• Early menopause occurs when menstrual periods permanently stop before the age of 45 years.
• Menopause before the age of 40 is termed 'premature menopause'
• There are many possible causes for spontaneous menopause but in over 50 per cent, no cause is found.
• Early menopause may impact on many different aspects of life including physical and psychological wellbeing.
• Women need specialised management including hormone replacement therapy, counseling and ongoing long-term follow up.
• The long-term risks of early menopause include early onset of osteoporosis and heart disease.
• Early menopause causes loss of fertility.

What is early or premature menopause?

Menopause (when menstrual periods permanently stop) is called ‘early’ if it occurs before the age of 45 years and ‘premature’ if it occurs before the age of 40 years.

Why does early and premature menopause occur?

Early or premature menopause occurs when the ovaries ‘run out of eggs’ and oestrogen and progesterone (ovarian hormones) are produced in only very small amounts. The periods then stop and menopause symptoms may occur.

The reason why the eggs (follicles) disappear from the ovaries is unknown but normally after age 35, the number of eggs seems to reduce more rapidly. In women who experience early or premature menopause, this reduction in egg numbers starts earlier.

Early menopause can:

• occur spontaneously*
• be caused surgically when a woman has her ovaries removed
• be caused chemically by chemotherapy
• be caused by radiotherapy when directed at the lower abdomen

How often does it occur?

Premature ovarian failure occurs in about one per cent (1 in 100) of women before the age of 40 and 0.1 per cent (1 in 1000) before the age of 30. Overall the risk of early menopause for all reasons (including surgical and as a result of cancer treatment) is about 8-10 per cent before the age of 45.

What causes early menopause?

Premature ovarian failure

When early menopause occurs spontaneously, as a result of early failure of the ovaries, this is called ‘premature ovarian failure’ (POF). In around 60 per cent of POF cases, there is no cause found. If a cause is identified, these may include:

• A genetic abnormality such as:
  • Turners Syndrome (a chromosomal condition 45xo)
  • 47xxx (normal 46xx) (47xxx is a chromosome pattern associated with early menopause)
  • Fragile x syndrome (a carrier of this genetic condition may develop early menopause)
  • Other, very rare, genetic causes
• Associated with an autoimmune disorder (e.g. hypothyroidism such as Hashimoto’s disease)
• Metabolic disorders (e.g. galactossaemia)
• Infections such as mumps oophoritis (infection of the ovaries with the mumps virus)

For more information see Premature ovarian failure

Surgical menopause

Early menopause can be caused surgically when a woman has her ovaries removed (oophorectomy) either independently, or at the time of hysterectomy. The removal of the ovaries causes a very sudden drop in both oestrogen and testosterone in the body resulting in the sudden onset of menopausal symptoms. For more information see Surgical Menopause 

Menopause after chemotherapy

Early menopause can also be caused chemically by chemotherapy for cancer treatment or treatment for autoimmune diseases such as Rhematoid arthritis. Chemotherapy given for the treatment of cancer not only destroys cancer cells but can also affect organs where cells rapidly divide, such as the ovary. Chemotherapy can also have toxic effects on the ovary when used as a treatment for severe, non-cancer disease.

The effect of chemotherapy on the ovaries depends on several factors. These include:

• Age of the woman at the time of chemotherapy
• Duration, dose and types of agents given

The ovaries may stop functioning over a period of time or stop suddenly. Sometimes the menstrual periods cease temporarily, but often it is permanent.

What symptoms are associated with early menopause?

Younger women may experience similar menopausal symptoms to older women although these may be more severe. Psychological distress, sexual function and altered body image may all be experienced. The psychological and physical effects as well as the impact of early menopause varies between women. For more information see Symptoms or Emotional Wellbeing

Are there long-term health risks associated with early menopause?

The risks of developing osteoporosis or heart disease appear to be higher for women with early menopause than for women reaching menopause at the expected age. For this reason, it is important that advice is sought from your health practitioner. For more information see Risks

How do I know if I have early menopause?

Early menopause may be considered if your periods are becoming irregular and infrequent, or you develop symptoms similar to the menopause change. The diagnosis of early menopause can be difficult to make and depends on the absence of menstrual periods for a prolonged time and menopausal range hormone levels measured via blood tests.

Further Resources

Fact sheet

 Early and Premature Menopause 97.31 Kb

External website

Australian Early Menopause Network

 
Content updated June 8, 2010