Premature and Early Menopause: Causes, Symptoms and What to Expect

If you're in your 30s or early 40s, and have been experiencing symptoms like irregular periods, unexpected hot flashes, and maybe even some mood swings, you might wonder, "Could this be menopause already?"

Sound familiar? Then, there’s a chance you’re dealing with early or premature menopause.

But, dealing with things you thought you had more time to prepare for, like premature menopause, especially when you had plans for a family or had no warning, could be a lot to process. With the right information and support, it is manageable.¹

In this article, we break down what premature menopause means, explore the causes, symptoms, and how it might affect your health, so you could better understand what's happening and what to expect.

What Is Early Menopause?

Natural menopause occurs when your periods stop for good.¹ It happens when you go 12 consecutive months without a period, usually between ages 45 and 55.¹

For some women, it could come earlier. When it does, depending on the timing, it could be early, surgical, or premature menopause.

• Early menopause: It may show up before age 45 and affects around 5% of women.^1,2 It could appear without cause or due to medical or surgical treatment.^1,3
• Premature ovarian insufficiency (POI): It happens when the ovaries stop working as usual before age 40.⁴ Your ovaries still work, but you may not ovulate as much, causing fewer periods or difficulties getting pregnant.⁵ It affects 1 in 1,000 women under 30, and 1 in 100 before 40.⁵
• Surgical menopause: It may happen immediately after your doctor removes both ovaries at any age.⁶ Symptoms may feel more sudden and intense than natural menopause.⁷

Symptoms of Early and Premature Menopause

When you notice early menopause or POI symptoms, it might not be the first thing that comes to your mind.^1,4,8 You might think of thyroid issues, stress, or other conditions first, and that's pretty normal.

But it could be worth talking to your doctor if you notice any of these signs of early menopause or POI. Let’s take a look at these now.

What Are the Signs of Early Menopause?

Early menopause and POI symptoms may feel the same as menopause, the difference is the timing.⁸

Physical symptoms:

• Irregular or absent periods¹
• Hot flushes ¹
• Night sweats¹
• Vaginal dryness and discomfort¹
• Low sex drive¹
• Trouble sleeping¹
• Bladder changes including urgency, frequency, and leaks^1,9
• Joint pain and muscle stiffness¹⁰
• Dry and itchy skin¹⁰
• Thinning hair¹¹
• Breast soreness¹¹
• Headaches¹⁰
• Heart palpitations¹⁰

Emotional and cognitive symptoms:

• Mood swings, irritability, and low mood¹¹
• Anxiety, sometimes appearing for the first time¹¹
• Brain fog¹¹
• Low confidence or self-esteem¹¹

Unexpected leaks or rushing to the bathroom throughout the day could feel frustrating, but it's more common than you might think during early menopause.^9,11

If this is something you're navigating, our guide on menopause and bladder health covers everyday tips. You can also explore our range of women's incontinence products to help you feel confident every day.

What Causes Early and Premature Menopause?

Sometimes both early menopause and POI causes are unknown.^1,5 In other cases, medical reasons, genetics, and lifestyle factors could play a role.^1,4

Genetic Causes

Is early menopause genetic? Well, if there is no clear medical reason for early menopause, genetics may be the culprit.^1,4

Some genetic causes of early menopause and POI include:

• Family history: Your genes play a big role in POI and early menopause.^1,4 If someone in your family had POI or early menopause, it might be the same for you too.^1,3
• Turner syndrome: A genetic condition where one X chromosome is missing or doesn't develop fully.¹² It could affect your ovaries leading to POI or early menopause.^1,4
• Fragile X syndrome: A genetic condition that affects how you develop.¹³ Women who carry the gene may not have the full condition themselves but could still experience POI or early menopause.^1,4
• Galactosaemia : It is a rare genetic metabolic disorder.¹³ It could have a toxic effect on your ovaries, which could make POI more likely.¹⁵

Other chromosome disorders could also affect your ovaries' function.¹ If you have a family history of them, early menopause, or POI, speaking with your doctor about genetic testing could help you understand your personal risk better.

Autoimmune Causes

An autoimmune condition happens when your immune system mistakes a part of your body for an invader.² Sometimes it could affect your ovaries, causing POI or early menopause.^1,4

Some of these conditions that could cause an autoimmune menopause include:

• Thyroid disease¹
• Addison's disease¹
• Rheumatoid arthritis¹
• Lupus (SLE)¹⁶
• Type 1 diabetes¹⁶
• Myasthenia gravis¹⁶
• Inflammatory bowel disease (IBD)¹⁶

POI that comes with autoimmune conditions may put you at a higher risk of developing others, especially Addison's disease and type 1 diabetes.17If you have any of these conditions, it could be worth speaking to your doctor about your risk.

Medical Treatments, Conditions and Surgery

Sometimes, certain medical treatments or conditions could cause early menopause or POI. If you notice symptoms during or after any of these factors, it could be worth speaking with your doctor about your options first.

Chemotherapy and Early Menopause

Chemotherapy is a common cause of early menopause.6 Certain drugs your doctor may use in cancer treatment could affect the ovaries.⁶

For some women this may be temporary while for others it could be permanent depending on the type of drug your doctor uses.^6,18

If pregnancy is something you’re hoping for after treatment, it may be worth speaking to your doctor beforehand.⁶

Pelvic Radiation

It could affect your ovaries, causing early menopause.6 Depending on your age and dose, these effects may be temporary or permanent.⁶

Bilateral Oophorectomy (Removal of Both Ovaries)

It might be a preventive measure or a treatment option, but it could cause immediate (surgical) menopause.⁶

It happens because the procedure causes a sudden drop in estrogen levels rather than a gradual one, like in natural menopause; which means symptoms could feel more intense than usual.^6,7

Epilepsy

It is a seizure disorder that affects how your brain communicates with your ovaries through hormones.¹⁹

Both epilepsy and its medication could increase your risk for early menopause.¹⁹ If you notice changes in your cycle, it could be helpful to speak to your doctor about them.

Lifestyle Factors and the Role in Early Menopause

For some women, certain lifestyle factors may influence when menopause begins, they include:

Smoking

Regular smokers might notice menopause symptoms 1 to 2 years earlier than non-smokers.^1,20 It happens because toxic chemicals in cigarettes may affect your egg supply, and estrogen levels over time.^1,20

Very low body weight or low BMI

Your body partly makes estrogen in fatty tissue, so women with a very low BMI might have lower estrogen stores, which could mean menopause may show up a little earlier.^1,21

Diagnosis and Tests for Early and Premature Menopause

If you've been experiencing symptoms for a while and haven't had any answers yet, you're not alone. Getting a diagnosis could feel like a relief, even when the news is hard to hear.

How Do Doctors Test for Early Menopause?

Your diagnosis process might look like:

Symptom and Menstrual History

Your doctor will ask about your menstrual cycle changes, when it began and how long it's been happening.¹⁶ They may also ask about your medical or family history.¹⁶

Laboratory Tests

After getting your history, your doctor might order one or more of these tests to help with your diagnosis:

• Follicular stimulating hormone (FSH) blood test: Two separate readings taken at least 4 to 6 weeks apart could hint to the doctor that you have begun menopause earlier.^1,22
• Estrogen blood test: Your doctor might check for estrogen levels to help with your diagnosis.^1,22
• Anti-Müllerian hormone (AMH) blood test: It tells your doctor how close you are to menopause, or if you're in menopause, but it's not a routine test.^1,22

To help rule out other conditions, your doctor might suggest further tests based on your family or medical history.16 Some of them include:

• Thyroid function test: It helps check if a thyroid condition might be causing your symptoms.¹⁶
• Adrenal function test: To check for any sign of Addison's disease.¹⁶
• Genetic testing: To help rule out conditions like Turner and Fragile X syndrome.¹⁶

Getting a POI or early menopause diagnosis could bring up a lot of emotions. It could help to bring someone you trust to your appointments, and don't hesitate to ask your doctor any questions. They are trained to help you through this process.

Management and Treatment of Early and Premature Menopause

POI and early menopause are manageable. Your doctor might suggest options that range from hormonal therapy to lifestyle changes to help protect your bone, heart, and overall health long term.^4,16,22

Let's look at possible treatments or changes:

Hormone replacement therapy (HRT)

If you have POI, your doctor might suggest you take it to help replace estrogen levels until at least age 52 to help protect your health.^5,23

It has several options you could choose to fit your health needs and preferences.⁴ It comes in patches, tablets, creams, vaginal rings, and intrauterine devices.⁴

Non-hormonal treatment

If HRT isn't suitable for you, your doctor could suggest other ways to help manage your symptoms and protect your long-term health. ^4,24

These might include certain medications or lifestyle changes depending on your needs.

Some lifestyle changes you could try include:

• Regular pelvic floor exercises to help strengthen your pelvic floor muscles.⁹
• Eating a balanced diet rich in calcium to help with your bone health.⁴
• Getting enough vitamin D, safely through sunlight with sunscreen.⁴
• Maintaining a healthy weight with aerobic and weight-bearing exercises for your heart health.⁴
• Using our women's incontinence products to help you stay confident and comfortable when bladder leaks happen.
• Training your bladder with techniques such as timed voiding to help with urgency.⁹

If a family is in your future plans, speaking to a specialist early could be worth it so you may understand your options.

And if you're finding the emotional side hard to navigate, a mental health professional could help with support options like cognitive behavioral therapy. It might help with anxiety or low mood.²²

The Physical and Emotional Impact of Early and Premature Menopause

Early menopause and POI could bring a range of physical and emotional changes. For many women, it could be unsettling and overwhelming because there wasn't time to prepare.

The physical impact

Many of the physical symptoms of early menopause and POI are the same as those of natural menopause: hot flashes, night sweats, sleep disruption, and joint discomfort.^1,8

But experiencing them earlier could mean navigating them while still managing a full and active life.

Urinary symptoms like urgency, frequency, and bladder leaks could make it harder to feel at ease during everyday activities.

Low sex drive, vaginal dryness, and mood swings may also affect intimate relationships.

Skin, hair, and breast changes might affect how you feel about yourself, and trouble concentrating or a memory lapse may make it harder to focus at work and give your best.

These changes like bladder leaks are manageable with the right support.¹

Our menopause and bladder health guide and line of women's incontinence pads, liners, and underwear may help you feel comfortable and confident each day while your doctor helps with managing your symptoms.

The emotional impact

It could feel harder coming to terms with menopause when it happens earlier than expected. It may leave you confused about your identity, or even isolated because you feel out of step with your friends.

If you want a family, a POI diagnosis could feel devastating, even if pregnancy could still be possible.⁴

These feelings are valid and normal for anyone. Finding the right support whether through a healthcare professional, a trusted person in your life, or a community of women who truly understand, could make a real difference.

In the US, resolve helps connects women with POI and early menopause with peer support and resources.

The long-term implications

Estrogen helps keep your heart, bones, and blood vessels healthy.⁵ Because early menopause and POI expose your body to lower estrogen levels for longer than average, it may carry some longer-term health risks worth paying attention to, including heart disease, fractures, osteoporosis, and, in some cases, dementia.⁵

Speaking to your doctor about monitoring your bone and heart health over time could be a helpful step. They might recommend HRT to help till natural menopause sets in around 52 years.^5,23

FAQ

Can Early Menopause Be Reversed?

While you may not always be able to reverse the effects of POI, it doesn't always mean a complete and permanent end of your ovaries' function.¹⁶

You might still notice periods, and a small number of women may even get pregnant naturally.¹⁶

Speaking to your doctor about your options could be a helpful first step. They might suggest options like hormone therapy and lifestyle changes to help protect your bones, heart, and overall health long term.⁴

Is Early Menopause Good or Bad for Your Health?

Noticing menopause earlier is neither a good nor a bad experience, but it does come with some long-term health risks that are worth paying attention to.⁵

You may have longer periods of lower estrogen levels, putting you at risk for heart disease and osteoporosis.⁵

Speaking to your doctor about monitoring your bone and heart health could be a helpful first step. They might even recommend HRT to help until natural menopause sets in to protect your health. ^5,23

What Causes Premature Ovarian Insufficiency (POI)?

POI happens when the ovaries slow down or stop working as usual before age 40.⁴

Sometimes it could show up without any clear cause, but when your doctor finds a cause, it could be one of the following:

• Chromosomal conditions like Turner and Fragile X syndrome.⁴
• Autoimmune conditions such as thyroid and Addison's disease.⁴
• Medical treatments like chemotherapy, pelvic radiation, or surgery.^6,7

During your diagnostic process, your doctor may order a genetic test or autoimmune screening, such as a thyroid function test, to help rule out any of these causes.¹⁶

Can You Still Get Pregnant with Early Menopause?

If you have POI, it may still be possible.⁴ Around 5–10% of women with POI give birth without any fertility treatments, though it may vary depending on how well your ovaries work.^4,5

For women whose early menopause came because of surgery or certain medical treatments, the chances of getting pregnant may be lower.⁶

If pregnancy is something you're hoping for, speaking to a specialist early could help you understand your options, such as in vitro fertilization.⁴

How Is Early Menopause Diagnosed?

If you've been noticing changes in your cycle or other early menopause symptoms, it could be worth speaking to your doctor sooner rather than later.

Your doctor might start your diagnosis process with questions about your menstrual history and symptoms.¹⁶

Afterward, they could order a blood test to check your FSH levels. You might need to check your FSH levels twice, 4 to 6 weeks apart, because they can fluctuate.^1,22

Sometimes your doctor might also check your estrogen levels to help confirm menopause.²²

Depending on your results and medical history, your doctor may also run additional tests, such as a thyroid function test or genetic testing.¹⁶

What Are the Long-Term Health Risks of Early Menopause?

Because early menopause and POI mean your body has lower estrogen levels for longer than average, it may come with some longer-term health risks such as osteoporosis, heart disease, and, in some cases, memory issues.⁵

You could help manage these risks with everyday steps, such as:

• Regular weight-bearing exercise⁴
• A diet rich in calcium and vitamin D4
• Regular health check-ins⁴
• Regular pelvic floor exercises⁹
• Using women's Incontinence products for bladder leaks

Your doctor might also recommend HRT to help protect your bones and heart until natural menopause sets in around age 52.^5,23

What Is the Earliest Age Menopause Can Start?

Early menopause, happening before age 45, affects about 5% of women.² Premature menopause, which occurs before age 40, is less common, affecting around 1%.²

Menopause in your 20s is very rare, impacting only about 0.1% of women.² It could also occur in teenagers, especially those with Turner syndrome, though this is very rare, affecting around 1 in 10,000 girls under 20.^{5, 25}

Whatever your age, POI and early menopause are manageable with the right support.

References

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3. Cappelloni L. Early Menopause Risk Factors [Internet]. Healthline. Healthline Media; 2025 [cited 2026 May 21]. Available from: https://www.healthline.com/health/menopause/risk#surgery

4. Martin K. Primary ovarian insufficiency: Symptoms, treatment, and fertility [Internet]. www.medicalnewstoday.com. 2021. Available from: https://www.medicalnewstoday.com/articles/primary-ovarian-insufficiency

5.Premature Ovarian Insufficiency - Leeds Teaching Hospitals NHS Trust [Internet]. Leeds Teaching Hospitals NHS Trust. 2025. Available from: https://www.leedsth.nhs.uk/patients/resources/premature-ovarian-insufficiency/

6. Menopause and cancer [Internet]. St George’s University Hospitals NHS Foundation Trust. Available from: https://www.stgeorges.nhs.uk/service/living-with-and-beyond-cancer-2/supporting-pelvic-health-abdominal-related-concerns-sparc/sparc-menopause-and-cancer/

7. WebMD Editorial Contributors. Should You Take Estrogen After Your Hysterectomy? [Internet]. WebMD. 2024. Available from: https://www.webmd.com/menopause/surgical-menopause-estrogen-after-hysterectomy

8.Early and premature menopause [Internet]. www.nhsinform.scot. Available from: https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/early-and-premature-menopause/

9. Ames H. What is the link between perimenopause and an overactive bladder? [Internet]. Medicalnewstoday.com. Medical News Today; 2022 [cited 2026 May 18]. Available from: https://www.medicalnewstoday.com/articles/overactive-bladder-perimenopause#link

10. NHS. Symptoms - Menopause [Internet]. NHS. 2022. Available from: https://www.nhs.uk/conditions/menopause/symptoms/

11. Todd L. What are the 34 symptoms of menopause, and what helps? [Internet]. 2021. Available from: https://www.medicalnewstoday.com/articles/what-are-the-34-symptoms-of-menopause#symptoms

12. Marcin A. Mosaic Turner Syndrome: What It Is and How It’s Treated [Internet]. Healthline. 2024. Available from: https://www.healthline.com/health/childrens-health/mosaic-turner-syndrome

13. Levine H, Benisek A. Fragile X Syndrome [Internet]. WebMD. WebMD; 2024. Available from: https://www.webmd.com/children/what-is-fragile-x-syndrome

14.Supporting someone with Galactosaemia [Internet]. NHS. 2025. Available from: https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/supporting-someone-galactosaemia

15. Fenton A. Premature ovarian insufficiency: Pathogenesis and management. Journal of Mid-Life Health. 2015;6(4):147.

16. Sopiarz N, Sparzak PB. Primary Ovarian Insufficiency [Internet]. National Library of Medicine. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK589674/

17. Rudnicka E, Kruszewska J, Klicka K, Kowalczyk J, Grymowicz M, Skórska J, et al. Premature ovarian insufficiency – aetiopathology, epidemiology, and diagnostic evaluation. Menopausal Review. 2018;17(3):105–8.

18. Morgan KK. Ovarian Cancer in Younger Women [Internet]. WebMD. 2025. Available from: https://www.webmd.com/ovarian-cancer/ovarian-cancer-younger-women

19. Sazgar M, Mnatsakanyan L, Pack AM, Harden CL. Epilepsy and Anti-Seizure Medications: Secret Agents for Endocrine Disruption. Epilepsy currents/Epilepsy currents. 2023 Dec 6;24(2):79–83.

20. Zhu D, Chung HF, Pandeya N, Dobson AJ, Cade JE, Greenwood DC, et al. Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies. Basu S, editor. PLOS Medicine. 2018 Nov 27;15(11): e1002704.

21. Bjune JI, Strømland PP, Jersin RÅ, Mellgren G, Dankel SN. Metabolic and Epigenetic Regulation by Estrogen in Adipocytes. Frontiers in Endocrinology. 2022 Feb 22;13.

22.Menopause: Identification and management [Internet]. NICE. 2026. Available from: https://www.nice.org.uk/guidance/ng23/chapter/Recommendations

23. CDC. Menopause, Women’s Health, and Work [Internet]. Women’s Health. 2024. Available from: https://www.cdc.gov/womens-health/features/menopause-womens-health-and-work.html

24. Guo Z. Precision pharmacology in menopause: advances, challenges, and future innovations for personalized management. Frontiers in Reproductive Health [Internet]. 2025 Nov 13;7. Available from: https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2025.1694240/full

25. Porcu E, Cipriani L, Damiano G. Reproductive health in Turner’s syndrome: from puberty to pregnancy. Frontiers in Endocrinology [Internet]. 2023 Dec 5;14:1269009. Available from: https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1269009/full