15 Causes Of Premature Or Early Menopause: Could It Happen To You?

woman looking at pregnancy test

While every menopause journey is unique, there is some consistency with the average age of onset. It’s 51 in the United States, but that number can vary and happen much earlier. Knowing if you’re at risk for premature or early menopause is crucial, as it can increase your risk of several health conditions. Plus, you may want to make family planning decisions earlier if that’s something you’re considering for your future. Prepare for menopause by understanding the causes of premature or early menopause.

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    Preparing for premature or early menopause

    If menopause arrives before age 40, then it is categorized as premature. If it occurs after age 40 but before age 45, it is known as early menopause.

    Are you trying to figure out if you’ll reach menopause earlier? Knowing if you’re at risk for early menopause is important so you can prepare earlier for risks associated with early and premature menopause and the potential for more severe symptoms. 

    The menopause journey is like a marathon and can last up to ten years. And like marathon training, the steps you take today can help you manage menopause better now and in the future.

    Lifestyle changes like healthy foods, rich with nutrients you need for menopause, and exercise can dramatically affect your menopause experience and reduce health risks associated with premature and early menopause, like dementia and cardiovascular concerns.

    You may also want to talk to your OB-GYN to discuss the best timing for attempts to become pregnant if that’s important to you and part of your life plan.

    That way, you’re prepared if menopause strikes before you have a child or while trying to get pregnant.

    If you develop menopausal symptoms or are at risk for premature or early menopause. a doctor can help with diagnosis as well as do a work-up for other possibilities. Although part of the evaluation may include lab work, menopause by definition, is the point in time when you have gone 12 consecutive months without a period. 

    Reasons for premature or early menopause

    There are several causes of premature or early menopause including:

    1. family history of premature or early menopause
    2. getting your period before age 11 (aka early menarche)
    3. primary ovarian insufficiency (POI)
    4. genetic conditions
    5. autoimmune conditions
    6. treatment of autoimmune conditions
    7. myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
    8. hysterectomy in premenopause
    9. oophorectomy
    10. endometriosis
    11. Race/ethnicity
    12. chemotherapy | pelvic radiation | hormone therapy to treat cancer
    13. smoking
    14. HIV/AIDS
    15. the mumps virus

    Let’s break down each cause.

    three generations of women

    1. Family history of premature or early menopause

    If your mom, sister, aunt, or grandmother had premature or early menopause, the chance increases that you will also have a similar experience. Genetics can impact the age you hit menopause.

    As has been noted in a clinical study, having a sister or multiple relatives with early menopause and having a relative with premature menopause increased the risk.

    The likelihood was greatest if the woman’s sister had early menopause.

    2. Early first period

    When did you get your period? Sometimes women don’t remember the precise date, and other women remember the exact moment.

    If you don’t remember, think about the rough age. Was it at or before age 11?

    That’s early and is referred to as early menarche.

    The typical age of menstruation is 13.

    Why does the age 0f first menstruation matter?

    In an analysis of more than 50,000 post-menopausal women across several countries and nine studies. women were found to be twice as likely to have premature menopause if they had early menarche and a third more likely to have early menopause.

    The risk was even greater if they had never been pregnant (nulliparous).

    The analysis included women from Japan, the UK, Australia, and Scandinavia.

    If you had your first period at or before age 11, having a proactive discussion with your GYN regarding premature and early menopause could be beneficial in planning the timing for beginning efforts to become pregnant if having children is important to you.

    It may also merit a conversation regarding freezing your eggs for future use as a potential plan B in case you experience premature or early menopause.

    3. Primary ovarian insufficiency (POI)

    Previously known as premature ovarian failure, POI is a condition in which the ovaries lose their reproductive and endocrine (hormone) functions before age 40.

    POI can cause menopausal symptoms due to the drop in estrogen levels it triggers. It also increases the risk of cardiovascular disease, osteoporosis, and potential changes in the brain. 

    There is no clear-cut consensus in the medical community on the causes of POI. Some potential possibilities include:

    1. “toxins” – chemicals and pesticides, cigarette smoke, chemotherapy, and radiation therapy
    2. an autoimmune condition in which antibodies are formed against one’s ovaries
    3. chromosome changes – seen in conditions like Turner’s syndrome and fragile X syndrome

    4. Genetic conditions

    Turner’s syndrome and Fragile X syndrome are two genetic conditions that can cause premature and early menopause.

    Turner’s syndrome is a genetic condition found only in women who are biologically female. It involves a missing, or sometimes abnormal, X chromosome. Instead of having the two X chromosomes normally found in each cell of the body in women, there is only one, or one of the two is abnormal.

    There are many negative health impacts related to this condition (e.g., hypothyroidism, hypertension, short stature, hearing loss), but one of the manifestations of Turner’s is primary ovarian insufficiency, which in turn leads to premature or early menopause.

    Fragile X syndrome is a genetic condition related to a mutation (of the FMR1 gene).

    Fragile X-Associated Primary Ovarian Insufficiency (FXPOI) is a condition in which there is a loss of normal ovarian function before the age of 40 in women who have a “premutation” in the FMR1 gene located on the X chromosome. In addition to having issues with their periods and potential infertility, between 12% and 28% of women with FXPOI will experience premature or early menopause.

    If you have been diagnosed with either Turner’s syndrome or fragile X syndrome, having a genetic counselor as part of the care team is beneficial.

    5. Will autoimmune conditions trigger premature or early menopause?

    In certain autoimmune conditions, it appears that antibodies develop against a woman’s ovaries, which leads to an inability for them to produce hormones like estrogen and progesterone.

    As a result, autoimmune disease can increase the risk of premature and early menopause. Conditions found to increase the risk include thyroid disease, Crohn’s disease, rheumatoid arthritis, and lupus.

    6. Can treatment of autoimmune conditions cause premature menopause?

    Yes, in some instances.

    For example, women with lupus treated with cyclophosphamide may develop premature menopause due to its potentially toxic effect on the ovaries.

    The reduction in ovarian reserve appears to be related to the dose of the drug, so developing ovarian failure due to the medication is not necessarily a given.

    7. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

    Chronic fatigue syndrome is a chronic condition diagnosed when the following criteria are met. A person must have all three of these symptoms:

    1. the inability for six months or more to participate in activities that were possible prior to illness due to extreme fatigue
    2. unrefreshing sleep
    3. post-exertional malaise (PEM)

    In addition, they must also have at least one of these symptoms:

    1.  impaired memory or ability to concentrate
    2. orthostatic intolerance (development of lightheadedness, dizziness, rapid heart rate) when moving from a reclining position to standing up

    A 2015 study reported an association between CFS and multiple GYN conditions. In addition to early menopause, others included endometriosis, pelvic pain, bleeding between periods, and excessive menstrual bleeding.

    Women with CFS were also found to have undergone hysterectomy at a higher rate than those without the condition. The potential causes of the association remain unclear and are the subject of ongoing research.

    doctor pointing to reproductive system image and talking about hysterectomy

    8. Hysterectomy in pre-menopause

    A hysterectomy is the removal of the uterus. Your doctor may recommend this surgery for uterine fibroids, uterine/ovarian/cervical cancer, endometriosis, or uterine prolapse.

    The reason for the hysterectomy will help you, and your doctor determine the best surgical treatment option for your situation. Your doctor may recommend:

    • Total hysterectomy involves the removal of both the ovaries and the cervix.
    • Single or bilateral oophorectomy is a hysterectomy that involves removing one (single oophorectomy) or both ovaries (bilateral oophorectomy).
    • Hysterectomy with ovarian preservation means the ovaries are not removed. The cervix may or may not be removed.

    If your ovaries are removed with a total hysterectomy or if you undergo single or bilateral oophorectomy, there is an abrupt, precipitous drop in estrogen and progesterone rather than the more gradual (and usually volatile) change that occurs during perimenopause.

    Ovarian preservation and menopause symptoms

    However, even if you preserve your ovaries during a hysterectomy, it doesn’t mean you will avoid early or premature menopause.

    A 2011 study found after 4 years of follow-up that almost 15% of women experienced premature ovarian failure even when their ovaries were preserved.

    And the risk was almost twice as great compared to women with an intact uterus.

    There are several theories regarding why ovarian failure or insufficient ovarian reserves may occur with hysterectomy even when the ovaries are not removed, which include:

    1. disruption of blood flow to the ovaries related to the surgery
    2. the underlying condition which necessitated surgery
    3. an increase in FSH (follicle-stimulating hormone) levels following the removal of the uterus resulting in a reduction in the number of eggs in the ovaries as well as the quality of the eggs

    Therefore, it is important (as always, when it comes to your health and well-being) for anyone undergoing a hysterectomy to make sure you ask questions, get a complete picture of your options, and ask about the pros and cons of each approach.

    9. Oophorectomy

    Oophorectomy is the surgical removal of one or both (bilateral) ovaries.

    Some of the reasons for this surgery include ovarian cysts, ovarian cancer, endometriosis, and to reduce the risk of cancer in those with the BRCA1/2 gene.

    It can also cause early or premature menopause.

    black woman suffering from endometriosis touching pain points

    10. Endometriosis and the link to early menopause

    Endometriosis is a condition in which tissue similar to that which lines the uterus is found in other locations in the body outside of the uterus. This tissue is typically found in the reproductive organ system zone in the pelvis – ovaries, fallopian tubes, vagina, and the lining of the pelvis.

     A 2022 study found an association between endometriosis and the risk of early menopause.

    Approximately 10% of women suffer from endometriosis. Symptoms include general abdominal/pelvic pain, pain with intercourse, urination, and/or bowel movements, and pelvic pain and cramping during monthly periods that may be more severe than experienced by those without endometriosis. The pain a person experiences may or may not correlate with the amount of tissue outside the uterus.

    Endometriosis can lead to internal scarring and adhesions, which may lead to infertility and other issues related to the other organs that may be impacted by the errant tissue.

    Endometriosis has also been associated with lower ovarian reserve and inflammation, which can directly and negatively impact ovarian function. In turn, these factors can lead to premature and early menopause. Additionally, those with endometriosis may be more likely to undergo the type of gynecologic surgery that increases the risk of premature and early menopause.

    11. Race/ethnicity and premature and early menopause

    At pausitive health, we’re committed to talking about how the menopause journey can vary among women for a multitude of reasons. For example, where you live in the world and your race/ ethnicity are factors that can have an impact on when and how the menopause journey is experienced.

    • Black women tend to have more severe symptoms and a longer perimenopause timeframe.
    • Asian women are more likely to have fewer and less severe symptoms.
    • Hispanic/Latina women are more likely to report vaginal dryness.
    • And white women suffer from more severe GI symptoms.

    When it comes to premature and early menopause, Black and Hispanic women/Latinas in the U.S. tend to have an earlier onset of menopause. They have been observed to hit menopause up to 3 years earlier than their Asian and white counterparts.

    Additionally, Black women also have a higher incidence of premature menopause than other races/ethnicities. A higher rate of fibroids in Black women+ leads to a higher rate of surgical menopause and symptoms overnight if ovaries are removed during a hysterectomy.

    However, it’s important to remember these findings are noted when looking at large populations of women. For any given individual, the pattern may not be present. There are also other factors such as socioeconomic status, mindset, one’s culture, and education level that can also play a role in the type of experience a woman may have during the menopause journey.

    12. Chemotherapy | pelvic radiation | hormone therapy to treat cancer

    A range of treatments for cancer can lead to premature or early menopause, including chemotherapy, pelvic radiation, and hormone therapy. The risk can be impacted by factors like the specific regimen, the dose, and the age at which treatment occurs.

    13. Smoking risks

    Smoking can lead to an onset of menopause as much as 2 years earlier than the average age and may result in more severe menopausal symptoms.

    The risk seems to correlate with the number of cigarettes smoked per day and how long a woman has smoked.

    Why smoking can increase the chance of early or premature menopause

    There are several theories regarding the reason smoking could increase the risk of premature and early menopause. They include:

    1. lower levels of estrogen due to smoking
    2. increased levels of testosterone due to smoking, which changes the usual hormone profile
    3. direct impact of tobacco by-products on the ovaries leading to premature ovarian failure
    4. lower levels of anti-Müllerian hormone (AMH); AMH levels relate to the number of eggs available for fertilization and ovarian reserve

    Health risks

    Smoking increases the risk of heart disease and osteoporosis (among many other conditions as well as cancers). The increased risk of premature and early menopause is yet another reason to quit smoking or, even better, never to start.

    The hormonal changes during the menopause transition also increase the likelihood of developing cardiovascular disease and osteoporosis. Therefore, the negative impact of smoking is further compounded when menopause comes earlier than the norm. The risk of both conditions would be even greater, kick in at an earlier age, and last for a longer period of time, assuming a typical life expectancy.

    14. HIV | AIDS

    If you have HIV or have progressed to AIDS, you may experience early menopause.

    Studies suggest:

    • Menopause may occur up to 5 years earlier than in those without an HIV infection.
    • The rate of premature menopause may be as high as 12% compared to 5% in women without HIV.
    • The reason for premature or early menopause is unclear. It appears there are likely a multitude of potential co-existing potential causes, including lower ovarian reserve related to infection and immunosuppression, the effect of medication taken to treat and maintain the infection in a chronic disease state, higher rates of smoking among those with HIV/AIDS, co-infection with hepatitis C, and being underweight.

    Some of the negative consequences of premature and early menopause – increased risk of cardiovascular disease and osteoporosis – are further compounded because HIV/AIDS itself increases the risk of both.

    15. Mumps

    Mumps is the most common infection associated with premature menopause. The virus appears to have a direct effect on the ovaries, which can result in ovarian failure.

    stressed woman with hands on head

    Can stress cause early menopause? 

    Now, let’s cover some theories you may have heard. First stress.

    You never want to overlook stress. It can make menopause symptoms worse, and there’s some thought that it could bring menopause on earlier, although the risk is unclear.

    A study of Korean women found a correlation between high stress on a daily/chronic basis and an earlier age of onset of natural menopause. However, the age of onset was later than that which would fall in the premature or early menopause timeframe. And no direct cause-and-effect was established.

    Stress can reduce estrogen levels, but no definitive direct connection has been found between high levels of stress or chronic stress and the development premature and early menopause. However, such stress increases cortisol levels which can impact your overall health.

    Polycystic ovary syndrome (PCOS) and early and premature menopause

    PCOS (aka polycystic ovarian syndrome) is a condition in which hormonal imbalances lead to abnormal development of the eggs in the ovaries or eggs are not released from the ovaries as they should.

    PCOS can lead to irregular or missed periods, which can cause cysts to form in the ovaries.

    PCOS occurs in 10% of women of childbearing age. As you might expect, those with PCOS may have problems with infertility. In fact, it is one of the most common causes of infertility. The risk of PCOS is greater if you are obese or if you have a mother, sister, or aunt with PCOS.

    The cause of PCOS is unclear, but factors considered contributory include insulin resistance (which leads to increased levels of insulin) and elevated levels of androgen hormones (e.g., testosterone).

    Some of the symptoms of PCOS are similar to those seen in menopause – weight gain, hair thinning/loss – and others similar to those experienced during the perimenopause stage of the journey, including irregular periods and acne. Additional symptoms include hirsutism (excessive hair growth found in a distribution typically found in men – chin/face, chest, back), skin tags, and darkening of the skin in neck creases and the groin, and underneath the breasts.

    Like menopause, those with PCOS are at increased risk of cardiovascular disease, depression, anxiety, and elevated cholesterol levels. However, women with PCOS were less likely to have hot flashes, night sweats, and loss of libido but more likely to report vaginal dryness.

    Unlike those with premature or early menopause, individuals with PCOS have a later age of onset of menopause – up to 4 years later compared to women without PCOS.

    Can having your tubes removed cause early menopause? 

    If you’ve had your tubes tied (tubal litigation), it will not cause early menopause.

    Multiple studies indicate that, currently, no connection between tubal ligation and the development of premature or early menopause has been found.

    Why does it matter?

    Knowing if you’re at risk for premature or early menopause can help you prepare for what lies ahead, address time-sensitive concerns such as family planning, and take steps to optimally manage symptoms and help reduce the risk of the chronic conditions which may develop.

    That way, you control the menopause journey rather than letting it control you!

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