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It’s the middle of the night, and you wake up sweating. You’ve also been getting hot flashes throughout the day, and you missed your last two periods—even though you’ve taken multiple pregnancy tests that came back negative. If you’re a menstruating person in your 30s or 40s, these symptoms may sound like menopause, which typically doesn’t happen until your late 40s or 50s. Could these actually be signs of early onset menopause instead?

While only a healthcare provider can truly answer this for you, menopause can come early (which is different from perimenopause or the stage right before menopause, BTW).

Here are nine things experts want you to know about why early menopause happens, if the treatment options are any different from regular menopause, and how it affects your overall health.

First, what is early onset menopause?

Before we dive in, let’s get a quick refresher on menopause: It’s a normal part of aging where menstruating people stop getting their period and, eventually, are no longer able to conceive. Along with your period ending, menopause can bring about other symptoms that affect day-to-day life.

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Early onset menopause is when the transition arrives ahead of schedule. “Any menopause symptoms before 40 is considered premature menopause,” Michael Thomas, MD, an OB/GYN and the department chair of Obstetrics & Gynecology at the University of Cincinnati College of Medicine, tells Well+Good. He adds that when menopause happens in your early 40s, it’s considered menopause—but not premature.

It’s important to differentiate the two because it helps providers order proper tests (i.e., bloodwork that establishes menopause is causing symptoms) and provides you with the right treatment.

Another thing worth noting: Both early onset menopause and menopause are preceded by something called perimenopause. Studies say this phase usually lasts about four years, but Dr. Thomas notes that sometimes, perimenopause might be shorter for those with early-onset menopause.

9 things to know about early onset menopause

1. Early menopause is a spectrum

The Office on Women’s Health notes the average age for menopause is 52. But that doesn’t mean every menstruating person will start it at this age. Our bodies all have their unique timelines, similar to how we accomplish career and life milestones at our own pace.

More often, menopause is an ongoing process that can begin between the ages of 45 and 55. But if it starts earlier, it may be diagnosed as early or premature.

“Going through menopause is a continuum, like going through puberty but in reverse. With puberty, women gain ovarian function, and ovaries make estrogen. In menopause, women lose ovarian function, and ovaries stop making estrogen,” says Pamela Promecene, MD, an OB/GYN and professor at UT Health Houston.

2. The signs are similar to regular menopause

Turns out, the signs of early menopause in your 30s and 40s will look similar to signs of menopause at a later age. We’re talking about hot flashes, missed periods, and vaginal dryness, among other common symptoms. The only difference between early onset and ‘regular’ menopause is the age when symptoms start.

Okay, there is one exception to this. And that is when you’re on the pill. If you’re on hormonal birth control, the signs of early menopause may be muted or nonexistent. This is because menopause symptoms happen from a lack of estrogen, which birth control pills provide plenty of (and therefore mute symptoms).

3. The most common cause is unknown

There are a lot of menopause myths surrounding what causes it to happen early—including stress, unhealthy diet, birth control, etc. But the truth is the cause of early onset menopause is often unknown. There may be some specific conditions to blame, however, including the following:

• Ovary removal: “Surgical removal of the ovaries before the age of 45 will also cause early menopause,” says Dr. Promecene. 
• Chromosomal disorders: “Rare disorders that affect one of the female X chromosomes can cause early menopause,” says Dr. Promecene.
• Pelvic radiation: Radiation in the pelvic region or chemotherapy treatments may also cause early menopause.

“However, most of the time, no one knows why it happens,” says Dr. Thomas. He adds that it’s important to run additional tests and rule out any potential causes before labeling early menopause as one of those things that “just happens.”

If all your tests come back normal, it could be something that just happened, and that’s okay. It won’t have a huge effect on overall health—with the right treatment. (More on that later.)

4. Birth control won’t cause early menopause

It’s no secret that birth control disrupts hormones, but can birth control cause early menopause? One study analyzed the age of menopause onset in over 100,000 people and found no correlation between birth control use and early menopause. Almost every other study we’ve found, and the experts we interviewed suggested the same.

“Birth control pills don’t stop future cycles or cause early menopause. It’s been shown that on or off birth control pills, your average age to menopause is still the same,” Dr. Thomas says.

5. You may still get your period from time to time

It’s true: The transition from perimenopause to early onset menopause may mean you still get your period from time to time. It just may not look the same as it did before (i.e., lighter in color, flow, and texture).

But this also means…you could still get pregnant. As long as you’re still getting some kind of period, this means you may still be fertile. So, if you’re hoping to avoid pregnancy, it’s best to use a form of contraception while having sex—whether it’s condoms or hormonal birth control.

6. Stress might be to blame (at least in part)

Healthcare providers are telling us all the time to reduce our stress for various health reasons. But can stress cause early menopause? The answer is a bit complicated.

One January 2021 study in PLOS One found stressful events can make menopause symptoms 21 percent more severe. But stress can’t cause early menopause. “Stress may contribute to many health conditions, including menopausal status, but stress alone does not cause early or premature menopause,” says Dr. Promecene.

Long story short: There’s no direct correlation between stress and menopause arriving early, but stress may play a supporting role.

7. Bone health is vital when menopause comes early

Bone health is not something we think about too often, but if you’re dealing with early menopause, it might be a good time to start. Dr. Thomas explains that more time with low estrogen levels can lead to lower bone density and a higher risk of osteoporosis.

Dr. Promecene echoes this: “Starting at the same bone density, women who experience menopause at age 40 will have lower bone density at age 50 than women who go through menopause at age 50.”

Both Drs. Promecene and Thomas recommend starting bone density scans at an earlier age if you’re in early menopause. You may be a strong candidate for hormone therapy, which can help maintain healthy estrogen levels and keep bones strong.

8. Early menopause can sometimes run in families

Medical researchers can’t say for sure that early menopause is 100 percent genetic, though there does seem to be a genetic component.

“If your mom went into menopause at age 38, there’s a good chance you may go into menopause around that age, too,” says Dr. Thomas. The same goes for older siblings and other relatives on the maternal side.

Ultimately, when you start menopause will be similar to when relatives did (and early menopause tends to run in families), but predicting when a person will start menopause isn’t an exact science.

9. Treatment options are the same

No matter your age or when you start menopause, the treatment options are typically the same.

Treatment options are typically the same for all people going through menopause, no matter their age. Recent studies have found that common treatments and lifestyle changes to reduce menopause symptoms include the following:

• Hormone therapy
• Non-hormonal medications to target specific symptoms, such as hot flashes
• Calcium supplements
• Exercise
• Healthy weight maintenance or weight loss (if recommended by your healthcare provider)
• Cognitive behavioral therapy
• Mindfulness interventions

As we’ve learned, early menopause can increase your risk of lower bone density and osteoporosis, so hormone therapy can be especially helpful during this time. Dr. Thomas notes that early menopause can also affect your ability to conceive, which may require difficult conversations with your partner (if you wish to get pregnant) and mental health support.

Whether menopause happens early or when it’s “supposed to happen,” support from your loved ones can reduce stress and make you feel more comfortable as you try treatment options.

When to see a healthcare provider

“If you do not have periods, and all of a sudden you’re starting to have hot flashes and symptoms that older women may have, it’s best to see a provider to make sure you know what’s going on,” says Dr. Thomas. 

He also recommends documenting any irregularities, whether it’s skipped periods or menopausal symptoms like nighttime sweats or vaginal dryness. By writing down these concerns, they’ll be easier to bring up in a regular checkup or an appointment with your provider, specifically about early menopause.

No matter how old you are when menopause arrives, you deserve to feel supported throughout the transition. If menopause starts to happen before you’re 45 years old, it may be especially beneficial to pay attention to bone health—and to know that menopause’s timeline doesn’t have to affect yours.