What is Early Menopause?

Definition, Causes, and Treatments for Early Menopause

Female doctor using stethoscope during check up
What is early menopause and why does it occr?. David Jakle/Image Source/Getty Images

At what age are menopause symptoms considered "early menopause?" What's the difference between early menopause and premature ovarian failure (POF)?  When menopause symptoms begin early, it can be upsetting or even scary. Understanding the definition and possible causes can help you protect yourself against the health risks that come along with the hot flashes.

What is Early Menopause? - Definition

When women in their late thirties or early forties begin to have symptoms of perimenopause such as hot flashes or vaginal dryness, they often wonder whether this is an early menopause.

The precise definition of "early" can vary with regard to menopause, but the diagnosis is usually made when menopause occurs early enough that it can cause infertility, disabling symptoms, or raise the risk of disease.

What Age is Considered Early and Premature Menopause?

While the average age of menopause in the United States is 51, the usual range is from 45 to 55. If you completely stop having periods before the age of 45, it is called an early menopause. If you stop menstruating even earlier—before the age of 40—it is called premature menopause.

What Causes Early Menopause?

There are several reasons you might experience early menopause, including:

  • Surgery - Surgery to remove the ovaries and fallopian tubes (salpingoophorecotmy) results in menopause. It's important to note that removing only one ovary does not usually cause menopause. Removing the uterus alone, without the ovaries, likewise does not result in menopause. Menses will cease, but the hormones generated by the ovaries will continue to be present. For example, you may still experience premenstrual symptoms and will not be at an increased risk of developing osteoporosis related to low estrogen levels.
  • Chemotherapy - Many cancer chemotherapy regimens result in menopause. This is not always permanent, especially when a woman is young when she receives these treatments.
  • Radiation - Radiation treatments to the abdomen and pelvic regions may result in menopause.
  • Inherited factors - Women may inherit the tendency to go through menopause at a young age from her parents, or she may inherit a syndrome which causes the ovaries to stop working early.
  • Lifestyle habits - Lifestyle habits may lead to or combine with other factors to increase the risk of early menopause. Women who smoke go through menopause, on average, two years earlier than women who do not smoke.
  • Nulliparity - There is some evidence that not having children results in earlier menopause.
  • Other factors. Although a direct correlation has not been shown, there is some association with early menopause in women who have a history of: heart disease, pelvic surgery, exposure to toxic chemicals, depression treatment, epilepsy treatment or not giving birth.

Often, early menopause is due to a combination of the above factors rather than one single cause.

"Temporary" Menopause

Sometimes what seems like an early menopause is actually a temporary menopause where menses stop due to medical treatments or a medical condition. Temporary menopause can be caused by cancer treatments, very low body weight, intensive exercise, stress, or as a side effect of medication. Once the underlying cause of the temporary menopause is eliminated, the ovaries may return to normal function.

It's not uncommon for a woman who has gone through menopause during chemotherapy (especially if she very young) to resume menstruating (and have the ability to become pregnant) later in life.

What is the Difference Between Early and Premature Menopause?

As noted earlier, the difference between these terms is age. Premature menopause is when your periods stop—for any reason—before the age of 40. Early menopause refers to menopause that occurs before the age of 45.

What is Premature Ovarian Failure?

Premature ovarian failure (POF),also called ovarian insufficiency or ovarian hypofunction, is when a woman's ovaries diminish in function before the age of 40. While premature menopause means that periods have stopped completely, in POF periods may continue irregularly for months or years. POF may be an inherited condition, or the ovaries may fail for no apparent reason. Premature ovarian failure almost always results in infertility.

What are the Symptoms of Early Menopause?

The symptoms of early menopause are essentially the same as those of menopause at a later age. But since the symptoms may or may not be due to menopause, and because women don't always realize that these symptoms mean they are losing ovarian function, it's a good idea to have your medical provider evaluate you if you are under 40 and experience any of the following:

Any of these symptoms could signal that your ovaries are beginning to produce lower amounts of hormones. But these symptoms are not always due to menopause, so sorting out the causes is an important step in staying healthy.

Does Early Menopause Put Me At Risk For Any Health Issues?

Estrogen has protective effects against certain conditions, and the premature lack of estrogen may increase risk. Some health conditions associated with early menopause or lack of estrogen include:

  • Osteoporosis
  • Heart disease
  • Thyroid disease
  • Glaucoma
  • Depression - Menopause does not cause depression, but depression is more common in women who experience earlier menopause.

Should I Get Treatment if I Have an Early Menopause?

The answer to this question, like so many questions about menopause, is "It depends." Many women decide to use hormone therapy when their menopause is very early, especially if it happens in their twenties or thirties. In addition to treating the symptoms of menopause such as hot flashes and vaginal dryness, hormone therapy can help prevent or delay some other health risks like osteoporosis. There are many reasons why estrogen therapy is beneficial medically in early menopause, but not all people choose to go this route, and for women with breast cancer, this is not an option. This is an important decision and should be discussed with a doctor or medical provider who can help you weigh these factors:

  • How serious or disruptive your symptoms are in your daily living.
  • What risks you might have based on your family or personal medical history.
  • What risks you might have related to estrogen and other hormones.
  • What non-hormonal treatments are available for conditions you are at risk for as well as the symptoms of menopause.
  • Your personal wishes and beliefs about various menopause treatments.

Early menopause can be physically and emotionally distressing. If you suspect you may be going through menopause too soon, talk to your doctor or medical provider about what may be causing your symptoms and whether you should be treated. Also, especially for those who feel frightened because they cannot take estrogen, keep in mind that there are treatments other than estrogen that may help with the symptoms, and treatments other than estrogen that can lower your risk of conditions common in those with early menopause.

Sources:

Georgakis, M., Thomopoulos, T., Diamantaras, A. et al. Association of Age at Menopause and Duration of Reproductive Period With Depression After Menopause: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2016. 73(2):139-49.

Martin, K., and R. Barbieri. Treating Menopausal Symptoms with Hormonal Therapy. UpToDate. Updated 06/08/16.

Muka, T., Oliver-Williams, C., Kunutsor, S. et al. Association of Age at Onset of Menopause and Time Since Onset of Menopause With Cardiovascular Outcomes, Intermediate Vascular Traits, and All-Cause Mortality: A Systematic Review and Meta-analysis. JAMA Cardiology. 2016. 1(7):767-776.

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