Early Menopause: Symptoms, Risks, and Treatments
Women's HealthMenopause

6 Things to Know About Early Menopause

6 Things to Know About Early Menopause
Adobe Stock
By
Published on February 19, 2026
by
Most women experience menopause naturally between age 45 and 55.

 During this transition, the ovaries stop releasing eggs and produce very low levels of the hormones estrogen and progesterone.

 You’re considered to be in menopause if you haven’t had a menstrual period for 12 months in a row.

When menopause occurs before age 40, it’s often referred to as premature menopause. If it occurs before age 45, it’s called early menopause.

 Early menopause and premature menopause can happen for different reasons, sometimes naturally and sometimes due to medical treatments like chemotherapy.

Experiencing menopause symptoms earlier than expected can feel unsettling. But there are effective ways to manage these symptoms so you can stay healthy and live a full, active life.

1. There Are Different Types of Early Menopause

Early menopause can occur for different reasons, and the cause often determines the plan of care, says Marie Nakhoul, MD, a board‑certified ob-gyn in the University of Maryland Medical System and an assistant professor at the University of Maryland School of Medicine in Baltimore. Healthcare providers group early menopause into a few main categories, based on the cause.

Natural Early Menopause

Natural, or spontaneous, early menopause happens when ovarian function simply declines on its own sooner than expected.

 In this case, menopause usually occurs between age 40 and 45, says Dr. Nakhoul, and there’s no clear external cause. The transition often mirrors typical menopause, just at a younger age, she says.

Induced Menopause

When menopause occurs because of medical treatment rather than natural aging, it’s called induced, or medical, menopause, says Nakhoul. Induced menopause often occurs after surgery to remove the ovaries (oophorectomy) or during cancer treatment such as chemotherapy or radiation.

 Because hormone levels drop suddenly in this case, symptoms often develop quickly and feel more intense.

If you’re planning to start a treatment that could affect your ovaries, talk with your care team ahead of time about fertility preservation options if possible.

Premature Ovarian Insufficiency

In some cases, the ovaries stop functioning as they should before age 40, a condition known as premature ovarian insufficiency (POI).

 This condition is not a true form of menopause but often leads to menopauselike symptoms.

 “Ovarian function can be intermittent, so some people still have occasional [menstrual] cycles or ovulation,” says Nakhoul.

2. Symptoms Are More Than Just Hot Flashes

While hot flashes tend to get the most attention, early menopause may begin in less obvious ways.

Often the earliest sign is simply that the menstrual cycle begins to change, says Alyssa Dweck, MD, a Menopause Society-certified practitioner based in New York City and the chief medical officer of Bonafide Health. Periods may become irregular, with longer gaps between cycles, sometimes more than 60 days. Some people also notice their periods becoming heavier or lighter than usual.

As hormone levels continue to shift, hot flashes and night sweats may become more frequent, along with sleep disruptions and mood changes, says Dr. Dweck. Many women describe feeling more anxious or irritable, or just not like themselves, Nakhoul says.

Some symptoms tend to get less attention, and many people don’t immediately connect them to hormonal changes, especially if they’re younger and not expecting menopause yet, says Dweck. These symptoms can include the following:

  • Brain fog
  • Changes in sexual desire
  • Vaginal dryness
  • Joint pain
  • Thinning hair or skin

  • Weight gain or fat redistribution around the midsection
Urinary changes such as urgency or recurrent urinary tract infections can also occur, says Nakhoul.

Because these symptoms can overlap with other health issues, early menopause isn’t always the first thing that comes to mind. But if you’re noticing several of these symptoms, especially along with changes in your period, discuss them with your healthcare provider.

3. Early Menopause Is Linked to Health Risks

The age at which menopause begins can affect your health in many ways, largely due to the drop in estrogen.

 “Early menopause means the body spends more years in a low-estrogen state, and estrogen supports multiple systems [in the body],” says Nakhoul.
Estrogen is important for sexual and reproductive health, but it also helps keep the bones strong, protects the heart and blood vessels, and supports brain function and mood.

 When estrogen levels drop earlier than expected, these protective effects diminish sooner. Research shows that entering menopause before age 45 is linked to higher risks of heart disease and bone loss.

 These risks are even greater when menopause happens before age 40.

Bone Health

When estrogen levels are low, bone loss can occur faster.

 Over time this increases the risk of osteopenia (early bone thinning), osteoporosis (a more advanced condition in which the bones become brittle), and fractures, says Nakhoul.
A study of over 21,000 postmenopausal women found that those who entered menopause before age 40 were more likely to break a bone than those who experienced menopause at age 50 or older.

Weight-bearing exercise, strength training, and getting sufficient calcium and vitamin D can help protect your bones.

 In some cases, a gynecologist may also recommend bone density testing earlier than usual to monitor bone health.

Heart Health

The heart and blood vessels can be affected by the drop in estrogen.

 Dweck says that estrogen helps keep the inner lining of the blood vessels flexible and functioning well. Without that support, the blood vessels can become stiffer and more prone to damage.

At the same time, cholesterol levels can rise during menopause.

 Specifically, more LDL (“bad”) cholesterol tends to stay in the bloodstream, which increases the risk of heart disease and stroke.

 You might also notice higher blood pressure or find it harder to manage your blood sugar, which can raise the risk of diabetes.

Because these changes don’t always cause noticeable symptoms at first, keep a close eye on key health numbers such as blood pressure and cholesterol levels. Staying active, keeping a healthy weight, and eating a heart-healthy diet become even more important to help lower your risk.

Mental Health

Taking care of your mental health is just as important as caring for your physical health during early menopause. Because the brain uses estrogen to help regulate mood, sleep, and focus, a drop in this hormone can affect these areas.

 It’s common to experience increased anxiety or irritability, says Nakhoul. You may also notice a frustrating cycle in which the hormonal changes disrupt your sleep, and the lack of rest makes it harder to manage your mood or stay focused.

On top of these changes, learning that you’re experiencing early or premature menopause can be difficult and isolating, especially if you were planning to have children or weren’t ready for this stage of life. Feelings of grief, loss, and frustration are common and completely valid.

Talking with a therapist or counselor who understands reproductive health and connecting with others who’ve experienced early menopause may help you feel less alone and more supported as you adjust.

4. Hormone Replacement Therapy Can Help Protect Your Bones and Heart

Lifestyle changes are a good foundation if you’re experiencing early menopause, but many healthcare providers also recommend hormone replacement therapy (HRT), as it serves two important purposes, says Nakhoul. “The first purpose is symptom relief, because hormone therapy can be very effective for hot flashes, night sweats, and sleep. The second is health protection,” she says, to replace the hormones that you’ve lost unexpectedly early.

HRT fills the hormonal gap, and it’s approved by the U.S. Food and Drug Administration (FDA) for treating hot flashes and preventing bone loss, Dweck says. For younger women who are facing many years without natural estrogen, hormone replacement can also help keep the heart and blood vessels healthy and support brain function.

Many people find their emotional health improves with HRT, Nakhoul adds, especially as they start getting better sleep and their physical symptoms become easier to manage. HRT can also improve vaginal and urinary symptoms, including dryness and discomfort during sex, says Nakhoul.

Healthcare providers generally recommend starting hormone therapy within 10 years of the onset of menopause and before age 60.

 How long you stay on HRT depends on your individual needs. “In most cases, we recommend continuing hormone therapy until the average age of natural menopause, around 52, but sometimes until 60,” says Nakhoul. Ultimately, you and your gynecologist will work together to decide on the best timeline based on your health history and how you’re feeling.
It’s worth noting that the FDA removed the warning that previously raised concerns about menopause hormone therapy.

 This update helps clarify that HRT can be a safe option for many people when used appropriately. That said, HRT isn’t the right choice for everyone, which is why discussing your personal health history and the pros and cons with your healthcare provider is important.

5. Nonhormonal Options Can Help Manage Symptoms

For those who can’t take hormone therapy or prefer not to take it, there are other effective ways to manage early menopause symptoms, including nonhormonal medications, lifestyle changes, and integrative therapies.

For Hot Flashes and Night Sweats

  • Certain Antidepressants Low doses of some antidepressants, including selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, can reduce hot flashes and night sweats, and may help with mood changes.

     These medications don’t contain hormones and are often used when estrogen isn’t an option.
  • Gabapentin Originally used for nerve pain and seizures, gabapentin (Neurontin) can be effective for hot flashes, especially nighttime symptoms that interfere with sleep.

  • Nonhormonal Medications Newer drugs like fezolinetant (Veozah) and elinzanetant (Lynkuet) act directly on the brain’s temperature-control center to help manage moderate to severe hot flashes.

     They can be very effective for some people, says Nakhoul, though they’re generally not as strong as estrogen.

For Sleep and Mood

Cognitive behavioral therapy (CBT), including CBT for insomnia, may help improve sleep.

 Nakhoul says that CBT can be especially useful when sleep disruption and mood changes occur together.

For Vaginal and Urinary Symptoms

For dryness, discomfort during sex, or urinary symptoms, nonhormonal vaginal moisturizers and lubricants can help.

 Selective estrogen receptor modulators are a nonhormonal oral medication that can act like estrogen in the vaginal tissues to improve dryness or pain.

 Pelvic floor physical therapy may be useful for some people.

Other Approaches

  • Lifestyle Changes “Lifestyle modifications are beneficial for symptom control and for health benefits,” says Dweck. These include avoiding tobacco, limiting alcohol, eating a balanced diet, exercising regularly with strength training, getting consistent sleep, managing stress, and staying connected with your community.

  • Complementary and Integrative Treatments Some people try acupuncture, hypnotherapy, relaxation, supplements, and mindfulness practices.

     Nakhoul says that using a layered approach, meaning combining a few strategies at the same time, can be helpful since menopause symptoms tend to overlap. Such supplements are not regulated by the FDA — you should speak with your doctor before starting any new supplements, as they can potentially interact with other medications or medical conditions.

Finding the right combination of nonhormonal options often takes some trial and error, and what works well for one person may not be the best fit for someone else. If you’re curious about any of these approaches, or you’re not sure where to start, discuss your symptoms, health history, and preferences with your healthcare provider to see which options might work best.

6. Pregnancy May Still Be Possible

Concerns about future pregnancy are natural if you’ve been told you’re in early menopause. But there are options to look into. “Time and clarity matter,” says Nakhoul, who recommends seeing a reproductive endocrinologist as soon as early menopause is suspected.

In POI, ovarian function can sometimes be intermittent, meaning pregnancy can happen on its own, though it’s uncommon and unpredictable, Nakhoul says. For many people, in vitro fertilization using donor eggs or donor embryos offers a more reliable path.

 If you’re facing medical treatment that could induce early menopause, cryopreservation (egg freezing) before treatment starts may be possible when timing allows, says Dweck.

Your doctor may be able to recommend resources and support groups for those going through fertility preservation. “What I want patients to feel at the end is that they are not alone in this. We can protect their health proactively, manage symptoms thoughtfully, and talk through fertility options with compassion and a real plan,” says Nakhoul.

The Takeaway

  • Early menopause means menopause begins before age 45, and when it occurs before age 40, it’s called premature menopause. Symptoms can include changes in periods, hot flashes, sleep problems, and mood shifts.
  • Because estrogen levels drop sooner than expected, early menopause is associated with increased risks of bone loss and heart disease.
  • Hormone therapy is often recommended for people with early menopause to manage symptoms and help protect long-term bone and heart health, though nonhormonal treatments can also be effective.
  • If you’re experiencing symptoms of early menopause or have concerns about your health or fertility, talk to a healthcare provider who can help you understand your options and provide support.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. What Is Menopause? National Institute on Aging. October 16, 2024.
  2. What Causes Menopause? Eunice Kennedy Shriver National Institute of Child Health and Human Development. November 16, 2021.
  3. Early or Premature Menopause. Office on Women’s Health. March 11, 2025.
  4. Premature and Early Menopause. Cleveland Clinic. September 6, 2022.
  5. Medically Induced Menopause: What To Know. UHealth Collective. October 9, 2025.
  6. Bieber A. How to Manage Medical Menopause. Cedars Sinai. January 23, 2025.
  7. Premature Menopause. Menopause Society.
  8. Primary Ovarian Insufficiency. Mayo Clinic. October 20, 2023.
  9. Menopause. Mayo Clinic. August 7, 2024.
  10. Rinaldi F et al. The Menopausal Transition: Is the Hair Follicle “Going Through Menopause”? Biomedicines. November 14, 2023.
  11. Menopause Symptoms and Relief. Office on Women’s Health. May 30, 2025.
  12. Nash Z et al. Bone and Heart Health in Menopause. Best Practice and Research Clinical Obstetrics and Gynaecology. May 2022.
  13. Estrogen. Cleveland Clinic. February 8, 2022.
  14. Menopause and Bone Loss. Endocrine Society. January 24, 2022.
  15. Williamson L. The Connection Between Menopause and Cardiovascular Disease Risks. American Heart Association. February 20, 2023.
  16. Kamińska MS et al. Menopause Predisposes Women to Increased Risk of Cardiovascular Disease. Journal of Clinical Medicine. November 13, 2023.
  17. Van Oortmerssen JAE et al. Lipid Metabolism in Women: A Review. Atherosclerosis. June 2025.
  18. Cho JM et al. Beyond Hot Flashes: The Role of Estrogen Receptors in Menopausal Mental Health and Cognitive Decline. Brain Sciences. September 2025.
  19. Borozan S et al. Hormone Replacement Therapy for Menopausal Mood Swings and Sleep Quality: The Current Evidence. World Journal of Psychiatry. October 19, 2024.
  20. Macmillan C. 4 Things to Know About Early and Premature Menopause. Yale Medicine. June 24, 2024.
  21. Hormone Therapy. Menopause Society.
  22. Fact Sheet: FDA Initiates Removal of “Black Box” Warnings from Menopausal Hormone Replacement Therapy Products. U.S. Department of Health and Human Services. November 10, 2025.
  23. Review: Nonhormone Therapies for Menopausal Hot Flashes. Cleveland Clinic. July 9, 2024.
  24. Iyer TK et al. Nonhormone Therapies for Vasomotor Symptom Management. Cleveland Clinical Journal of Medicine. April 2024.
  25. Lederman S et al. Fezolinetant for Treatment of Moderate-to-Severe Vasomotor Symptoms Associated with Menopause (SKYLIGHT 1): A Phase 3 Randomised Controlled Study. The Lancet. April 1, 2023.
  26. Panay N et al. Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause: A Phase 3 Randomized Clinical Trial. JAMA Internal Medicine. September 8, 2025.
  27. Huang AJ et al. Nonhormonal Treatment of Menopausal Vasomotor Symptoms. JAMA Internal Medicine. July 1, 2025.
  28. Sarmento ACA et al. Use of Moisturizers and Lubricants for Vulvovaginal Atrophy. Frontiers in Reproductive Health. December 22, 2021.
  29. Cuccu I et al. Update on Genitourinary Syndrome of Menopause: A Scoping Review of a Tailored Treatment-Based Approach. Life. November 19, 2024.
  30. Mercier J et al. Pelvic Floor Muscle Rehabilitation for Genitourinary Syndrome of Menopause: Why, How, and When? Climacteric. April 5, 2023.
  31. Navigating the Road to Menopause. Office on Women’s Health. October 26, 2025.
  32. Manage Menopause With These Lifestyle Updates. NYU Langone Health.
  33. Dietary Supplements: What You Need to Know. Office of Dietary Supplements. January 4, 2023.
  34. Han E et al. Oocyte Cryopreservation for Medical and Planned Indications: A Practical Guide and Overview. Journal of Clinical Medicine. May 18, 2023.
Meet Our Experts
See Our Editorial PolicyMeet Our Health Expert Network
John-Paul-McHugh-bio

John Paul McHugh, MD

Medical Reviewer
Member of American College of Lifestyle Medicine

John Paul McHugh, MD, is an obstetrician-gynecologist and lifestyle medicine specialist in southern California. He has always placed wellness at the center of his work, in both delivering babies and improving practice standards. Dr. McHugh believes that bringing lifestyle medicine to the center of health and wellness empowers patients to make the change they seek and enjoy the benefits of true wellness.

He is a graduate of Harvard Medical School and the Massachusetts Institute of Technology and a fellow of the American College of Lifestyle Medicine. He served as a department chair at Scripps Mercy Hospital in San Diego and is now the chair-elect for the American College of Obstetricians and Gynecologists for California.

He has published several articles in the American Journal of Lifestyle Medicine and served as a peer reviewer for many articles. He contributed to the first textbook of lifestyle medicine in women's health: Improving Women's Health Across the Lifespan.

See full bio
Maggie-Aime-bio

Maggie Aime, MSN, RN

Author

Maggie Aime is a registered nurse with over 25 years of healthcare experience, who brings medical topics to life through informative and inspiring content. Her extensive nursing background spans specialties like oncology, cardiology, and pediatrics. She has also worked in case management, revenue management, medical coding, and as a utilization review nurse consultant. She leverages her unique insights to help individuals navigate the U.S. healthcare system and avoid financial pitfalls.

Maggie applies her extensive clinical expertise to create empowering education for readers at all stages. She is passionate about illuminating issues from disease prevention to health and wellness to medical personal finance. Her work can be found in GoodRx Health, Next Avenue, HealthNews, Insider, Nursing CE Central, Nurse Blake, AllNurses, and BioHackers Lab.

An active member of several professional nursing and journalism associations, Maggie founded The Write RN to fulfill her calling to teach.

When she's not crafting the next great article, you can find Maggie volunteering, reading, playing the piano, or savoring sunrise views at the beach.

See full bio
See Our Editorial PolicyMeet Our Health Expert Network