When menopause occurs before age 40, it’s often referred to as premature menopause. If it occurs before age 45, it’s called early menopause. Early menopause and premature menopause can happen for different reasons, sometimes naturally and sometimes due to medical treatments like chemotherapy.
Experiencing menopause symptoms earlier than expected can feel unsettling. But there are effective ways to manage these symptoms so you can stay healthy and live a full, active life.
1. There Are Different Types of Early Menopause
Early menopause can occur for different reasons, and the cause often determines the plan of care, says Marie Nakhoul, MD, a board‑certified ob-gyn in the University of Maryland Medical System and an assistant professor at the University of Maryland School of Medicine in Baltimore. Healthcare providers group early menopause into a few main categories, based on the cause.
Natural Early Menopause
Induced Menopause
If you’re planning to start a treatment that could affect your ovaries, talk with your care team ahead of time about fertility preservation options if possible.
Premature Ovarian Insufficiency
In some cases, the ovaries stop functioning as they should before age 40, a condition known as premature ovarian insufficiency (POI). This condition is not a true form of menopause but often leads to menopauselike symptoms. “Ovarian function can be intermittent, so some people still have occasional [menstrual] cycles or ovulation,” says Nakhoul.
2. Symptoms Are More Than Just Hot Flashes
While hot flashes tend to get the most attention, early menopause may begin in less obvious ways.
As hormone levels continue to shift, hot flashes and night sweats may become more frequent, along with sleep disruptions and mood changes, says Dr. Dweck. Many women describe feeling more anxious or irritable, or just not like themselves, Nakhoul says.
Some symptoms tend to get less attention, and many people don’t immediately connect them to hormonal changes, especially if they’re younger and not expecting menopause yet, says Dweck. These symptoms can include the following:
- Brain fog
- Changes in sexual desire
- Vaginal dryness
- Joint pain
- Thinning hair or skin
- Weight gain or fat redistribution around the midsection
Because these symptoms can overlap with other health issues, early menopause isn’t always the first thing that comes to mind. But if you’re noticing several of these symptoms, especially along with changes in your period, discuss them with your healthcare provider.
3. Early Menopause Is Linked to Health Risks
The age at which menopause begins can affect your health in many ways, largely due to the drop in estrogen. “Early menopause means the body spends more years in a low-estrogen state, and estrogen supports multiple systems [in the body],” says Nakhoul.
Estrogen is important for sexual and reproductive health, but it also helps keep the bones strong, protects the heart and blood vessels, and supports brain function and mood. When estrogen levels drop earlier than expected, these protective effects diminish sooner. Research shows that entering menopause before age 45 is linked to higher risks of heart disease and bone loss. These risks are even greater when menopause happens before age 40.
Bone Health
A study of over 21,000 postmenopausal women found that those who entered menopause before age 40 were more likely to break a bone than those who experienced menopause at age 50 or older.
Heart Health
The heart and blood vessels can be affected by the drop in estrogen. Dweck says that estrogen helps keep the inner lining of the blood vessels flexible and functioning well. Without that support, the blood vessels can become stiffer and more prone to damage.
Because these changes don’t always cause noticeable symptoms at first, keep a close eye on key health numbers such as blood pressure and cholesterol levels. Staying active, keeping a healthy weight, and eating a heart-healthy diet become even more important to help lower your risk.
Mental Health
Taking care of your mental health is just as important as caring for your physical health during early menopause. Because the brain uses estrogen to help regulate mood, sleep, and focus, a drop in this hormone can affect these areas. It’s common to experience increased anxiety or irritability, says Nakhoul. You may also notice a frustrating cycle in which the hormonal changes disrupt your sleep, and the lack of rest makes it harder to manage your mood or stay focused.
On top of these changes, learning that you’re experiencing early or premature menopause can be difficult and isolating, especially if you were planning to have children or weren’t ready for this stage of life. Feelings of grief, loss, and frustration are common and completely valid.
Talking with a therapist or counselor who understands reproductive health and connecting with others who’ve experienced early menopause may help you feel less alone and more supported as you adjust.
4. Hormone Replacement Therapy Can Help Protect Your Bones and Heart
Lifestyle changes are a good foundation if you’re experiencing early menopause, but many healthcare providers also recommend hormone replacement therapy (HRT), as it serves two important purposes, says Nakhoul. “The first purpose is symptom relief, because hormone therapy can be very effective for hot flashes, night sweats, and sleep. The second is health protection,” she says, to replace the hormones that you’ve lost unexpectedly early.
HRT fills the hormonal gap, and it’s approved by the U.S. Food and Drug Administration (FDA) for treating hot flashes and preventing bone loss, Dweck says. For younger women who are facing many years without natural estrogen, hormone replacement can also help keep the heart and blood vessels healthy and support brain function.
Many people find their emotional health improves with HRT, Nakhoul adds, especially as they start getting better sleep and their physical symptoms become easier to manage. HRT can also improve vaginal and urinary symptoms, including dryness and discomfort during sex, says Nakhoul.
Healthcare providers generally recommend starting hormone therapy within 10 years of the onset of menopause and before age 60. How long you stay on HRT depends on your individual needs. “In most cases, we recommend continuing hormone therapy until the average age of natural menopause, around 52, but sometimes until 60,” says Nakhoul. Ultimately, you and your gynecologist will work together to decide on the best timeline based on your health history and how you’re feeling.
It’s worth noting that the FDA removed the warning that previously raised concerns about menopause hormone therapy. This update helps clarify that HRT can be a safe option for many people when used appropriately. That said, HRT isn’t the right choice for everyone, which is why discussing your personal health history and the pros and cons with your healthcare provider is important.
5. Nonhormonal Options Can Help Manage Symptoms
For those who can’t take hormone therapy or prefer not to take it, there are other effective ways to manage early menopause symptoms, including nonhormonal medications, lifestyle changes, and integrative therapies.
For Hot Flashes and Night Sweats
- Certain Antidepressants Low doses of some antidepressants, including selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, can reduce hot flashes and night sweats, and may help with mood changes. These medications don’t contain hormones and are often used when estrogen isn’t an option.
- Gabapentin Originally used for nerve pain and seizures, gabapentin (Neurontin) can be effective for hot flashes, especially nighttime symptoms that interfere with sleep.
- Nonhormonal Medications Newer drugs like fezolinetant (Veozah) and elinzanetant (Lynkuet) act directly on the brain’s temperature-control center to help manage moderate to severe hot flashes. They can be very effective for some people, says Nakhoul, though they’re generally not as strong as estrogen.
For Sleep and Mood
For Vaginal and Urinary Symptoms
For dryness, discomfort during sex, or urinary symptoms, nonhormonal vaginal moisturizers and lubricants can help. Selective estrogen receptor modulators are a nonhormonal oral medication that can act like estrogen in the vaginal tissues to improve dryness or pain. Pelvic floor physical therapy may be useful for some people.
Other Approaches
- Lifestyle Changes “Lifestyle modifications are beneficial for symptom control and for health benefits,” says Dweck. These include avoiding tobacco, limiting alcohol, eating a balanced diet, exercising regularly with strength training, getting consistent sleep, managing stress, and staying connected with your community.
- Complementary and Integrative Treatments Some people try acupuncture, hypnotherapy, relaxation, supplements, and mindfulness practices. Nakhoul says that using a layered approach, meaning combining a few strategies at the same time, can be helpful since menopause symptoms tend to overlap. Such supplements are not regulated by the FDA — you should speak with your doctor before starting any new supplements, as they can potentially interact with other medications or medical conditions.
Finding the right combination of nonhormonal options often takes some trial and error, and what works well for one person may not be the best fit for someone else. If you’re curious about any of these approaches, or you’re not sure where to start, discuss your symptoms, health history, and preferences with your healthcare provider to see which options might work best.
6. Pregnancy May Still Be Possible
Concerns about future pregnancy are natural if you’ve been told you’re in early menopause. But there are options to look into. “Time and clarity matter,” says Nakhoul, who recommends seeing a reproductive endocrinologist as soon as early menopause is suspected.
In POI, ovarian function can sometimes be intermittent, meaning pregnancy can happen on its own, though it’s uncommon and unpredictable, Nakhoul says. For many people, in vitro fertilization using donor eggs or donor embryos offers a more reliable path. If you’re facing medical treatment that could induce early menopause, cryopreservation (egg freezing) before treatment starts may be possible when timing allows, says Dweck.
Your doctor may be able to recommend resources and support groups for those going through fertility preservation. “What I want patients to feel at the end is that they are not alone in this. We can protect their health proactively, manage symptoms thoughtfully, and talk through fertility options with compassion and a real plan,” says Nakhoul.
The Takeaway
- Early menopause means menopause begins before age 45, and when it occurs before age 40, it’s called premature menopause. Symptoms can include changes in periods, hot flashes, sleep problems, and mood shifts.
- Because estrogen levels drop sooner than expected, early menopause is associated with increased risks of bone loss and heart disease.
- Hormone therapy is often recommended for people with early menopause to manage symptoms and help protect long-term bone and heart health, though nonhormonal treatments can also be effective.
- If you’re experiencing symptoms of early menopause or have concerns about your health or fertility, talk to a healthcare provider who can help you understand your options and provide support.
Read the full article here
