What causes early menopause?

Most women expect menopause to arrive sometime in their early fifties. But for around one in ten, it comes much earlier -  sometimes in their forties and occasionally even before age 40.^1,2 This is known as early or premature menopause. While it’s more common than many realise, it’s often poorly understood.

Natural vs. early menopause: what’s the difference?

Natural menopause happens when your ovaries gradually stop releasing eggs and your hormone levels, particularly oestrogen, drop. It’s diagnosed when you’ve gone 12 consecutive months without a period, and typically occurs between the ages of 45 and 55.¹

Early menopause refers to menopause that happens between the ages of 40 and 45. If it occurs before the age of 40, it’s considered premature menopause; or more accurately, primary ovarian insufficiency (POI), which reflects the fact that your ovaries might not be working quite as they should, rather than fully “shut down.”²

The signs are often the same: hot flushes, irregular periods, mood swings, vaginal dryness, and difficulty sleeping, but the earlier menopause occurs, the longer someone will live without the protective effects of oestrogen.² That can carry significant health risks, including increased chances of osteoporosis, heart disease, and even cognitive decline later in life.

So what causes early menopause? 

1. Genetics

Perhaps the strongest predictor of early menopause is family history. If your mother, sister, or grandmother experienced early or premature menopause, your chances of following a similar pattern are significantly higher. Large-scale studies have found that genetic factors account for up to 50% of the variation in when menopause occurs.³

In some cases, early menopause is linked to chromosomal conditions such as Turner syndrome or fragile X syndrome. Being part of a multiple pregnancy (e.g. a twin) may also raise the risk, potentially due to shared genetic and developmental factors.⁴

2. Surgical menopause

Surgery to remove both ovaries causes immediate menopause, regardless of age. This may be done to treat or prevent various cancers.⁵

While removing one ovary won’t trigger menopause, it may contribute to an earlier transition. A hysterectomy (removal of the uterus) without ovary removal will stop periods, but doesn’t necessarily bring on menopause. However, research suggests it may still nudge the timing forward by a few years.⁵

3. Cancer treatment

Certain types of chemotherapy and pelvic radiation can damage the ovaries, leading to early menopause. The risk depends on the type of drugs used, the dose, and your age at the time of treatment. For some, the effect is temporary; for others, it’s permanent. Hormone therapy used in breast cancer treatment can also impact ovarian function.⁶

4. Autoimmune conditions

In some autoimmune diseases like Addison’s disease, Hashimoto’s thyroiditis, or lupus, the immune system may mistakenly attack the ovaries, impairing their ability to function. This can lead to early or premature menopause, although it’s a less common cause.⁷

5. Smoking and body weight

Smoking has long been associated with earlier menopause. It accelerates the breakdown of oestrogen in the body and may damage ovarian follicles. Women who smoke are up to two years more likely to reach menopause earlier than non-smokers, and the more they smoke, the greater the risk.⁸

Being underweight may also play a role. Low body fat can mean reduced oestrogen production, especially if weight loss is linked to restrictive eating, chronic illness, or intense physical activity.⁹ On the other hand, being overweight or obese is generally associated with later menopause.¹⁰

6. Early puberty

Women who started their periods very early (before the age of 11) may be more likely to reach menopause sooner. Likewise, those who have never had children appear to be at higher risk, although the reasons aren’t fully understood.¹¹ One theory is that fewer pregnancies mean more ovulations over a lifetime, which may exhaust the ovarian reserve sooner.¹²

7. Early life and social factors

Some research suggests that adverse childhood experiences, including poverty, abuse, neglect, or parental separation, may influence the timing of menopause. The exact biological mechanisms aren’t clear, but chronic stress in early life may affect hormone regulation and ovarian development.¹³

Nutritional deprivation in early life, such as childhood famine or low birthweight, may also play a role. Women from lower socioeconomic backgrounds have consistently been shown to experience menopause earlier on average, which may reflect a combination of environmental, behavioural, and biological influences.¹⁴

The numan take

Early menopause isn’t rare, and it isn’t something to be brushed off as just bad luck. Whether it’s driven by genetics, medical treatment, or other factors, it deserves proper recognition and care. If you suspect you might be going through menopause earlier than expected, talk to a healthcare provider, explore your options, and take steps to support your health.

References

1. Gold EB. The timing of the age at which natural menopause occurs. Obstetrics and gynecology clinics of North America. 2011;38(3): 425–440

2. Hamoda H, Sharma A. Premature ovarian insufficiency, early menopause, and induced menopause. Best practice & research. Clinical endocrinology & metabolism. 2024;38(1): 101823.

3. Ceylan B, Özerdoğan N. Factors affecting age of onset of menopause and determination of quality of life in menopause. Journal of Turkish Society of Obstetric and Gynecology. 2015;12(1): 43–49.

4. Barros F, Carvalho F, Barros A, Dória S. Premature ovarian insufficiency: clinical orientations for genetic testing and genetic counseling. Porto biomedical journal. 2020;5(3): e62.

5. Secoșan C, Balint O, Pirtea L, Grigoraș D, Bălulescu L, Ilina R. Surgically induced menopause-A practical review of literature. Medicina (Kaunas, Lithuania). 2019;55(8): 482.

6. Del Mastro L, Catzeddu T, Boni L, Bell C, Sertoli MR, Bighin C, et al. Prevention of chemotherapy-induced menopause by temporary ovarian suppression with goserelin in young, early breast cancer patients. Annals of oncology. 2006;17(1): 74–78.

7. Szeliga A, Calik-Ksepka A, Maciejewska-Jeske M, Grymowicz M, Smolarczyk K, Kostrzak A, et al. Autoimmune diseases in patients with premature ovarian insufficiency-our current state of knowledge. International journal of molecular sciences. 2021;22(5): 2594.

8. Hayatbakhsh MR, Clavarino A, Williams GM, Sina M, Najman JM. Cigarette smoking and age of menopause: a large prospective study. Maturitas. 2012;72(4): 346–352.

9. Szegda KL, Whitcomb BW, Purdue-Smithe AC, Boutot ME, Manson JE, Hankinson SE, et al. Adult adiposity and risk of early menopause. Human reproduction (Oxford, England). 2017;32(12): 2522–2531.

10. Zhu D, Chung HF, Pandeya N, Dobson AJ, Kuh D, Crawford SL, et al. Body mass index and age at natural menopause: an international pooled analysis of 11 prospective studies. European journal of epidemiology. 2018;33(8): 699–710.

11. Mishra GD, Pandeya N, Dobson AJ, Chung HF, Anderson D, Kuh D, et al. Early menarche, nulliparity and the risk for premature and early natural menopause. Human reproduction (Oxford, England). 2017;32(3): 679–686.

12. Ulrich ND, Marsh EE. Ovarian reserve testing: A review of the options, their applications, and their limitations. Clinical obstetrics and gynecology. 2019;62(2): 228–237.

13. Kapoor E, Okuno M, Miller VM, Rocca LG, Rocca WA, Kling JM, et al. Association of adverse childhood experiences with menopausal symptoms: Results from the Data Registry on Experiences of Aging, Menopause and Sexuality (DREAMS). Maturitas. 2021;143: 209–215.

Namazi M, Sadeghi R, Behboodi Moghadam Z. Social determinants of health in menopause: An integrative review. International journal of women’s health. 2019;11: 637–647.