Premature Menopause: Causes, Symptoms & Solutions

Is your period becoming increasingly irregular, with bleeding stopping earlier than you'd expected? Changes like these can be signs of premature menopause – a phase that affects women before the age of 40 and can have an impact on fertility as well as general health.

In this article, you'll find out what causes it, which symptoms to watch out for and what solutions exist to help you maintain your hormonal balance and wellbeing.

What is premature menopause? 

Premature or early menopause is a rare disorder in which menstrual cycles stop permanently before the age of 40.

Menopause is the stage of life in which pregnancy is no longer possible. Most women experience this natural process between the ages of 45 and 55. In premature menopause, which affects around 1% of women, the ovaries stop producing oestrogen and progesterone considerably earlier.

This can affect your fertility, your bone density and your cardiovascular health – but also your emotional wellbeing and quality of life.

The difference between premature menopause and primary ovarian insufficiency

Primary ovarian insufficiency is a dysfunction of the ovaries that usually occurs in women aged between 18 and 29 and means that the ovaries can no longer produce normal amounts of hormones.  Although premature menopause and premature ovarian insufficiency are often used interchangeably, there are important differences.

Menopause means the definitive end of menstrual cycles and is the result of the depletion of the ovarian follicles – so it is fundamentally irreversible. When it occurs prematurely, it begins before the age of 40. 

Premature ovarian insufficiency, on the other hand, is characterised by the fact that in around half of the young women affected, the ovaries still function intermittently. According to PubMed, PMID 10818427, these women can occasionally produce oestrogen and even ovulate; pregnancies are possible – albeit rarely – even years after the initial diagnosis.

To date, however, there are no proven treatments that can restore fertility following a diagnosis of primary ovarian insufficiency.

Common causes of premature menopause 

Often the precise reason why menopause begins before the age of 40 remains unknown. The early onset may be due to a wide range of factors – from a genetic predisposition and medical conditions through to lifestyle influences.

Specialists have, however, identified several key categories that increase the risk of entering menopause prematurely:

Genetic factors in premature menopause 

If no obvious medical cause for premature menopause can be identified, genetic predisposition is the most likely explanation. This can be passed down through families – which is why women with close relatives (mother, sister) who experienced premature menopause have an above-average risk of going through the same thing before the age of 40.

Autoimmune conditions 

Autoimmune conditions such as Hashimoto's thyroiditis or rheumatoid arthritis can cause the immune system to mistake its own cells, tissues and organs for invaders and attack them. If the inflammation triggered by these conditions affects the ovarian tissue, it can influence oestrogen production and bring on premature menopause.

Chromosomal abnormalities 

Some women are born with chromosomal changes that impair ovarian function. People with Turner syndrome, for instance, are born with an incomplete chromosome, which can lead to limited ovarian function and an early entry into menopause. Other subtle genetic abnormalities can also reduce the reserve of ovarian follicles at a young age.

Viral infections 

Although less common, certain viral infections can damage ovarian tissue and contribute to an early onset of menopause. Research suggests that viruses such as parvovirus B19 can reduce the activity of thyroid hormones and oestrogen in the body and, if left untreated, affect the ovaries.

Aggressive medical treatments 

Chemotherapy, radiotherapy and surgical procedures involving the ovaries have repeatedly been linked to an increased risk of early menopause. While these treatments can be life-saving in serious illnesses such as cancer, they do accelerate the onset of menopause.

Lifestyle and environmental factors 

Smoking, chronic stress and exposure to toxins or certain environmental chemicals can affect oestrogen levels and have a negative impact on ovarian function. A poor diet, a sedentary lifestyle and too little sunlight can also contribute to hormonal imbalances that encourage premature menopause.

Symptoms and signs of premature menopause 

Premature menopause is often difficult to spot at first, as the initial symptoms can be subtle. Irregular cycles and periods lasting longer or shorter than usual are easily attributed to other causes.

As menopause progresses, the signs become clearer and include physical complaints as well as emotional and cognitive changes that affect your quality of life and wellbeing.

Early menopause – physical symptoms  

The most obvious symptom of premature menopause is periods becoming less frequent or stopping altogether, without pregnancy or any other obvious explanation.

There are, however, other physical signs that can appear before menopause sets in – and it's important to arrange a gynaecological examination as soon as you first notice them. Speak to a doctor if you notice any of the following:

• Hot flushes
• Night sweats
• Sleep disturbances
• Spotting
• Vaginal dryness (may cause discomfort or pain during intercourse)
• Reduced libido
• Changes to the menstrual cycle (irregular periods, or bleeding that is shorter or longer than usual)
• Absence of periods (amenorrhoea)
• Other symptoms (weight fluctuations, headaches, thinning hair, dry skin, palpitations)

Premature menopause – emotional and cognitive symptoms 

Alongside the physical complaints, premature menopause can also affect your emotional wellbeing and your ability to concentrate. The most common symptoms include:

• Anxiety (persistent worry or inner tension)
• Depression
• Irritability, accompanied by disproportionate emotional reactions or rapidly shifting moods
• Difficulties with concentration and memory

Premature menopause – how the diagnosis is made

The diagnosis is made by a gynaecologist on the basis of a combination of clinical examination, hormone tests and imaging.

An irregular cycle and the absence of periods for 12 consecutive months can be clear indicators. So do see a specialist as soon as possible if you suspect you're entering menopause earlier than usual. Early detection helps to prevent complications and to choose the right solutions.

Recommended hormone tests for premature menopause

Blood tests are carried out on medical advice to assess ovarian function and hormone levels. The most commonly recommended tests measure the following:

• FSH (follicle-stimulating hormone): to assess ovarian function;
• LH (luteinising hormone): together with FSH, can confirm ovarian insufficiency;
• Oestradiol (oestrogen): a low level points to premature menopause;
• Anti-Müllerian hormone: to assess ovarian function;
• TSH (thyroid-stimulating hormone): to check thyroid health;
• Additional tests, depending on your history and any coexisting conditions.

Transvaginal ultrasound in premature menopause 

If the doctor considers it necessary, they may carry out a transvaginal ultrasound to assess the structure and size of the ovaries as well as the follicle reserve.

The ultrasound findings, combined with the hormone tests, provide a clearer picture of ovarian function and the health of the reproductive system.

Medical history and clinical assessment in premature menopause

A full assessment also includes a gynaecological pelvic examination and, where appropriate, further tests to rule out other causes of cycle disturbances.

To make the diagnosis, the doctor will also take into account your menstrual history, your family history and any coexisting conditions. It's therefore important to mention all the symptoms you've noticed, any previous medical treatments, any operations and any existing autoimmune conditions.

The effects of premature menopause on health 

Premature menopause affects more than just fertility and the absence of monthly bleeding.  An early start to this stage of life can have consequences for general health – both physical and psychological.

The early drop in oestrogen levels affects many of the body's systems, from the skeletal and cardiovascular systems through to mental state and emotional balance. Premature menopause is therefore associated with a number of risks, including:

Risk of osteoporosis 

Oestrogen plays a key role in maintaining bone density. A dramatic drop in levels before the normal age of menopause can accelerate the loss of bone mass and increase the risk of osteoporosis and fractures.

Cardiovascular disease 

In women of childbearing age, oestrogen helps protect the cardiovascular system. It helps raise levels of "good" cholesterol (HDL) and keep "bad" cholesterol (LDL) under control.

If menopause begins earlier, the premature drop in oestrogen can be associated with a rise in LDL levels and therefore a higher risk of high blood pressure and heart disease.

Declining cognitive performance 

Low oestrogen levels can have a negative effect on cognitive functions such as memory, attention and processing speed. Studies suggest that premature menopause may increase the risk of long-term cognitive decline.

Depression 

Alongside the emotional changes that come with an early start to menopause, the drop in oestrogen also affects neurotransmitters such as serotonin, which are involved in regulating mood. This can increase the risk of depression, anxiety and irritability. Psychological support, counselling and, in some cases, medication can help in managing the symptoms.

Premature menopause – treatment 

Premature menopause cannot be reversed, but treatment aims to ease the symptoms and reduce long-term risks. It is decided together with your gynaecologist – depending on the severity of your symptoms, your general state of health and individual goals such as wanting children or preventing osteoporosis.

From hormone therapies to lifestyle recommendations, there are numerous ways to manage the symptoms of premature menopause:

Hormone replacement therapy (HRT)

The decision to opt for this treatment is made solely on medical advice, weighing up the associated risks.

In hormone replacement therapy, oestrogen is administered to compensate for the body's reduced natural production, thereby replacing some of the hormones the ovaries can no longer produce. It is considered one of the most effective ways of relieving menopausal symptoms such as hot flushes, vaginal dryness and night sweats.

It can also reduce the risk of osteoporosis and cardiovascular disease. 

Non-hormonal treatments 

For women who cannot or do not wish to undergo hormone therapy, there are effective non-hormonal options for easing symptoms.

These include medicines to reduce hot flushes and night sweats, as well as calcium and vitamin D supplements that support bone and heart health.

Patients who feel the effects of premature menopause more acutely on an emotional level may be prescribed antidepressants or anxiolytics.

Natural remedies and complementary therapies 

Changes to daily habits and certain complementary therapies can help with managing symptoms, but should be discussed with your gynaecologist beforehand.

Red clover and black cohosh are plants frequently used in herbal medicine to relieve hot flushes. Relaxation and mindfulness techniques can help with anxiety and low mood, while exercise and yoga can help maintain bone mass and improve sleep.

Last but not least, a balanced diet is crucial for general health and hormonal balance.

Lifestyle recommendations for women with premature menopause 

Alongside any medication recommended by your doctor, a healthy lifestyle is just as important in getting the symptoms of premature menopause under control.

It's about simple changes and healthy habits when it comes to diet, exercise and managing stress. Put into practice day after day, they can make an enormous difference in maintaining your hormonal balance and overall wellbeing at every stage of life – all the more so when menopause begins early.

A balanced diet 

A nutrient-rich diet with sufficient protein, complex carbohydrates, good-quality fats and as many vitamins and minerals from vegetables and fruit as possible supports the health of your bones, heart and brain.

Drinking enough and limiting your intake of sugar, trans fats and highly processed foods is just as important for a body that functions at its best – and for your skin.

It's also worth including dairy products, leafy green vegetables, oily fish and fortified foods such as cereals and soya in your diet. These provide an adequate amount of calcium and vitamin D, helping to maintain bone density and prevent osteoporosis.

Regular physical activity

An active lifestyle helps to maintain bone and muscle mass while also protecting cardiovascular health.

Strength training with light weights is recommended to strengthen bones and muscles. Endurance exercise such as walking, running or swimming supports the heart and lungs, while stretching and yoga improve flexibility and balance and release muscular tension.

Managing stress

Chronic stress can intensify the symptoms of premature menopause and hormonal imbalances. To regulate your emotions and find some calm, you could try any number of mindfulness techniques – such as breathing exercises and deep meditation – or indeed leisure activities that make you feel good.

A regular sleep routine is also recommended, so that your body has time to recover. Support from family and friends can be a great help during this stage of life too.

Frequently asked questions about premature menopause 

Even though premature menopause means the end of natural fertility, it's important that every woman understands this: life does not stop here. This new phase doesn't determine your worth and doesn't define you – it simply reminds you to take better care of your health.

What's more, there are plenty of options to help you manage the symptoms and maintain your hormonal balance while looking after both body and mind. If you still have questions and would like to know more about how to get through this time as easily as possible, we hope you'll find the answers you need in the section below.

Can you get pregnant during menopause?

In most cases, premature menopause marks the end of natural fertility. Pregnancies resulting from occasional ovulation after the onset of menopause aren't impossible, but they are very rare. If you would like to have children, there are options such as in vitro fertilisation (IVF) that you can discuss with a specialist.

At what age can premature menopause occur? 

While normal menopause usually begins between the ages of 45 and 55, premature menopause occurs before the age of 40. Depending on the cause, in some cases it can even begin around the age of 30.

Does premature menopause affect fertility?

Yes, premature menopause is characterised by the end of the menstrual cycle and the loss of the ability to become pregnant. If you would like to have children, it's important to see a specialist as early as possible and to explore the various options for preserving fertility.

Are there natural remedies for treating the symptoms of premature menopause?

Some plants and supplements, such as red clover and certain vitamins and minerals, are thought to ease the symptoms of premature menopause. Their effectiveness isn't guaranteed, however, and it's always advisable to consult your doctor before using natural remedies.

Can lifestyle prevent premature menopause?

A healthy lifestyle cannot always prevent premature menopause, particularly when the causes are genetic or medical. A balanced diet, an active lifestyle and managing stress can, however, help to ease symptoms and reduce long-term health risks.

How does premature menopause affect bone health?

Throughout your reproductive years, oestrogen protects your bone density. In women who enter menopause prematurely, however, levels fall dramatically, which can accelerate the loss of bone mass and increase the risk of fractures and osteoporosis. Regular exercise and a diet rich in calcium and vitamin D will help you keep your bones strong and healthy.

Is there a link between stress and premature menopause?

Stress is not a direct cause of premature menopause, but it can intensify accompanying symptoms such as hot flushes, insomnia or mood swings. Relaxation techniques, meditation and a balanced lifestyle will help you reduce its negative effects.

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