardiovascular system. Women who experience early menopause have a higher risk of heart disease and stroke later in life.
  • Neurological Concerns: Studies suggest an increased risk of neurological diseases like dementia.

Emotional Impact

Beyond the physical symptoms, the emotional and psychological effects of early menopause can be profound. For many young women, the loss of fertility can lead to feelings of grief, sadness, and depression. It can also cause anxiety about aging and the other health risks associated with a sudden transition. Seeking support from a healthcare professional or a mental health counselor is crucial.

Treatment Options

  • Hormone Replacement Therapy (HRT): For most women with early or premature menopause, the recommended treatment is Hormone Replacement Therapy (HRT), also commonly referred to as Menopausal Hormone Therapy (MHT), or estrogen replacement therapy. This treatment replaces the estrogen that your body is no longer producing. It can help manage symptoms like hot flashes and vaginal dryness and, more importantly, can help protect against long-term risks like osteoporosis and heart disease. While HRT has been a subject of debate, it is generally considered safe and highly beneficial for women who enter menopause at an early age. The goal is to replace the hormones until the natural age of menopause (around 51).
  • Lifestyle Changes: In addition to medical treatment, certain lifestyle changes can help manage symptoms and promote long-term health.
    • Diet: A balanced diet rich in calcium and Vitamin D can support bone health.
    • Exercise: Regular weight-bearing exercise can help maintain bone density and support cardiovascular health.
    • Stress Management: Techniques like yoga, meditation, and deep breathing can help with mood swings and anxiety.

When to See Your Provider

Menopause is a natural transition, but when it happens early or prematurely, it carries specific risks that require careful medical attention. The distinction between perimenopause and menopause, and the potential long-term effects of an early transition, are important to understand. 

If you are under the age of 45 and experiencing irregular periods, hot flashes, or any other signs of menopause, it may be time to check in with your provider. At CT Coastal OBGYN, we can perform a physical exam and blood tests to check your hormone levels, help diagnose the cause, and create a tailored management plan—which may include hormone replacement therapy and lifestyle adjustments—to help you navigate this change and maintain your health for years to come.