What You Need to Know About Early Menopause
Type the word “menopause” into the search bar, and Google will show you images of women as old as your grandma, skin wrinkled after years of sun exposure, and hair as white as a cotton ball. Commercials touting treatments for menopause symptoms show middle-aged women with gray-streaked locks complaining about night sweats and hot flashes. Sure, these depictions seem right on the money — but they also construct the idea that menopause *only* occurs in women who have graced this planet for more than half a century. And that's simply not true.
In reality, about 5 percent of women are menopausal by age 45 (known as early menopause), and 1 percent of women are menopausal by age 40 (known as premature menopause), says Mary Jane Minkin, M.D., a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University and a North American Menopause Society-certified menopause clinician. So if you think you’re transitioning to menopause before you feel like you’re “over the hill,” don’t (figuratively) sweat it. Here, your guide to premature and early menopause, from the exact processes going on in your body and the common risk factors to the steps you can take to work through the changes.
Let’s rewind: What is menopause, anyway?
Even though the term itself contains “pause,” menopause is actually when your periods have stopped for good and your ovaries no longer produce eggs, says Kameelah Phillips, M.D., an ob-gyn and the founder of Calla Women's Health in New York City. Typically, in your mid- to late-40s, you’ll go through a transitional period leading up to menopause known as perimenopause. “The ovaries’ function starts decreasing, so you’re no longer ovulating regularly,” she explains.
During the transition, which can last anywhere from two to eight years, your ovaries will produce lower amounts of estrogen and progesterone than usual, and your periods might become irregular, shorter or longer, and heavier or lighter, according to the U.S Department of Health’s Office on Women’s Health (OWH). You might start experiencing hot flashes, vaginal dryness, mood swings, and problems sleeping during this time, too. (BTW, you can *still* become pregnant while you're transitioning, so, if you don't want to have a child, you should continue to use your preferred method of birth control until one full year after your last period.)
Once you’ve gone a full year without having a period, you’ve officially reached menopause, which occurs — on average — at age 51 in the United States; however, it can vary by ethnicity, body weight, family history, and medical history, says Dr. Phillips. For example, some studies have found that increased BMI is associated with menopause occurring at a later age. And others have reported that African American and Latina women reach menopause about two years earlier than white women, according to an article published in the journal Obstetrics and Gynecology Clinics of North America.
At this point, rather than the stabbing period cramps and bloody tampons that marked your 20s and 30s, you’ll typically have to deal with hot flashes and vaginal dryness caused by your body’s changing estrogen levels, according to the OWH. But most significantly, you won’t be able to get pregnant. “It’s the hallmark of the end of your reproductive age,” says Dr. Phillips. (Related: How Coronavirus Might Affect Your Reproductive Health)
What are premature menopause and early menopause, exactly?
Since everybody and every body is different, a person might start the transition to and reach menopause earlier than the average. When menopause takes place before you’re 45 years old, it’s called “early” menopause, and if it happens before you’re 40, it’s known as “premature” menopause, says Dr. Phillips. “It’s a slight distinction, but definitely in the early 40s, we would not expect someone to be in menopause,” she explains.
While there isn’t a one-size-fits-all cause of premature or early menopause, some factors can up your odds of dealing with it. Receiving cancer treatments such as radiation or chemotherapy (which can damage the ovaries), having certain health conditions (such as autoimmune diseases, HIV and AIDS, and chronic fatigue syndrome), and undergoing surgery to remove the uterus (aka a hysterectomy) can all increase the likelihood that you experience premature or early menopause, according to the OWH. Certain risky lifestyle choices can play a huge role, too. “Smokers tend to go through menopause one to two years earlier than non-smokers — and they tend to have worse hot flashes and tend to get more bone loss,” says Dr. Minkin. (More on that bone loss point later.)
Even if you've never smoked a single puff of a cigarette and don't have any other conditions, you could be predisposed to premature or early menopause if it runs in your family, explains Dr. Phillips. “When women come in and they’re like, ‘Oh my gosh, I’m so sick of my period. When are they going to stop?’ I tell them to ask their mom,” she says. “Often moms, aunts, sisters, and grandmas can be a little bit of a window into the future as to what their own menopausal journey will be like.”
But can starting menopause early put your health at risk down the line? Unfortunately, research has shown a link between premature and early menopause and increased risk of premature death, cardiovascular disease, certain neurologic diseases, osteoporosis, problems becoming aroused or satisfied with sex, and mood disorders, according to a scientific review published in the journal Maturitas. What's more, the review suggests that the risk of negative health effects increases the earlier you reach menopause — and there aren't any steps you can take to pump the brakes on your transition, says Dr. Phillips.
Some lifestyle changes can help you maintain your sense of wellbeing and certain treatments can help lessen the intensity or frequency of symptoms, she explains. "But [they can't] halt the process." Hormonal treatments, specifically, may also help reduce your risk of adverse health effects, but they can't effectively prevent all of these consequences, according to the article. (Again, more on that to come.)
What are the symptoms of premature or early menopause?
In the perimenopause phase, before your ovaries have completely stopped producing eggs, you might experience night sweats, hot flashes, difficulty sleeping, and mood swings — all of which are common symptoms whether or not you transition to menopause early or at the average age, says Dr. Phillips. However, patients with premature or early menopause have reported that these symptoms can be more intense, she says, and research shows that hot flashes are often more severe in premature menopause cases.
Hormonal contraceptives can also mask early menopause symptoms, including hot flashes, night sweats, and menstrual irregularities, making it less obvious to know if you're in the perimenopause phase, according to the North American Menopause Society. So if you're taking a hormonal form of birth control, keep an eye out for any unusual changes and bring your concerns up with your doctor.
After you’ve reached menopause (think: haven’t had a period for a year), your body's reduced estrogen levels, in combination with your slowing metabolism, may lead to weight gain, according to the OWH. Your other menopause symptoms may ease up, but some people can experience hot flashes for the rest of their lives, according to the Cleveland Clinic.
Luckily, you don’t have to wake up covered in sweat or deal with other pesky symptoms day-in and day-out. To ease vaginal dryness, Dr. Minkin recommends Replens’ vaginal moisturizer (Buy It, $15, amazon.com), and for hot flashes, she suggests Remifemin (Buy It, $14, amazon.com) or Bonafide's Relizen (Buy It, $110, amazon.com), supplements that may relieve symptoms. (Just know that supplements are not regulated by the FDA, so chat with your doctor about them first). Prescription medications — such as estrogen, SSRIs (selective serotonin reuptake inhibitors, a type of medicine usually used to treat depression), and some blood pressure medications — may also be used to help with the intensity of hot flashes, explains Dr. Phillips.
If you'd rather go ~au naturel~ with your treatments, making some tweaks to your daily routine can help alleviate the side effects. Try keeping track of — and then avoiding — your hot flash triggers (think: spicy foods, alcohol, caffeine, or stress), taking up yoga or stretching, or losing weight, as flashes may be worse for those who are overweight, according to the OWH. To catch better ZZZs, the OWH also suggests getting regular physical activity and avoiding alcohol and large meals before bedtime; to manage mood changes, look for ways to reduce stress, and consider joining a menopause support group. (Pro tip: Don't be afraid to ask your doc for nearby recommendations.)
"Eliminating processed foods, salt, and caffeine, following a Mediterranean-style diet, and having regular exercise are all lifestyle changes that women can use to help them through this process," says Dr. Phillips. "These changes can help minimize weight gain and lipid or cardiovascular changes that women may begin to experience during this time." (Related: How to Tweak Your Nutrition for Your Age)
Are there any long-term health effects of premature or early menopause?
It’s easy to blame your hormones for making you moody AF, feeling tired 24/7, and just about every other annoyance, but they’re not all bad. In fact, estrogen can actually help keep your heart and bones strong (which is just one reason why it's considered an important hormone for your health). So when they dip as a result of premature or early menopause — or even menopause at an average age — some health problems can arise. “There’s definitely some evidence that early menopause can have longer-term effects as it relates to heart and bone health,” says Dr. Phillips.
A key hormone in regulating the female reproductive system, estrogen also helps keep blood vessels relaxed and helps the body manage cholesterol levels. With low levels of estrogen being produced, cholesterol can potentially build up on the artery walls leading to the heart, increasing the risk of heart disease, according to the OWH. This same drop in estrogen can increase the rate you lose bone mass, which can raise your risk of developing osteoporosis.
But you're not totally SOL. To potentially treat and prevent some of these serious health problems (such as osteoporosis and build-up on the arteries) as well as ease side effects (including hot flashes), Dr. Minkin points to hormone replacement therapy. “Not only can [it] take care of most of your symptoms, but it can also protect against these health complications,” she explains. In most cases, you’ll take a pill containing estrogen or a combo of estrogen and progesterone daily to make up for the lack of hormones your body naturally produces, though there are also skin patches, vaginal creams, gels, and rings that get the job done, according to the U.S. National Library of Medicine (NLM).
Typically, hormone replacement therapy can be a treatment for people who are under 59 years old and are within 10 years of reaching menopause, though younger individuals and those closer to their final period are less likely to experience harmful side effects from the therapy, according to the OWH. For some women, this treatment can increase your risk of developing blood clots, breast cancer, and gallbladder disease, as well as suffering from heart attacks and strokes, according to the NLM. So talk with your healthcare provider before you go all in. (Related: Why Are More Young People Having Strokes?)
And if you have premature menopause and still want to have kids, in-vitro fertilization (IVF) can be an option. A 2009 study showed that IVF treatments using donor eggs can be successful in patients with premature menopause and early menopause, though patients over 40 years old were more likely to experience complications, including pre-term labor and placental complications. As the saying goes: Talk to your doctor about what options may be best for you.
What if you think you’re transitioning to premature or early menopause?
Before you start freaking out, take a deep breath and remind yourself that it’s a totally normal, physiological process. Book an appointment with your doctor if you've missed two to three cycles (that is, assuming you're not pregnant) and are experiencing other menopausal symptoms. Then, your physician can perform blood work to confirm whether or not you’re truly transitioning to menopause.
“We would also want to make sure this isn’t a thyroid condition or some other condition that affects your mood, ability to regulate your temperature, etc.,” says Dr. Phillips. “Then we want to give you anticipatory guidance on what you can expect over the few months to years, and you can also start talking or understanding what medical options there are for treatment — if you want that.”
And remember, no matter how early you start experiencing menopause symptoms, you’re not alone. “Menopause, even during the ‘normal’ time, is something that our culture has not put into the forefront, and that does women a huge disservice...It’s not fair that women undergo this really important life change without the support and validation that they need,” says Dr. Phillips. “If you’re blessed to live long enough, everyone enters menopause... It’s all part of that [reproductive] continuum — it just needs to be talked about.”