Are you in your 30s or early 40s wondering if you could already be in menopause? You may tell yourself there’s no way, until the next time you have a hot flash, can’t sleep, or feel like you’re losing your mind. Then you begin to think about that pesky weight that won’t budge from your midsection no matter what you try. Oh, and what about sleep? You jolt awake at 2 AM, unable to fall back asleep. If you’re scratching your head and wonder if it could be happen-ing, it may be!
Premature and early menopause means for some women, menopause arrives long before the typical average age of onset (which is age 51 in the U.S.). When it hits matters, because symptoms can be more severe and it can cause other health risks. There are also benefits too!
What are premature and early menopause?
Premature menopause happens when menopause arrives before age 40.
Early menopause means menopause occurs at age 40 or older but before age 45.
It all comes down to the age at which you have gone 12 consecutive months without a period. This chart can be handy to know where you stand.
When You Have Not Had Periods for 12 Consecutive Months...
| Age | Type of Menopause |
|---|---|
| younger than 40 | premature menopause |
| 40 or older but younger than 45 | early menopause |
| 51 (typical age of onset in the U.S.) | menopause |
There are 15 causes of premature and early menopause related to your family history, personal health history, and race/ethnicity. Knowing if you’re at risk for it can help you prepare.
Symptoms of premature and early menopause
If your period stops in your 20s, 30s, and early 40s, you may be in premature or early menopause (if no other reason is found). If so, expect to have menopause symptoms.
80-85% of women on the menopause journey experience vasomotor symptoms (hot flashes, night sweats, and palpitations), also known as VSMs.
Other common symptoms are weight gain, issues with sleep, brain “fog,” vaginal dryness, and emotional volatility.
Less common symptoms include new or different body odor, cold flashes, itchy skin, burning tongue, muscle aches and pains also known as the musculoskeletal syndrome of menopause (MSM), leg pain, gas/bloating, headache, diarrhea/constipation, dry eye, gum disease, cavities, altered taste, and tooth sensitivity.
There are myriad others, so if you have had these and others not listed, talk with your healthcare provider. It can help you determine if you are experiencing premature or early menopause or if there is another possible cause of your symptoms.
How premature and early menopause affect symptoms
In addition to more severe symptoms, women may suffer from sadness or depression related to the early loss of fertility or changes to their bodies which occur sooner than expected.
How is it diagnosed?
Doctors typically make a diagnosis of premature or early menopause based on symptoms, age, and a diagnosis of menopause (the point at which there has not been a period for 12 consecutive months).
Sometimes blood tests are also performed to confirm premature or early menopause. These include FSH (follicle-stimulating hormone) and LH (luteinizing hormone).
How many women have premature or early menopause?
While there are many causes of premature and early menopause, neither is common in the U.S.
One percent of women experience premature menopause.
Five percent fall in the early menopause age timeframe.
Risks associated with premature and early menopause
No matter when you go through menopause, the hormonal changes put you at risk for certain health conditions, including:
- the risk of cardiovascular disease like heart disease and hypertension
- greater risk of heart failure
- osteoporosis (which, in turn, increases the risk of bone fracture)
- stroke
In addition, you’re also at increased risk for other health conditions like dementia, including Alzheimer’s.
If you go through premature or early menopause, the onset of that risk also occurs earlier. So, the increased likelihood of your developing cardiovascular disease, osteoporosis, and stroke is present for a greater number of years throughout your life.
That’s why it’s important to understand the causes of premature and early menopause.
Dementia risk with premature and early menopause
Premature and early menopause also have potential negative impacts on brain health.
Entering menopause at an age younger than the average of 51 increases the risk of both dementia and “presenile” dementia (onset of dementia before age 65).
When menopause occurs at an age younger than 45, the risk of dementia has been found to be approximately 30 – 35% greater than in those with onset at age 51 or older. The risk is even greater for women who also smoke.
Dementia is more common in women than men, and being of the female sex is a major risk factor for late-onset Alzheimer’s.
The reason for the seeming link between female sex and dementia is not yet completely clear, but there is a belief in some camps that estrogen can have a protective effect against changes in the brain which increase the likelihood of dementia. Since menopause results in a major drop in estrogen levels, those protective effects are lost during the transition.
Some studies of women in the perimenopausal or post-menopause stages of the journey have shown changes in brain MRIs – brain amyloid-beta deposition – which are greater than imaging in premenopausal women and males of the same age. Amyloid-beta deposition in the brain is one of two hallmarks of Alzheimer’s disease, the second being neurofibrillary tangles.
Can hormone therapy help with dementia risk?
Given the proposed link between dementia risk and lower estrogen levels, you might think HT could help mitigate that risk. However, so far study results are mixed.
In some instances, HT was found to have no effect.
In others, it was found to reduce the risk.
And some studies even indicate it can increase the risk.
Currently, HT is not recommended to attempt to reduce the risk of dementia, to treat dementia, or to slow cognitive decline.
How to reduce dementia risks
So, what can you do to take preventive action against the development of dementia?
As with overall health and well-being, living a healthy lifestyle is a major step to help reduce the likelihood of developing several different types of dementia, including vascular dementia and Alzheimer’s. Vascular dementia is defined by the National Institute on Aging as “as changes to memory, thinking, and behavior resulting from conditions that affect the blood vessels in the brain.” Some of the conditions that increase the likelihood of developing vascular dementia include hypertension, diabetes, and stroke.
Focus on:
- healthy eating – focus on foods that support brain health (e.g., the MIND diet; conveniently, many of them can also help you manage menopause symptoms!
- adequate physical activity levels (link)
- high-quality sleep of sufficient duration
- managing stress
- having a social network and a supportive circle of family and friends
These healthy habits can help reduce some of the modifiable (you can change them) factors that increase the risk of dementia – hypertension, diabetes, stroke, overweight and obesity, high cholesterol, alcohol use disorder, depression, and smoking.
Protecting your hearing also helps reduce the risk of dementia, as those with a hearing impairment are more likely to develop the condition.
Dementia risk calculators
A growing number of dementia risk calculators are being released.
One such tool was developed in Canada by researchers in Ottawa at the Institute for Clinical Evaluative Sciences and the Ottawa Hospital Research Institute.
As always, meeting with your healthcare practitioner is important to put things into perspective based on your situation, including your personal and family health history, race/ethnicity, genetic factors, and environmental toxin exposure.
Do premature and early menopause mean early death?
For several reasons, women often think about what’s next when they hit menopause. You may wonder what else will come early – including an early death.
It’s not as crazy a thought as you may think.
Studies indicate that those with premature and early menopause are at increased risk for premature death, explicitly related to cardiovascular disease and death from all causes generally.
In some instances, the risk appears to be related to not receiving treatment with HT following the onset of premature or early menopause. Of course, HT brings its own questions of risk vs. benefit. Some people should not use HT due to current underlying medical conditions or medical issues in the past, so discuss this approach with a doctor before making a decision.
Remember, studies are mixed on using HT to mitigate dementia risk.
Premature and early menopause life expectancy
The risk of developing type 2 diabetes at an earlier age is also greater for women who experience premature and early menopause.
While this may sound like grim news, you can make a change for the better that will serve you well in your 40s and 50s and years beyond.
Practice healthy lifestyle habits, including those above, to improve your chances of living a long and healthy life.
Consider your mindset about menopause and life. Is it a positive one? If you lean towards a glass half empty outlook, now would be a good time to explore ways to add more water to the glass, like a gratitude practice, mindfulness, volunteering, or spending more time engaged in activities you really enjoy.
Optimism can help you live longer.
Benefits of early menopause
Despite a potentially shorter life expectancy, believe it or not, there may be some potential benefits of premature or early menopause.
Earlier onset of menopause means an earlier age at which the body’s exposure to a certain level of estrogen is reduced. The risk of breast cancer may be lower in women with premature and early menopause due to a shorter lifetime duration of estrogen exposure.
And for those who have suffered from premenstrual dysphoric disorder (PMDD), premature and early menopause helps bring relief at a younger age.
PMDD is a very severe form of premenstrual syndrome (PMS). Symptoms in-clude a greater severity of the typical symptoms experienced with PMS, e.g., mood swings, abdominal cramping, increased appetite, or food cravings. Those suffering from PMDD may also experience additional symptoms like suicidal ideation and feelings of being out of control and overwhelmed.
Treatment of premature and early menopause
Once a diagnosis is made, it’s important to identify the root cause of premature or early menopause.
Any underlying condition should be addressed to avoid any potential additional complications related to it.
Next, since you can’t stop menopause from happening, there are steps you can take to minimize the health risks and improve longevity.
If you experience premature or early menopause, it is even more important to practice as healthy a lifestyle as possible.
Plus, that healthy lifestyle can positively impact your menopause journey.
For many women, it can reduce the severity and/or frequency of symptoms or help them to avoid some of them altogether. And it is key to your health and well-being, both now and for the rest of your life.
Lifestyle is always a priority, even when you consider other treatment options.
It’s never too late to make a change for the better.
These actions include:
- Healthy eating
- Physical activity – aerobic, strength training, balance, flexibility
- A sufficient number ( 7 – 9) hours of high-quality sleep
- Coping skills and techniques to address stress
- Professional support as needed to address mental health conditions or severe emotional distress
- A social network and community of support
- An optimistic outlook on life
- A source and a sense of purpose in your life
Hormone therapy for early menopause
Hormone therapy (HT) will likely be your doctor’s next recommendation. You may be advised to take it until the age of natural menopause, e.g., age 51 in the U.S. The goal is to maintain the same hormone profile that would normally be present until that time.
HT is both complex and complicated.
There are several options in terms of formulations, as well as multiple potential delivery systems. And whether or not your uterus is still intact can also impact the HT approach selected.
Consulting with a clinician well-versed in HT management and menopause is a key factor in optimizing your health and well-being during the menopause journey.
Other options will need to be explored for those who are unable to use HT due to the risks it may trigger in those with a family history or past personal medical history of certain conditions, e.g., current or past breast cancer, prior blood clots, heart attack or stroke, liver disease.
Non-hormonal options for early/premature symptoms
There are several non-hormonal medications and many non-hormonal modalities available to address the symptoms of premature and early menopause. Some of these will also help combat or mitigate the increased risk of osteoporosis, cardiovascular disease, and negative impacts on brain health. However, none will provide the same level of protection against the increased risk as HT.
Non-hormonal options include:
The bottom line
The vast majority of those on the menopause journey do not experience premature or early menopause. For those who do, the physical, emotional, and mental health challenges are further compounded in many different ways.
However, it is important to remember there are many approaches and options available to treat your condition and symptoms and to support you.
You are not alone. Ask for help and keep pursuing it until you get the care you need and deserve.
You do not need to suffer in silence!
Follicle-Stimulating Hormone (FSH) Levels Test | MedlinePlus
Luteinizing Hormone (LH) Levels Test | MedlinePlus
Zhu D, Hsign-Fang C, Dobson A, Pandeya N, Giles G, Bruinsma F, et al. Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data. The Lancet Public Health. 2019, Vol 4, Issue 11, E553-E564. DOI:https://doi.org/10.1016/S2468-2667(19)30155-0
Hall P, Nah G, Howard B, Lewis C, Allison M, Sarto G, Waring M, Jacobson L, Manson J, Klein L, Parikh N.
Reproductive Factors and Incidence of Heart Failure Hospitalization in the Women’s Health Initiative.
Journal of the American College of Cardiology. 2017
Volume 69, Issue 20, Pages 2517-2526, ISSN 0735-1097.
https://doi.org/10.1016/j.jacc.2017.03.557.
Early menopause may raise risk of dementia later in life | American Heart Association
Scheyer O, Rahman A, Hristov H, Berkowitz C, Isaacson RS, Diaz Brinton R, Mosconi L. Female Sex and Alzheimer’s Risk: The Menopause Connection. J Prev Alzheimers Dis. 2018;5(4):225-230. doi: 10.14283/jpad.2018.34. PMID: 30298180; PMCID: PMC6198681.
Hormones and dementia | Alzheimer’s Society
Kim, H., Yoo, J., Han, K. et al. Hormone therapy and the decreased risk of dementia in women with depression: a population-based cohort study. Alz Res Therapy 14, 83 (2022). https://doi.org/10.1186/s13195-022-01026-3
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