For half of the population, menopause is something that occurs during middle age and is a sign of the end of the reproductive years.
“Menopause is a natural process that occurs in women when their ovaries stop producing eggs, causing a permanent cessation of menstrual periods,” said Dr. Thomas Enyart, an OB-GYN with Orlando Health Physician Associates in Florida.
For most people, this happens at an average age of 52, according to Dr. Stephanie Faubion, the director of the Mayo Clinic Center for Women’s Health and medical director for the North American Menopause Society. Overall, a normal age range for menopause is 45 and older.
But in certain cases, menopause starts at a younger age — and that can sometimes be a problem. According to Faubion, 5% to 7% undergo early menopause, while 1% to 2% experience so-called premature menopause at an even earlier stage in life.
Speaking to HuffPost, experts explained what you should know about going through menopause early.
What is early menopause?
As its name suggests, early menopause is when menopause occurs before the natural age. Specifically, Faubion said it’s when menopause starts for those under 45. There is otherwise no difference between menopause and early menopause, she noted.
It is not the same as perimenopause, which refers to the few month or years before menopause begins. During perimenopause, people may start noticing changes and inconsistencies in their menstrual cycle (along with a few other issues) up until menopause happens.
What are the signs of early menopause?
“The signs and symptoms of early menopause are similar to those of natural menopause, including hot flashes, night sweats, vaginal dryness, mood changes and difficulty sleeping,” Enyart said, noting that emotional distress, anxiety and depression can also develop.
The difference is just the age at which these symptoms start, which is under 45 for early menopause and after 45 for “regular” menopause, according to Dr. Leah Millheiser, a clinical professor of obstetrics and gynecology at Stanford Medicine in California and the chief medical officer at telemedicine company Evernow.
Additionally, if your period stops for at least three months when you’re under 45 (and not pregnant), this is a sign of early menopause and needs to be checked out by a doctor, Faubion said.
It’s important to take note of a missing period since some people who go through early menopause do not have the typical symptoms of night sweats and hot flashes, she added. And without symptoms like these, “there’s not always a huge drive for them to get into a doctor’s office to see what’s going on, but they’re at risk in terms of bone, brain and heart [health] if they don’t use hormone therapy,” she said.
“They may also have a higher risk of developing certain cancers, including breast and ovarian cancer,” added Enyart.
Who is at risk of early menopause?
“Most of the time, we don’t know the cause” of early menopause, said Faubion. “So it’s therefore hard to say who’s at risk.”
While it can seem random, there are a few groups of people who have a higher likelihood of experiencing it. Chemotherapy or radiation therapy can induce menopause in some, Millheiser said, and ovary removal results in menopause as well. Family history — for example, if your mother, grandmother or sister went through early menopause — can put you at higher risk too.
There are also some other factors to keep in mind.
“If a woman started her period before the age of 11, she is at a higher risk of undergoing early menopause,” Millheiser said.
And those who smoke are likely to experience menopause an average of two years earlier than nonsmokers, she added. But Faubion noted that this two-year difference does not necessarily mean that menopause will begin under age 45 in all cases.
Additionally, some autoimmune diseases and genetic mutations can result in early menopause, Faubion said.
Early menopause is different than premature menopause.
There are two different categories of menopause that happen before the natural age: early menopause and premature menopause, which is also known as premature ovarian insufficiency.
This is when menopause occurs in people under the age of 40. For anyone experiencing premature menopause, it is “critical that those women receive hormone therapy up until the natural age of menopause,” Faubion said.
“These women … are at increased risk for heart disease, dementia, osteoporosis, mood disorders, sexual dysfunction and early mortality,” she added.
By utilizing hormone therapy until the natural age of menopause, you can lessen these kinds of health issues, Faubion noted.
Who is at risk for premature menopause?
“Whereas early menopause is just like ‘oh, I went through menopause earlier than most,’ [with] premature ovarian insufficiency, typically there’s a reason that somebody has gone through it,” said Millheiser.
It can be due to a medical condition, family history or autoimmune disorder, or it can be chromosomal, she said. “Hypothyroidism or rheumatoid arthritis can put you at risk,” Millheiser said.
Additionally, people with the chromosomal condition Turner syndrome are at heightened risk of developing premature menopause, along with those who suffer from chronic fatigue syndrome, she said.
“If you’re going through premature ovarian insufficiency, you should really be speaking to your clinician and trying to identify the cause,” Millheiser added.
What are the signs of premature menopause?
If your period unexpectedly stops when you’re under 40 (and not pregnant), this is a sign that you should see a medical professional, Faubion said.
“If a woman is not being hormonally manipulated — so, not on a birth control pill, doesn’t have an IUD [intrauterine device] in — and she’s missing periods, that’s not normal,” she said.
Night sweats, hot flashes and the other signs of symptoms of menopause are also signs of premature menopause. Like with early menopause, some people don’t have symptoms at all, Faubion added.
For people under 40, “there are issues with fertility and family planning that need to be considered. There’s the protection of bone density, which is extremely important,” she said.
“It’s [critical] … that those women use hormone therapy up until the natural age of menopause. It doesn’t matter if they’re having symptoms or not.”
Here’s what to do if you think you’re in early or premature menopause.
If a person thinks that they are going through early or premature menopause, they should talk to a doctor.
“The key is that they see somebody who’s knowledgeable,” Faubion said. You can go to menopause.org to find a practitioner who is certified in menopause management, she added. This can help decrease the possibility of a misdiagnosis, which some patients encounter.
“A lot of clinicians don’t [understand menopause],” Millheiser said. “And that is not because they didn’t want to learn about it; it’s because the medical field has failed clinicians in the United States in terms of their awareness of menopause — what it is, how to treat it.”
She added that “as a menopause practitioner at a major academic center, I see women who come in who are like ‘you are the fourth doctor I have seen for my menopause concerns’” — and these are often patients with normal menopause symptoms and no significant comorbidities.
“That’s a common narrative,” Millheiser said.
Starting treatment is important, and the right medical professional can help you connect with other people who are going through menopause before the natural age — so you feel less alone.