When a woman in her late 40s or early 50s starts having symptoms such as hot flashes and night sweats, the possibility that she’s approaching menopause will probably cross her mind. But what if a woman in her early to mid-40s has these same symptoms? Is it possible that it’s actually menopause? And how early can menopause start?
Perimenopause vs. Menopause: What’s the Difference?
Contrary to popular belief, menopause only lasts a single day — the one that marks an entire year without a period. The time leading up to menopause, when a woman has symptoms related to changing hormone levels, is called perimenopause.
“It's important to recognize that the definition of menopause is 12 consecutive months without menstruation, but that’s one day in time if you look back on your calendar,” says Dr. Alyssa Dweck, Chief Medical Officer at Bonafide. She adds that because menopause technically spans just one day, some women refer to every day after menopause as postmenopause. “Much of this is semantics, but important distinctions, nonetheless,” Dr. Dweck says.
While menopause is technically just a one-day moment in time, perimenopause lasts much longer. The average length of perimenopause is four years, although it varies widely from person to person.1 “It could be four years, it could be 10 years,” Dr. Dweck explained. “It’s really different for each individual.”
What is Considered Early Menopause?
The average age that a woman reaches menopause — that is, she goes 12 consecutive months without a period — is approximately 51, according to Dr. Dweck.2 “There is a broad range of age of onset,” she adds.
When a woman reaches menopause between the ages of 40 and 45, this is considered to be early menopause, while menopause before age 40 is known as premature menopause.3
What Causes Early Menopause?
Early menopause can happen on its own, without any clear cause; about 5% of women, or one in 20, go through early menopause naturally.4 Other potential reasons a woman may experience early menopause include:
“Genetic factors strongly influence the age of menopause,” Dr. Dweck explains. She adds that if your mom experienced early menopause, there’s a good chance you will, too.
Chemotherapy or Pelvic Radiation
Both chemotherapy and pelvic radiation treatments for cancer can damage the ovaries, causing some women to go into menopause.5 And while chemo-induced menopause can be permanent, in some cases, it can be temporary, particularly for many younger women who have been treated for breast cancer.6
“During a first or second chemo cycle, some women lose their periods for more than a year’s time, which is diagnostic of menopause” Dr. Dweck explains. But as the time passes and treatment ceases, it is possible to see the unexpected return of menses.
Surgical Removal of the Ovaries
A woman who undergoes a bilateral oophorectomy, for any reason (the surgical removal of both of the ovaries), may start to experience menopause symptoms right away since periods will immediately stop, and hormone levels will quickly drop, significantly. This is known as surgical menopause.7
Women who smoke cigarettes may reach menopause up to two years earlier — and experience more severe symptoms — as compared to nonsmokers.8 “Those who smoke tend to have an earlier menopause with perhaps more intensive vasomotor symptoms (hot flashes and night sweats),” Dr. Dweck cautions.
Certain Health Conditions
Some health conditions, including autoimmune disorders, such as thyroid disease and rheumatoid arthritis as well as chronic fatigue syndrome and HIV/AIDS, can make it more likely for a woman to experience early menopause.9
What Are the Symptoms of Early Menopause?
The symptoms of early menopause are, for the most part, the same as those of “normal” menopause. But because women generally aren’t expecting to go through menopause early, they may not recognize the symptoms for what they are.
“There may be bit of a disconnect with symptoms typical of menopause and women of a younger age; on other words, women may not even imagine that their symptoms could be due to menopause,” Dr. Dweck explains.
For women who experience surgical menopause after their ovaries are removed, symptoms may feel more severe because they come on so suddenly. “Women do speak about much more abrupt, severe symptoms, like hot flashes or night sweats, that occur almost instantly rather than gradually,” Dr. Dweck says.
When Should You See a Healthcare Provider?
No matter at what age you experience menopause, your healthcare provider can offer you guidance and help you manage your symptoms.
“If a 43-year-old has gone for 12 months without a period and is having symptoms like hot flashes, night sweats, vaginal dryness or whatnot, we would manage those symptoms similarly to how we would for somebody who's over 45,” Dr. Dweck says. “In terms of symptom relief, treatment options are similar when it comes to whether someone's younger than 45 or older.”
Dr. Dweck adds that the biggest concern with early menopause is overall health, since lack of estrogen for such a long period of time can raise the risk of conditions such as osteoporosis and cardiovascular disease.9 “This is where other individualized treatment or management options may apply,” Dr. Dweck says.
To support healthy bones, for example, Dr. Dweck explains a healthcare provider will want to make sure that someone is getting enough calcium in their diet and that their vitamin D levels are acceptable. They may also suggest supplementation or hormone replacement therapy to manage certain menopausal symptoms.
If you’re experiencing menopausal symptoms such as hot flashes, it’s worth speaking to your provider even if you think you’re too young for menopause — or you’re too embarrassed to bring it up.
“Many caring practitioners just don’t ask about or aren’t made aware that women are struggling, because they don’t want to talk about their symptoms,” Dr. Dweck says. She encourages all women to feel empowered to speak openly about the menopausal transition and ask their healthcare provider any questions they may have.
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