Premature menopause signs: How to spot the symptoms early

For many of us, the stages of womanhood were presented rather matter-of-factly in sex ed class. You’ll get your first period somewhere in your early teens, menstruate every month like clockwork, then welcome a baby (or several) once you’re a financially stable adult. Then, once you’re good and ready, you’ll cruise into menopause in your 50s. Or at least, that’s how it sounds in theory.

As many women unfortunately discover, the reality isn’t always quite so straightforward. Each of our internal hormonal clocks is set slightly differently, and the transition between these phases is a deeply personal experience.

One area that is (thankfully) gaining more attention is the variation in menopause timing. While the typical timeframe to enter menopause is 45 to 55, this is not the case for everyone [1]. Around 0.3 to 1% of women are estimated to enter menopause prematurely [2]. While this possibility can feel confronting, spotting the signs of premature menopause early can help empower you to take control of your symptoms and future planning.

Whether you’ve been feeling a little out of sorts recently and suspect hormonal reasons could be to blame — or you’re just looking to educate yourself about fertility early — here’s what you need to know about premature menopause.

What is premature menopause?

Premature menopause is a medical term used for the permanent end of menstruation before the age of 40 [3]. This occurs when the ovaries stop regularly producing eggs, and the production of the hormone oestrogen (which is important for conception) slows down. Premature menopause is sometimes referred to as premature ovarian insufficiency or POI, reflecting that the ovaries are functioning with impaired capacity [4].

Another term you may see associated with premature menopause is 'amenorrhoea.' However, this is a broader term for the absence of a menstrual period. While amenorrhoea is the key marker of premature menopause or POI, there are also other reasons women lose their periods earlier than expected [5].

It is still possible to conceive during premature menopause, as around 5 to 10% of women still ovulate occasionally and spontaneously [6]. However, natural conception is much more difficult for other women in this age group.

As well as the reproductive challenges, the lead-up to premature menopause can be accompanied by a host of physical and psychological symptoms. However, due to the life stage and symptom overlap with other causes such as stress, burnout or PCOS, it's unfortunately commonly overlooked and dismissed in younger women.

Early or premature menopause: what's the difference?

While the terms are often used interchangeably, early and premature menopause are slightly different. Early menopause encapsulates the ages between 40 and 45 and is more gradual in nature, following a more typical oestrogen decline trajectory, just earlier [7]. Meanwhile, premature menopause occurs before the age of 40 and tends to be more abrupt.

It’s important to make the distinction between the two, as premature menopause can be accompanied by significant lifelong health issues beyond infertility.

Interestingly, many people also get premature menopause and perimenopause mixed up. However, perimenopause is actually the natural transition phase leading up to the last period, normally lasting 2 to 10 years. Meanwhile, menopause is technically a one-off event, defined as the 12-month mark since the final period.

So, when we talk about premature menopause, we are actually referring to women who have already ceased menstruation permanently. However, many of the symptoms we'll discuss below are actually experienced in premature perimenopause.

The signs and symptoms of premature menopause

Premature menopause symptoms are very similar to those experienced in regular menopause. The difference is, they come on earlier than expected and sometimes, very suddenly.

Menopausal symptoms (premature or otherwise) are far-reaching, due to the vital impact oestrogen has on the body [8]. It plays a role in nearly every function in the body, from our skin to our sleep and sex drive. Here’s what to look out for.

Menstrual changes

Commonly, the first symptom women notice in premature menopause is changes to their period. This may include:

• Irregular periods
• Skipped cycles
• Much lighter periods
• Heavier bleeding
• Longer or shorter cycles
• Periods stopping altogether

Temperature changes

Yes, the hot flushes are real. Declining oestrogen can disrupt the body’s temperature regulation system — so, if you experience any of the below and it’s not just because you’re stuck on the tube in the middle of a heat wave, it may be worth looking into.

• Sudden feelings of intense heat
• Flushing in the chest, neck, or face
• Excessive sweating
• Waking during the night, drenched in sweat
• Chills following hot flushes

Sleep disturbances

Unsurprisingly, body temperature changes can also wreak havoc on your slumber. But, beyond that, fluctuating oestrogen can also impact your circadian rhythm. This can manifest in sleep issues, including:

• Difficulty falling asleep
• Frequent waking during the night
• Early morning waking
• Restless sleep
• Increased anxiety at night
• More frequent nightmares
• Fatigue during the day, despite getting plenty of sleep

Mood changes 

Just in case women didn’t have enough of an emotional rollercoaster to deal with, premature menopause can kick mood fluctuations into overdrive. Oestrogen interacts closely with neurotransmitters, including serotonin, dopamine, and GABA, and causes potential mental health symptoms, including:

• Anxiety
• Low mood
• Irritability
• Emotional sensitivity
• Tearfulness
• Panic symptoms
• Reduced stress tolerance
• Feeling emotionally “flat” or like yourself

Cognitive symptoms

Whether it's losing your train of thought in a work meeting or dropping the ball more frequently in your personal life, many women in premature menopause describe feeling mentally slower or less sharp. This can be quite confronting for women who are otherwise highly ambitious and organised! The cognitive symptoms may include:

• Brain fog           
• Forgetfulness
•  Difficulty concentrating
• Reduced verbal fluency, or tripping over your words more often
• Mental fatigue
• Trouble multitasking
• Headaches

Vaginal and sexual health changes

Some women going through premature perimenopause or menopause also notice differences in the bedroom. These may include:

• Vaginal dryness
• Pain or disco during sex
• Recurrent UTIs
• Burning or irritation
• Reduced libido or sex drive
• Difficulty becoming aroused
• Pelvic discomfort

Skin, hair, and body changes

In case all of that wasn't already enough to deal with, many women also notice differences in how they look and feel, physically. This is due to the role oestrogen plays in collagen production, skin hydration, muscle maintenance, and fat distribution. Women may notice:

• Drier or thinner-looking skin
• Itchy skin
• Hair thinning
• Increased facial hair
• Changes in body composition, such as weight gain (particularly around the abdomen and mid-section), or increased difficulty losing weight
• Reduced muscle tone
• Joint aches
• Reduced skin elasticity 

What causes premature menopause?

Researchers aren't exactly sure what exactly causes premature menopause. Instead, it seems to be related to a complex interplay of genetic, biological and lifestyle factors. That said, there are a few factors that seem to increase risk [9]. These include:

• Chromosomal abnormalities (such as Turner syndrome or Fragile X syndrome)
• A family history of premature menopause (such as your mother or sister)
• Smoking cigarettes
• Starting menstruation early (before the age of 12)
• Autoimmune conditions such as rheumatoid arthritis, thyroid disease, or type 1 diabetes
• Poor nutrition
• Undergoing chemotherapy or pelvic radiation
• Surgeries such as an oophorectomy (removing the ovaries) or uterus (hysterectomy)

In some cases, such as with chemotherapy or radiation, these risk factors can be temporary and reversible. However, it depends on the individual and the nature and duration of exposure.

It's also worth noting that scientists have found a potential link between endocrine-disrupting chemicals (EDCs) and premature menopause [10]. This includes phthalates (found in vinyl plastics, synthetic fragrances, and personal care products), PCBs & PFAS (found in non-stick cookware and certain fabrics) and BPA (found in metal food cans and polycarbonate plastics). However, this research is still in the very early stages, and it's not possible to make definitive conclusions.

How is premature menopause diagnosed?

Unfortunately, doctors can't just take one look at you and know you're in premature menopause — nor is there a ‘one and done’ test. Rather, a premature menopause diagnosis typically involves a combination of symptom assessment, medical history, and hormone testing.

Your GP will likely take a detailed history of your menstrual and reproductive history, including family history and age of first menstruation. They’ll likely also order several blood tests, including Follicle-stimulating hormone (FSH), oestradiol, Anti-Müllerian hormone (AMH), thyroid function, prolactin and autoimmune markers. Depending on your symptoms and health history, they may also look at genetic testing, pelvic ultrasound, bone density scanning and autoimmune screening.

Sadly, it can be tricky getting some doctors to take your concerns seriously if you’re on the younger side and are otherwise in good health. The good news is, it’s also now easier than ever to be proactive about your reproductive health, thanks to home tests that allow you to test your hormone levels and ovarian reserve (via AMH levels). While these won’t give you a full picture of your reproductive health, they give you some valuable data you can use to better advocate for yourself.

Long-term health risks of premature menopause

Even if you're not trying to get pregnant or have already crossed that bridge, it's important to be aware of the signs of premature menopause early. This is because it can have additional long-term health issues that can endure well after your last period [11]. These include:

• Increased risk of cardiovascular disease —  Women who enter menopause before age 40 face about a 40% higher lifetime risk of developing coronary heart disease  [12]
• Increased risk of type 2 diabetes
• Increased risk of dementia and Alzheimer's disease
• Increased risk of osteoporosis and fractures

These long-term effects are due to the protective effect oestrogen has on heart, brain, bone and overall health.  However, with an intentional approach, it is possible to manage these risks early.

When to speak to your GP about premature menopause

Even if you're not concerned about the fertility impact of premature menopause, it's a good idea to speak to a healthcare professional about premature menopause. Firstly, it helps to put your overall health in context and pinpoint the cause of mysterious symptoms that may pop up. It also means you can work proactively with your GP on a plan to manage the potential long-term health risks.

Managing premature menopause

Experiencing premature menopause is rarely a result of anything you've done or haven't done. It's a natural process that, unfortunately, some women experience before they're ready. The good news is, you don't just have to grin and bear it. By knowing the signs early, you can take action and start feeling more like yourself again.

While some women manage the symptoms of premature menopause naturally, this can be a process of trial and error and won't work for everyone. The gold standard treatment for premature menopause is Hormone Replacement Therapy, or HRT.

Providing reliable relief for the majority of symptoms, HRT is more accessible than ever before — available in patch, gel, pessary or oral forms. In some cases, it's also available to women under 40. If you're experiencing the symptoms of premature menopause, you may wish to discuss this option with your doctor.

While not a substitute for HRT, another aspect of premature menopause you may wish to address is weight loss management. Many women find that reaching a healthy weight helps to reduce the severity of their symptoms (especially joint pain, hot flushes and night sweats), as well as helping to restore their confidence.

Taking a targeted and biological approach to weight loss, the Juniper Programme is well-suited to women in premature perimenopause and menopause. Combining medical weight loss with lifestyle coaching, it helps to reduce cravings, improve metabolic function and have you feeling more in control of your own body again. With a strong focus on maintaining and building bone mass and muscle, it also helps to safeguard against the chronic health risks of premature menopause.

In most cases, Juniper's Weight Loss Programme can be used safely alongside HRT to help manage. You can check your eligibility here.

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