We’ve all heard about The Change and associate it with getting older, no longer being able to have kids, and never having to worry about a period again (silver lining). But for some women, menopause happens much earlier than they would have expected, completely taking them by surprise and derailing plans for a growing family.
“Premature menopause is relatively uncommon,” Alan B. Copperman, M.D., director of the division of reproductive endocrinology and infertility at Mount Sinai Hospital and medical director of Reproductive Medicine Associates of New York. Yet for women who were planning to have children toward the end of their reproductive years, it can be devastating.
The average age a woman hits menopause is 51. Perimenopause, or the period of natural decline in reproductive hormones, usually starts in a woman’s 40s, but can happen mid-30s, too. It’s marked by symptoms like an irregular menstrual cycle and those hallmark hot flashes. You’ve officially reached menopause after being period-free for 12 straight months.
Some women, though, reach menopause before they even turn 40. This is referred to as premature or early menopause, and is preempted by premature ovarian failure (POF), a condition where a woman’s ovaries stop working before she turns 40. About 1 percent of women are affected by POF. For some of these women, POF can develop as early as their teenage years, and for others, it happens in their 20s or 30s.
Oftentimes, premature menopause and POF are used interchangeably, Copperman says. The key difference, though, is that POF can be intermittent, according to the American Society of Reproductive Medicine. A woman experiencing POF can still possibly get pregnant through assisted reproductive technologies like IVF—an estimated 10 percent of women with POF become pregnant using their own eggs, with or without an assisted technology.
However, once your period is gone for a full year, you’ve officially entered menopause—and menopause is for good.
What causes early menopause?
Early menopause can either happen on its own or be caused by certain medical treatments, though many times the cause is unknown. Chromosome defects, like Turner’s syndrome, can affect ovary formation and cause someone to experience very early menopause. An autoimmune disease that cause the immune system to mistakenly attack the ovaries is another potential cause, as is genetics. “If your mom had menopause in her 20s or 30s, that can be hereditary,” Copperman says.
Cancer treatments like chemotherapy and radiation therapy can damage the ovaries and cause POF. Some women may find that a portion of their ovarian function returns naturally over time, while others may simply continue into menopause. Women who undergo surgery to remove their ovaries—like Angelina Jolie, who elected to have her ovaries and fallopian tubes removed along with undergoing a double mastectomy after learning she had the BRCA1 mutation—will experience menopause immediately after.
Though early menopause is uncommon, every woman will start to see her ovarian function decline with age, no matter what. “There’s only one direction the ovaries go,” Copperman says. “It’s inevitable that there will be reproductive aging,” meaning the quantity and quality of your eggs will slowly and steadily diminish over time. So if you’re planning to have children later in life, it’s not a bad idea to visit a reproductive specialist and get a full fertility workup to assess your current reproductive health. Having all the information will help you make the best decision possible.
How can you tell if you’re starting to go through menopause early?
The signs of early menopause are essentially the same as the signs of menopause, prompted by the hormonal changes you go through as your reproductive organs prepare to call it quits. Here are the symptoms that may signal a decline in ovarian function. (Note that they can also signal a number of other fixable health problems. “We can frequently reassure women that their ovaries look fine and we need to look elsewhere to find the cause of their symptoms,” Copperman says. “Just because your period is irregular or you have hormonally related changes doesn’t mean that the ovaries are failing.”)
1. An irregular menstrual cycle
An irregular menstrual cycle means something’s wonky with your ovulation. “As a woman undergoes ovarian aging, ovulation often occurs earlier in the cycle. Periods start coming a little earlier, and after a few shorter cycles, there’s a skipped cycle,” Copperman explains. Plenty of other things can make your period irregular, so it may actually be a treatable health problem and not a sign you’re nearing menopause.
2. Hot flashes
Hot flashes are the most common symptom of menopause, according to the Mayo Clinic. Some women get them once a day, some, once an hour. They can also manifest as night sweats, disrupting your sleep and even causing insomnia. Luckily, there are a lot of treatment options, including hormone therapy, prescription medication, and alternative medicine methods, that can help you ease the symptoms.
3. Vaginal dryness
Estrogen plays an important role in maintaining natural lubrication in the vagina. When your estrogen levels drop leading up to menopause, it’s likely you’ll experience vaginal dryness. Try using lube to make sex more comfortable, and speak with your doctor about easing dryness on a daily basis.
4. Mood swings
You’re sweating uncontrollably, not sleeping well, and your hormones are in free-fall. If that’s doesn’t make you snap, you’re a saint.
Even if you are going through early menopause, you have options.
If your doctor runs a fertility workup and concludes you have diminished ovarian reserve or even premature ovarian failure, it doesn’t mean you won’t ever have children. “The beauty with IVF today is we can take out eggs, fertilize them, and figure out which one is normal,” Copperman says, maximizing a woman’s chance of having a healthy baby. If you do enter menopause early and are unable to conceive with your own egg supply, he adds that options like egg donation are available, and give women with ovarian failure the chance to still carry and give birth.