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What Causes Early Onset Menopause?

Menopause occurs before age 45 in 5% of women—here’s what to look for.

What Causes Early Onset Menopause?

Menopause happens when your ovaries stop making eggs, which causes a drop in estrogen—a key hormone that keeps your reproductive cycle in check. If you haven't had a period for more than a year, that's an indication that menopause has started. Although rare, some women start menopause earlier than expected. 

What is Premature or Early Menopause?

Most women experience menopause between the ages of 45 and 55, with the average onset around 51 years old in the United States. Early menopause happens before the age of 45, while premature menopause occurs before age 40.

Factors such as damage to the ovaries or disruptions in estrogen production can trigger early menopause. Even if the ovaries remain intact, certain circumstances may prompt the body to enter menopause earlier than expected. If this occurs, it's crucial to get medical guidance from a healthcare professional.

POI vs. premature menopause

Premature ovarian failure (Primary Ovarian Insufficiency, or POI, is now the preferred term) and premature menopause are often confused. POI happens when there is a sudden and spontaneous cessation of periods. Unlike premature or early menopause, POI offers the possibility of the period returning. Women with POI may still ovulate, menstruate, or conceive. On the other hand, in early or premature menopause, there is a loss of ovulation and menstruation, leading to the inability to become pregnant.

Signs and symptoms of premature or early menopause

Menopause symptoms are the same whether you are 35 or 52. Early menopause begins with having irregular periods associated with symptoms caused by hormonal changes. Some of the more common symptoms include:

  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Insomnia 
  • Changes in your sex drive
  • Thinning hair or hair loss

How is early menopause diagnosed

If you begin to have irregular periods and menopause symptoms before age 45, it’s important to talk to your healthcare provider. They can help you navigate what is truly going on in your body. Certain blood tests can determine hormone levels, which will aid in diagnosing early or premature menopause.

Factors Influencing Early Onset Menopause

Surgical history

A hysterectomy (surgical removal of the uterus) is the second most common surgery among women in the United States—surgeons perform over 500,000 every year. When the uterus is removed, a woman cannot ovulate or have a period. She enters immediate menopause, known as surgical menopause. A hysterectomy is most common in women ages 40-50, which may qualify as early menopause.

Cancer treatment

Some cancer treatments cause an early onset of menopause. Depending on age and treatment, this cessation may be temporary or permanent. It is more common in cancers of the reproductive organs and pelvis, or treatments involving hormone therapy.

Autoimmune disorders

Autoimmune disorders like thyroid diseases, hyperparathyroidism, and Addison's disease may play a role in early menopause. These conditions may cause the immune system to mistakenly attack ovarian tissues, which leads to inflammation and damage to the ovaries. This disrupts normal reproductive function and accelerates the onset of menopause.  

Genetic Disorders

Genetic disorders, such as Turner's syndrome, can contribute to early-onset menopause. In Turner's syndrome, individuals are born with a missing or partially missing X chromosome. This leads to ovarian insufficiency, which increases the chances of experiencing menopause early.  

Lifestyle Choices

Long-term smoking contributes to early menopause because of polycyclic hydrocarbons found in smoke. Smoking also increases your risk of cardiovascular disease, stroke, osteoporosis, and all-cause mortality.

Other lifestyle factors that may contribute to early menopause are:

  • Vigorous exercise
  • Severe weight loss
  • High intake of polyunsaturated fats

It’s important to note that we need larger studies in this area of women’s health (and every area of women’s health) to help us further understand contributing factors to early or premature menopause.

Is Early Menopause Preventable? 

In most cases, causes of early menopause are beyond your control, such as genetics, disease, or surgery. If you’re a smoker, your health will improve in a multitude of ways by quitting. In the big picture, taking care of your body by eating healthy, exercising regularly, and practicing stress management will contribute to healthy aging and healthy menopause.

Are There Risks?

Women experiencing menopause at an earlier age may have more challenging menopausal symptoms. This can lead to issues such as sexual dysfunction and a diminished sense of intimacy. 

Women undergoing premature or early menopause face an extended period without the protective benefits of estrogen. This lack of estrogen increases the risk of developing health conditions, like osteoporosis, heart disease, and depression. The prolonged absence of estrogen may also increase risk of neurological diseases.

Treatment and Management

Unfortunately, there is no true treatment for all the changes that come with menopause. That said, symptoms may be manageable with supplementation and healthy lifestyle habits as mentioned in this article. When considering supplements, look for black cohosh, which has been shown to help the body regulate temperature for relief from hot flashes & night sweats, chasteberry for hormone management, and ashwagandha, which is traditionally used for sleep support & sexual function. 

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