What is early menopause, and what if it happens before 40?

Early menopause is when your periods stop before the age of 45. If it happens before 40, it’s called premature menopause or premature ovarian insufficiency (POI). It can happen on its own or as a result of treatment such as surgery or chemotherapy, and often there’s no clear reason. If you’re under 45 and your periods have become less frequent or stopped, the HSE and NHS both say to see your GP. That’s partly for your symptoms, and partly because replacing the missing hormones helps protect your bones and heart.

How early is “early”?

Menopause is when you haven’t had a period for 12 months. The NHS says it usually happens between 45 and 55, and the HSE says the average age in Ireland is 51.

• Early menopause: periods stop before 45.
• Premature menopause or POI: periods stop before 40. “Ovarian insufficiency” simply means the ovaries aren’t making enough hormones, particularly oestrogen.

The HSE says around 1 in 100 women reach menopause before 40. A booklet hosted by the British Menopause Society puts it at about 1 in 1,000 under 30.

What are the signs?

The main sign is your periods becoming less frequent or stopping when you’re not pregnant. Beyond that, the HSE says the symptoms are the same as for menopause at the usual age, including:

• hot flushes and night sweats
• difficulty sleeping, tiredness and lack of energy
• low mood or anxiety
• problems with memory or concentration
• vaginal dryness, discomfort during sex and a lower sex drive
• headaches, joint aches and heart palpitations (a fast, fluttering or pounding heartbeat)
• recurring urinary tract infections

The HSE also points out that some women have no symptoms at all, apart from their periods changing. That’s one reason it’s worth acting on missed periods even if you otherwise feel fine.

What causes it?

The HSE says that in most cases the cause isn’t known. Known causes include:

• surgery to remove your ovaries, which may happen during a hysterectomy (removal of the womb)
• cancer treatment: radiotherapy and chemotherapy can cause early menopause, which may be permanent or temporary. The risk depends on your age, the type of chemotherapy and the area treated; it’s higher with radiotherapy around the pelvis or brain
• chromosome differences, such as Turner syndrome
• autoimmune diseases, where the immune system attacks the body’s own tissues
• some infections, such as tuberculosis, malaria and mumps, in rare cases

It can also run in families, especially if a relative went through menopause in her 20s or 30s. The NHS adds that it’s more likely if you started your periods early, smoke or are underweight.

None of this is your fault, and many women with POI never find out why it happened.

How is it diagnosed?

Your GP will ask about your symptoms, your periods and your family history. For women over 45, a menopause diagnosis is usually based on symptoms alone. For younger women, blood tests to check hormone levels are more likely: the HSE says you’ll have blood tests, and the NHS says a GP may sometimes do them if you’re under 45.

For women under 40, the BMS-hosted booklet says at least two blood tests are needed, taken about four to six weeks apart, because hormone levels can go up and down.

Your GP may refer you to a GP who specialises in menopause, a gynaecologist or an endocrinologist (a hormone specialist).

Why treatment matters

Oestrogen does more than control your periods: it helps keep your bones and heart healthy. Both the HSE and NHS say early or premature menopause raises your risk of osteoporosis (weak bones that break more easily) and cardiovascular disease (heart and circulation problems).

That’s why the usual treatment is to replace the missing hormones, most often with hormone replacement therapy (HRT), and sometimes with the combined contraceptive pill. The HSE says you may be advised to stay on treatment until around 51, the usual age of natural menopause. This is different from taking HRT later in life for symptoms: here, the aim is partly to replace hormones your body would normally still be making.

Hormone treatment isn’t suitable for everyone. Both the HSE and NHS say it may not be an option if you’ve had certain cancers, such as some types of breast cancer. If that applies to you, your GP may refer you to a specialist menopause clinic. Your GP or specialist is the right person to talk through what suits you; don’t start or stop any hormone treatment without their advice.

The NHS also suggests regular exercise and calcium-rich foods such as yoghurt to help look after your bones.

In Ireland, HRT is free on prescription from participating pharmacies if you have a medical card or a Drugs Payment Scheme card, as the HSE explains.

Fertility and contraception

Early or premature menopause can make it harder to get pregnant, because you don’t release an egg every month. But the HSE says a small number of women with POI do ovulate and become pregnant, so if you don’t want to get pregnant, keep using contraception until you’ve talked it through with your GP.

If you’d hoped to have children, this can be very hard news. Your GP can refer you to a fertility specialist. The HSE and NHS mention options such as egg donation, IVF with your own frozen eggs, surrogacy and adoption.

Looking after your feelings

An early menopause can bring grief, worry or a sense of losing control, on top of the symptoms. The HSE says counselling may help. Support groups include The Daisy Network (for women with premature menopause) and, in Ireland, the National Infertility Support and Information Group. If it’s affecting your mental health, the NHS notes you can refer yourself to NHS talking therapies in England without seeing a GP first.

What to do next

• See your GP if you’re under 45 and your periods have become less frequent or stopped, even if you have no other symptoms.
• Before the appointment, note your period dates, any symptoms, any past surgery or cancer treatment, and the age your mother or sisters reached menopause, if you know it.
• Ask your GP whether blood tests are needed, whether hormone treatment is right for you, how long you’d take it, and whether you need a referral to a specialist.
• Keep using contraception if you don’t want to get pregnant, until your GP says otherwise.
• Look after your bones: ask about exercise and calcium, and don’t smoke.