When Menopause Happens Early

By Purnima Rao, MD, FACOG

Every woman eventually goes through “the change” – menopause – when the body stops producing reproductive hormones and menstrual periods cease. It’s expected that women will start seeing signs of menopause in their 40s, which is considered perimenopause, and will reach menopause by 51, on average.

But some women find themselves experiencing hot flashes, mood swings, and skipped periods earlier than expected, beginning and ending menopause in their 30s or 40s.

If menopause occurs before age 40, it’s considered premature menopause, which only happens to 1% of women. Early menopause is when menopause occurs between the ages of 40 and 45, which happens in about 5% of women.

It’s important to note that menopause isn’t official until a woman hasn’t had a menstrual period for 12 consecutive months. If a woman is still having periods, but has symptoms of menopause, she is going through perimenopause, which can last months or years.

Signs of Early or Premature Menopause

The signs of early or premature menopause are the same as the signs of natural menopause, but younger women may not be aware of what those signs are. They may also assume there’s another reason for experiencing these signs, as menopause isn’t even on their radar. But if you’re noticing any of these physical or emotional signs and you’re having irregular periods, it’s a good idea to consult with your doctor, especially if you’re still planning on getting pregnant.

It’s unusual for a woman to experience all of these signs, as everyone’s menopause journey is different. The cause of these symptoms is a significant decrease in estrogen, progesterone, and/or testosterone.

• Hot flashes – The feeling of a wave of heat rising through the body, turning the face red and causing sweating; hot flashes tend to happen numerous times throughout the day
• Night sweats – Similar to hot flashes, but tend to cause excessive sweating, causing women to wake up drenched
• Vaginal dryness – A later sign of menopause, this occurs because the vaginal walls become thin, sometimes leading to painful intercourse
• Bladder control issues – Leaking of urine can occur because vaginal tissue becomes less elastic, the lining of the urethra thins, and the pelvic floor weakens
• Insomnia/disrupted sleep – Difficulty getting to sleep due to fluctuating hormones and difficulty staying asleep due to night sweats
• Heart palpitations – Occurs during menopause and experienced by 25% – 40% of menopausal women; excess stress hormones, such as cortisol and adrenaline, are released causing the heart to race
• Weight gain – An increase in pounds and belly fat, even when eating and exercise habits haven’t changed
• Skin changes – Acne can occur early on because of hormonal imbalance; later, skin can become dry and lose elasticity
• Headaches – Can get worse and more frequent during menopause; some women experience migraine headaches for the first time
• Breast tenderness – Burning, soreness, or pain in the breasts due to spikes in hormone levels
• Gastrointestinal issues – Bloating, constipation, diarrhea, acid reflux, irritable bowel syndrome, and other issues due to a decrease in the hormones that regulate the gastrointestinal tract
• Paresthesia – Declining estrogen impacts the central nervous system causing skin to feel itchy, tingly, or numb
• “Buzzing” or electric shock sensation in the head – Thought to be caused by neurons misfiring triggered by fluctuating hormones
• Dizziness/lightheadedness – Can be caused by hormonal changes, migraines, fatigue, or anxiety (all common during menopause)
• Sore joints/muscles – Lack of estrogen in the estrogen receptors in the joints and around the muscles cause pain and soreness
• Hair loss or thinning – Lack of estrogen and progesterone can cause hair to stop growing and fall out
• Increased facial hair – An increase in testosterone can cause hair growth in areas that are common for men, such as above the lip and on the chin
• Changes in body odor – Typically caused by excess sweating from hot flashes, night sweats, and anxiety
• Irritability, anxiety, and mood swings – Primarily caused by hormonal fluctuations and sleep deprivation, but also by the stress of dealing with other menopausal symptoms
• Decreased libido – Reduced sex drive due to lower estrogen levels; vaginal dryness and fatigue may also contribute
• Brain fog – Difficulty concentrating, memory loss, and confusion, possibly caused by hormonal fluctuation and lack of sufficient sleep
• Fatigue/low energy – Caused by the body adjusting to new hormonal chemistry and by lack of sufficient sleep

Causes of Early or Premature Menopause

There are some clear-cut reasons some women go through menopause earlier than normal, but many times the reason is unknown.

The most likely causes of early or premature menopause are:

• Surgery to remove the ovaries – A bilateral oophorectomy or removal of both of the ovaries causes menstruation to stop permanently and hormone levels to drop quickly, resulting in almost immediate menopausal symptoms. Before having the surgery, you should talk to your doctor about plans for post-surgical hormonal support.
• Family history – Women tend to go through menopause at the same age their mother did, but this isn’t always the case. If you experience premature or early menopause and your mother did not, your grandmother or another relative may have. If no other causes can be pinpointed, family history is likely the culprit.
• Surgery to remove the uterus – A hysterectomy to remove the uterus but not the ovaries may cause menopause to occur sooner than normal, but this is not always the case. Periods stop and pregnancy is no longer possible, but the ovaries continue making hormones.
• Chemotherapy or radiation treatments – These cancer treatments, particularly pelvic radiation, can damage the ovaries and cause periods to stop permanently or temporarily, increasing the possibility of earlier-than-normal menopause.
• Autoimmune diseases – There’s some evidence that conditions such as hypothyroidism, hyperthyroidism, and rheumatoid arthritis, may cause the immune system to mistakenly attack the ovaries and prevent them from producing hormones.
• Missing chromosomes – Conditions such as Turner’s syndrome, which cause the ovaries to not form normally, can cause early cessation of menstrual periods.
• Chronic fatigue syndrome – Research shows that women with this condition, which causes extreme tiredness, weakness, memory loss, muscle and joint pain, and other issues, are more likely to experience early or premature menopause.

Because premature and early menopause are so rare aside from the removal of both ovaries, some doctors attribute a woman’s symptoms to other conditions. However, if you suspect you’re going through menopause early, please make an appointment with your doctor.