Menopause Before 40: Health Risks Associated with Early Menopause

Menopause Before 40: Health Risks Associated with Early Menopause

Menopause Before 40: Health Risks Associated with Early Menopause

The mean age at which most women experience menopause is normally 51. However, not the case for every woman. Some women experience menopause at an earlier age, such as before 40.

This unusual early start of this phase of a woman’s reproductive life is believed to result from certain factors such as underlying illness, previous medical operations undergone by the woman, genetics, and so on. This menopause occurs very early before the usual age and is referred to as premature or early menopause. Early menopause can occur naturally, or it can be artificially induced.

Apart from the conventional vasomotor symptoms that plague menopausal women, women who experience menopause before age 40 also suffer extra physical and mental side effects.

Thus while menopausal women normally complain of hot flashes, anxiety, mood swings, and the likes, women who hit menopause before the age of 40 must first worry about the unexpected shortage of their childbearing years.

You may be wondering if there is any difference between premature menopause, ovarian insufficiency, and early menopause. These three are quite different.

Premature menopause and early menopause are a tad similar. They both refer to a woman entering the menopause stage before the natural time or age. It usually means that such women become unable to get pregnant. In a situation where there are no probable reasons, whether medical or surgical, for these unscheduled occurrences, it is known as a medical condition called Primary Ovarian Insufficiency (POI). You may also hear this condition referred to under a different name as Premature Ovarian Insufficiency.

In the past, the name for this condition was Premature Ovarian Failure (POF). Still, they scrapped it because it does not exactly fit the description of that condition. Women who experience early menopause may also have instances of ovulation, see their periods once in a while, and may even get pregnant. These cannot be medically possible if such women have ovarian failure.

Menopause is the stage in a woman’s reproductive life at which she stops witnessing her menstrual periods. That is, she does not experience menstrual bleeding anymore. A woman is medically declared menopausal after 12 concurrent months of not seeing her periods.

Naturally, this occurs from the age of 50 and above. It is a normal occurrence for women, signaling the end of a woman’s ability to conceive a child. Natural menopause happens in three phases: the perimenopause stage, the menopause stage, and the postmenopause stage.

The perimenopause stage is the first stage. It is the stage at which the woman’s body begins to change. The parts of her body affected are usually the reproductive organs and systems, especially the ovaries.

These changes commence with events like a reduction in hormone production by the ovaries. It leads to an imbalance in vital hormones such as estrogen, progesterone, and testosterone levels.

You may experience some symptoms of menopause, such as hot flashes and vaginal dryness at this stage. This stage lasts until you have fully hit menopause after missing your menstruation for 12 months.

The menopause stage follows the perimenopause stage. It is the main stage. It usually kicks off at the age of 50- 52. At this stage, your ovaries lose their egg production function. Another major characteristic of this stage is the fluctuations in hormone levels. Your estrogen hormone levels, in particular, become very low. Bear in mind, however, that there could be other reasons for not seeing your periods other than menopause. Such reasons may be using certain contraceptives or abnormal functioning of the thyroid.

The final stage is the postmenopausal stage. A woman is declared postmenopausal when she has passed through the menopausal stage. At this stage, you will witness a decline in the severity and frequency of perimenopausal and menopausal symptoms. However, these symptoms may not completely disappear until after a few years.

An important point to make at this juncture is that different women undergo the stages of menopause in different ways. Therefore, the experience of the journey of menopause varies for every woman.

One woman may witness vasomotor symptoms such as hot flashes for about a month and find out in 12 months that she has reached menopause; another woman may suffer even worse symptoms of menopause for a long time before getting to menopause and may still suffer those symptoms for a few more months or years after menopause.

There are a lot of reasons for these discrepancies. Bad lifestyle choices, personal and family health history, and even stress may influence how you experience menopause.

However, an unexpected factor affects how certain women, especially black women, experience menopause. You will find that recent research has shown that black women are in greater danger of premature menopause than white women. In addition, the frequency and severity of vasomotor symptoms and the length of the menopausal experience are also different for black women compared to white women.

Many women ask, ‘Is Premature menopause the same as early menopause?’

Premature or early menopause must not be mistaken for early menopause; the factor distinguishing one from the other is the time or age you experience each. While premature or early menopause refers to the menopause that happens before a woman ages 40, early menopause is the name for menopause occurring before a woman reaches 45.

However, both are mostly brought about by similar factors, and the vasomotor symptoms associated with them are very much alike. While only 1 percent of women under the age of 40 experience premature menopause, as t least 5 percent of women yet to get to age 45 undergo early menopause.

What are the Causes of Premature or Early Menopause?

Menopause Before 40: Health Risks Associated with Early Menopause Causes

The causes of premature or early menopause may be known or unknown. The known causes are usually underlying medical conditions the woman suffered or medical treatment she underwent in the past.

Some common factors contributing to the onset of premature or early menopause in women include the following.

Ovarian surgery: undergoing surgery to remove the ovary can have certain side effects, including premature menopause. The absence of the ovary means no more production of eggs and a drastic reduction in estrogen levels. This surgery brings about a major change in the woman’s body.

Smoking: there are myriad downsides to smoking already. Female smokers are liable to die young, but they are also liable to suffer premature menopause.

Hysterectomy: this is another major medical operation that affects your reproductive system and ups your chances of experiencing premature menopause.

Chemotherapy: chemotherapy treatment for cancer patients and radiation treatments can also bring about premature menopause.

According to the ‘Childhood Cancer Survivor Study (CCSS),’ which is peer research on people from across North America who survived cancer in their childhood between 1970 and 1986, ‘approximately 6% of childhood cancer survivors experienced acute ovarian failure (AOF) during cancer treatment or shortly after completing cancer treatment.’ ‘Another 8% retained ovarian function during treatment but later developed premature menopause.’

Premature Menopause: Suppose you have a family member or two that has experienced or is undergoing premature menopause. In that case, the chances are that you, too, might witness the condition.

Certain medical conditions can also contribute to the increase in chances of women undergoing menopause before the age of 40. These conditions include the following:

Abnormalities in chromosome makeup and number. These abnormalities include Turner’s syndrome.

Underlying diseases such as diseases of the autoimmune system include rheumatoid arthritis and bowel inflammation.

Human Immunodeficiency Virus(HIV) and Acquired Immune Deficiency Syndrome (AIDS).

Other infectious diseases such as mumps.

How Do You Know That You are Undergoing Premature or early Menopause?

Certain signs point to the possible onset of menopause at 40. Before menopause, many women experience fluctuations in the frequency of their menstruation. If you notice these changes, consult with your doctor for medical advice on what proper steps to take to manage the situation while it is at the earliest stage.

Your doctor will examine you to determine the possible causes of the changes. Most of the usual vasomotor symptoms are witnessed during premature menopause. Some of the symptoms associated with menopause at 40 include the following.

  • Hot flashes are typically hot or warm sensations circulating all over the body.
  • Dryness of the vagina which in turn leads to painful sexual intercourse.
  • Reduced sexual urge or desire. It is probably a result of vaginal dryness and fear of painful sexual intercourse.
  • Night sweats are also known as cold flashes because they are similar to hot flashes but occur at night.
  • Sleeplessness may be a result of night sweats.
  • Frequent pressing urge to urinate. It may be due to infections of the urinary tract.
  • Emotional instability: women going through premature menopause are likely to suffer constant changes in emotions such as common irritability, frequent mood changes, anxiety, and depression.
  • Dryness of certain body parts such as the eyes, mouth, or whole skin.
  • Softening of the breasts.
  • Abnormally sporadic heartbeats.
  • Migraines
  • Poor memory and having a hard time concentrating.
  • Painful aches in parts of the body such as the joints and muscles.
  • Bone thinning.
  • Bloating and increase in body size.
  • Weakness loss of hair.

Why Black Women Are Likely to Have Premature or Early Menopause, Compared with White Women

Black women have been shown to have a greater (3 times higher) chance of experiencing premature menopause compared to their fairer-skinned sisters.

The conclusion was reached by preliminary research presented on May 20 at the American Heart Association’s Epidemiology, Prevention, Lifestyle, and Cardiometabolic Health Conference 2021.

The research was conducted with 3522 black and white women, numbering 6514 subjects. The results showed premature menopause in 15.5 percent of the black women compared to a meager 4.8 percent of white women who experienced early menopause.

Researchers expressed their surprise at this unprecedented revelation. However, further research is required to discover the main causes of this major difference.

‘The disparities between when Black women and white women go through premature menopause are striking,’ says Dr. Priya M. Freaney, MD, a third-year cardiology fellow at Feinberg School of Medicine at Northwestern University in Chicago, lead author of the study.

It is believed that other factors such as racism and other social conditions peculiar to black women may contribute to this wide difference margin.

‘We need to further study social determinants of health, systemic, and structural racism and get a better understanding to address those factors to try to get to the root of these disparities,’ she added.

This difference in risk chances due to racial origins is a new finding. No previous studies showed a significant discrepancy in the chances of black women having premature menopause compared to white women.

‘This aspect of the study shows a significant racial difference that hasn’t been brought out in other research on premature menopause.’

These were the words of Stephanie S. Faubion, MD, the Center for Women’s Health director at the Mayo Clinic in Rochester, Minnesota, and the medical director of The North American Menopause Society (NAMS). (Dr. Faubion did not participate in this research work).

Is the Burden of Menopause the Same for Black Women and White Women?

As we have discussed earlier, menopause has three main stages: the perimenopause stage, the menopause stage, and the postmenopause stage.

Following the bewildering discovery that black women are more likely to have premature menopause when compared to white women, researchers went on to find out if women of both extreme races also go through the same menopausal transition process and for the same time.

To achieve this and uncover whether or not the burden of the menopausal transition is similar for the major races, researchers studied women who have passed menopause, that is, postmenopausal women aged 55 to 69. These subjects were from 6 population-centered groups in the United States of America.

The research also sought to find out the chances of Black women developing other health issues as a result of premature menopause when compared to white women.

The findings from the study revealed that premature menopause is at the root of coronary heart diseases for both black and white women. Black and white women who undergo menopause early are 40 percent more likely to go down with coronary heart diseases and other health complications than women who did not have premature menopause.

What is the Reason for this Disparity Based on Race?

When posed with this question, researchers replied that further research is needed to get the much-needed answers.

‘Right now, we don’t know why this difference exists. Is this purely related to genetics, or could it be other factors such as economic and healthcare inequities?’ says Dr. Faubion.

Everyone is peculiar in their way of undergoing certain medical conditions, menopause inclusive.

‘This finding drives home the point that we can’t assume everybody is the same,’ she emphasizes.

For this reason, special isolated and individualized research needs to be carried out to determine the peculiar reactions of certain smaller or larger groups of people to medical conditions that plague everyone. It will help develop customized treatments and management strategies to suit everyone’s unique complexities.

‘It highlights why it’s so important to include all races and ethnicities in research to determine who is a higher risk for different diseases so that we can individualize and personalize recommendations,’ she added.

Similarly, major research on women and their menopausal experience, known as the Study of Women’s Health Across the Nation (SWAN), sheds more light on the issue of black women’s special tendency to get into menopause at an earlier age than white women.

The study started in 1994. It observed black women and women of other ethnicities side by side to understand the outward, biological, mental, and societal differences that they go through during menopause.

Women from all walks of life, socioeconomic statuses, and diverse ethnic origins participated in this research work.

The average age at which most women reach menopause is 51. However, the findings from the SWAN research reveal that Black women get into menopause as early as 49.

It is two years ahead of the average menopausal age. The research also points to Latina women in the same bracket as their black sisters. Black women were also found to take more time to go through the various stages of menopause compared to white women.

Dr. Nanette Santoro, a professor and E. Stewart Taylor Chair of Obstetrics and Gynecology at the University of Colorado School of Medicine, was part of the research in SWAN. On the question of the reasons for the higher tendency of black women to have premature menopause or have a distinct experience of menopause, she had this to say: ‘My educated guess is that a lot of the differences have their basis in lifestyle, SES (socioeconomic status), and other stressors such as systemic racism and their long-term consequences.’

Women Should Approach Their Doctors About Menopausal Health Challenges

Experts have pointed out the need for medical practitioners to ask their patients about their menopausal health details on time. They believe this will help them be on top of their game in giving better medical advice on how to contain the situation before it gets out of hand.

In the same way, patients are urged to be open to their doctors and not be afraid to speak up and divulge critical details of their menopausal symptoms and conditions, such as the age at which they entered menopause, to their doctors.

These communications, researchers believe, will make for early detection and treatment of the health risks and conditions that are attendant to premature menopause.

‘The key takeaway here is that we need to be asking our patients about their menopausal history way earlier to be proactive about investigating and modifying their cardiovascular risk factors to help them stay healthy over the next many decades,’ says Freaney.

‘If women have experienced menopause before age 40 and their doctor doesn’t ask about it, they should feel empowered to initiate the conversation,’ she adds.

Now that you understand that every woman’s menopausal experience is unique, you know better to speak with your doctor frequently to ensure that she follows you on every step of the journey and provides you with medical advice and treatments that match your peculiar condition.

The time of vasomotor symptoms, health risks to be on the lookout for, personal health history, and family health are just a few of the pertinent topics you need to discuss with your medical practitioner when you next schedule a meeting.

Top 7 Health Risks Associated with Early Menopause

Many medical conditions are caused or exacerbated by the unprecedented onset of menopause at the early stage of a woman’s life, such as before the age of 40 or 45.

The reduction or total stoppage in estrogen production in the female body can have life-threatening consequences or expose the woman to various health hazards. Here are seven of the top health risks that plague women who hit menopause before the due time:

  1. Untimely death

‘Cardiovascular mortality was also increased in the women who underwent bilateral oophorectomy before age 45 years and did not take estrogen,’ says Rivera CM, Grossardt BR, Rhodes DJ, and others in their book titled, ‘Increased cardiovascular mortality after early bilateral oophorectomy.’

  1. Increased likelihood of getting down with neurological diseases such as memory loss and cognitive functions.
  2. Poor or unhealthy sexual life.
  3. Cardiovascular diseases result from reduced estrogen levels produced in the body.

‘Women who reach menopause, defined as no menstrual periods for 12 consecutive months before they reach the age of 40, have as much as a 40 percent increased risk of developing coronary heart disease compared with women who don’t go through the transition early. According to a study presented on May 20 at the American Heart Association’s Epidemiology, Prevention, Lifestyle, and Cardiometabolic Health Conference 2021.

  1. Psychological disorders and abnormal emotional changes may lead to depression and critical emotional distress.
  2. Osteoporosis due to bone thinning and low bone density.
  3. Infertility: the chances of conception for women who hit menopause early are abruptly cut short.

Diagnosing and Testing for Premature or Early Menopause

Early detection is necessary for timely treatment and management of premature or early menopause signs and symptoms.

Your first port of call is if you start noticing signs of menopause before you age 40 in the hospital, where you will consult your doctor or medical practitioner for relevant tests and advice.

Typically, your doctor will ask you the necessary questions to get a good understanding of your condition. She will then run several tests to find out what exactly ails you.

Some of the tests that you may have to undergo in the diagnosis of early or premature menopause include the following:

Tests to determine the levels of vital hormones such as estrogen.

Tests to find out if you are suffering from any other underlying medical conditions that may be the main or contributory cause of the symptoms you are experiencing.

Your doctor may also pose the following questions to determine the possibility of undergoing premature or early menopause. Such questions may take the following tenor:

‘How regular is your menstrual cycle?’ or ‘Do you have any family member or relative who went into menopause before 40 or 45?’

The answers to these questions and results from the test will go a long way in helping your doctor make a correct medical conclusion on whether or not you are about to go into premature or early menopause and give you advice on what necessary steps to take next.

Suppose you have gone 12 months straight without witnessing your menstrual periods. You are not on any medical treatment or drug that could have warranted this condition. In that case, it is most likely that you have hit menopause.

Strategies for the Treatment and Management of Premature Menopausal Condition

The treatment and management method of this condition is dependent on the cause of the condition. For example, many women experience menopause at 40 for various reasons. Therefore, your doctor shall recommend the right treatment method to manage the condition based on the reason you started experiencing menopause at an earlier than normal age.

However, hormone replacement therapy (HRT) is one of the most popular treatment mechanisms for menopausal symptoms. Unfortunately, this treatment may not be right for some women who may not be eligible to undergo such therapy for health reasons or other underlying risks.

Some downsides are associated with using hormone replacement therapy for women who experienced menopause at the right age. Still, such challenges are believed to not affect women who got into menopause at an early age.

Your doctor’s advice and recommendation are important in choosing whether or not to go ahead with this treatment. She will medically weigh the benefits and risks of you undergoing the treatment and, based on her expertise, point you in the right direction to take.

What Happens After Premature Menopause?

As pointed out earlier, the population of women who experience menopause before 40 or 40 is almost infinitesimal. Unless a woman’s ovaries are medically removed, it will be hard for her to be diagnosed with premature menopause. The more prevalent condition is primary ovarian insufficiency (POI).

Unlike women who have premature menopause, women who suffer the later condition, primary ovarian insufficiency (POI), experience occasional ovulation and menstruation. It means they have a small chance of getting pregnant, unlike women with premature menopause.

Suppose you are still intent on having more children despite your condition. In that case, you can explore the diverse options for assisted reproduction or fertility restoration.

There is also the option of trying out in vitro fertilization (IVF) with eggs from the egg bank. Again, you can visit your doctor or medical specialist for advice on which option fits you.


Premature menopause is uncommon among women, but this does not play down the dangerous nature of this medical condition.

Women who undergo this peculiar untimely onset of menopause do not just have menopausal symptoms to battle with. They also have to fight for their lives and the numerous life-threatening health risks of premature menopause.

Women of certain races, such as black women, are at higher risk of having this condition than their counterparts from other races. Researchers are still in the laboratories searching for answers to this disparity.

Premature menopause is not a death sentence. However, early detection and reporting are essential to managing this condition effectively. There are several options for treatment and management of menopause before 40 and even the possibility of having more children despite this condition.

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