Early menopause: symptoms, causes and tests

What is early menopause?

Menopause is when your periods stop for good. Worldwide, natural menopause usually happens between ages 45 and 55 (WHO). In Türkiye, the average age of menopause is reported as 47–49 (Hacettepe University Department of Public Health).

Two terms are used for menopause that comes before these ages (NHS, Early menopause):

• Early menopause: periods stopping before age 45.
• Premature menopause: periods stopping before age 40. In medicine this is often called premature ovarian insufficiency (POI), meaning the ovaries largely stop working before 40. Turkish sources abbreviate it as POY.

The terms can vary from source to source. For example, an information note from Hacettepe University’s Department of Public Health in Türkiye calls menopause before 40 “early menopause.” Checking which age cut-off an article means makes things easier.

This page explains the definition, the symptoms, why it matters and which tests are done; it does not cover treatment options.

How common is early menopause?

It is more common than people think. The Menopause Society says about 3 in 100 women reach menopause before age 40. A meta-analysis (a study that pools the results of many studies) combining 31 studies found a worldwide prevalence of 3.7 percent for premature ovarian insufficiency and 12.2 percent for early menopause. In the same study, premature ovarian insufficiency was more common in countries with medium and low human development levels (Golezar et al., 2019).

What causes early menopause?

Early menopause can happen naturally, or it can be the result of a treatment or surgery.

Medical treatment and surgery: Removal of both ovaries, chemotherapy and radiotherapy can bring on menopause (The Menopause Society; WHO). The NHS also adds some hormone medicines to this list.

Ovaries slowing down early: In premature ovarian insufficiency, the ovarian follicles (egg sacs) run out earlier than expected. The Menopause Society lists some genetic and autoimmune conditions (diseases in which the immune system attacks the body’s own tissue) among the known causes. The WHO also mentions chromosomal abnormalities and autoimmune diseases. For many people, no cause is found.

Risk factors: The NHS lists the following (NHS, Early menopause):

• A family history of early menopause.
• Having started your periods at a young age.
• Smoking.
• Being underweight.

Having one of these factors doesn’t mean you will have early menopause; it only makes it more likely.

What are the symptoms of early menopause?

The main symptom is periods becoming irregular or stopping completely before age 45. Otherwise, the symptoms are similar to menopause at the usual age (NHS, Early menopause):

• Hot flashes (hot flushes) and night sweats.
• Vaginal dryness.
• Difficulty falling or staying asleep.
• Low mood or anxiety.
• Reduced sex drive.
• Problems with memory and concentration.

In people who have had both ovaries surgically removed, symptoms usually start soon after the operation. In early menopause that happens naturally, the change can be more gradual: periods first become less frequent and the gaps between them get longer.

The emotional burden is also part of the picture. The Menopause Society notes that concerns about body image, sexuality and fertility are common among women going through early menopause. The NHS also stresses that early menopause can affect mental health.

Why does early menopause matter? Bones and heart

Early menopause is not only “a matter of symptoms.” Estrogen also protects your bones and blood vessels; when that protection drops years earlier than expected, long-term risks appear.

Bone health: The NHS says people who go through early or premature menopause are more likely to develop osteoporosis (thinning, weakened bones). The Menopause Society also writes that bone loss starting early can lead to osteoporosis-related fractures at a younger age.

Heart and blood vessel health: The NHS says the chance of cardiovascular disease is higher with early menopause. The WHO writes that as estrogen falls after menopause, the advantage women have over men in protection against cardiovascular disease is gradually lost. For this reason, The Menopause Society recommends regular cholesterol and blood sugar (diabetes) screening.

Brain: The Menopause Society notes that menopause can affect cognitive function and that estrogen has protective effects on the brain.

Because of these risks, guidelines place particular importance on discussing treatment options in detail with a clinician in early menopause (NHS, Early menopause; NICE NG23). Which option suits you depends on your health history; this is something to discuss with your clinician.

Which tests are done for early menopause?

Over 45, assessing menopause usually doesn’t require tests. Under 45, things are different. The NHS says a doctor may order a blood test for people under 45 who have menopausal symptoms. NICE also recommends considering an FSH test between 40 and 45 in those with cycle changes and menopausal symptoms, and under 40 when menopause is suspected (NICE NG23).

FSH (follicle-stimulating hormone) is a hormone that stimulates the ovaries and rises when ovarian function declines (The Menopause Society, Premature Menopause). Under 40, NICE recommends the following (NICE NG23):

• The assessment is based on symptoms, such as no periods or infrequent periods, together with raised FSH in two blood samples taken 4–6 weeks apart.
• A decision is not made on the basis of a single blood test.
• AMH (a hormone that reflects egg reserve) is not used routinely for this purpose.
• Your clinician also takes into account any previous treatments and your family history.
• If the situation is unclear, you are referred to a specialist in menopause or reproductive health.

In addition, your clinician may order a pregnancy test or tests looking into other causes of irregular periods. We explain in detail when hormone tests are useful on the is there a menopause test? page.

What can you observe yourself?

Early menopause is often noticed through a change in your bleeding pattern: cycles may get shorter or longer, and some months your period may not come at all. The Menopause Society’s criterion for under-40s is three or more missed periods. The easiest way to notice this is to write the start date of each period in a calendar. That way you can answer “When was my last period?” with a date instead of a guess, and your clinician can plan tests around your cycle. Adding hot flashes, night sweats and changes in your sleep to the same record also helps.

When should you see a doctor if you suspect early menopause?

The Menopause Society recommends that women younger than 40 who have missed three or more periods see a healthcare professional. The NHS also recommends seeing a doctor if you think you have menopausal symptoms, especially if you are under 45.

It helps to bring the following to your appointment:

• Your period dates for the last few months and any skipped cycles.
• When your symptoms started and how often they happen.
• The age at which your mother and sisters reached menopause, if you know it.
• Any surgery, chemotherapy or radiotherapy you’ve had.
• Whether you plan to have children.

A detailed checklist for preparing is on the before you see your doctor page.