Although the average age of a natural menopause is 51, for many women it happens earlier than this. Menopause can occur at any age; it depends on how the ovaries work in an individual or whether there has been any medical intervention that affects ovarian function.
If periods have naturally stopped (for over a year) when a woman is aged between 40-45, this is termed an ‘early’ menopause. If you haven’t had a period for more than a year and you’re under 40 – and if other causes have been ruled out – you may be diagnosed with Premature Ovarian Insufficiency or POI. Around 4 in 100 women go through menopause under the age of 40.
The symptoms of an early menopause or POI are basically the same as a more typical menopause, but the consequences to your long-term health of living longer with low levels of estrogen, progesterone and testosterone can be significant if left untreated. As well as problems with fertility, you have a greater risk of your bones becoming weaker over time and developing disease related to your heart and blood vessels, for example.
There are effective treatments for early menopause and POI that can minimise symptoms and reduce the health risks, and there are various options available for fertility treatments, should you wish to become pregnant.
Causes of early menopause or POI
Sometimes there is a clear reason why an early menopause or POI has happened. Examples of this is when the ovaries are removed surgically (perhaps because of ovarian cancer or a genetic mutation that predisposes to a greater risk of ovarian cancer, severe endometriosis or a severe premenstrual disorder), or the ovarian function is affected by treatments for cancer like chemotherapy or radiotherapy.
However, in 90% of cases, it’s simply not known what causes the ovaries to stop working as they should.
Some other possible causes of POI are:
- Auto-immune disease causing the body to mistakenly attack ovarian tissue. This is thought to account for 5% of POI cases. There may be links with disorders such as an underactive thyroid, type 1 diabetes or Addison’s disease.
- Genetic causes where there is an abnormality in the female sex chromosome or other genes affecting sex hormone function. The most common of these is Turner syndrome. POI can run in families and having one or more relatives with an early menopause or POI should alert other family members to its increased possibility. Sometimes it may be diagnosed in teenagers or those in their 20s, or in young women who may never have had a period.
- Infections like mumps, malaria or tuberculosis, in very rare cases, have caused POI.
Symptoms
Periods stop when eggs are no longer being released regularly, and this means the hormones estrogen, progesterone and testosterone are not being produced in the same way. When there is far less of these hormones circulating in your bloodstream, the body misses the benefits they were bringing, and symptoms can then occur.
Symptoms of early menopause and POI are similar to what you might experience during a menopause that naturally occurs at around the 50-year mark. But if your premature menopause is caused by surgery or cancer treatments, you may experience more sudden and/or severe symptoms than if it occurs naturally.
As well as your periods becoming lighter, more irregular or stopping altogether, there are several other symptoms you may notice:
- fatigue and problems sleeping
- brain fog
- hot flushes and night sweats
- lack of interest in and pleasure from sex
- joint pains and aching muscles
- hair and skin being dry, itchy, and dull
- headaches and migraine attacks
- vaginal dryness and soreness
- needing to wee more often, experiencing ‘leaks’, or bladder infections.
You can find out more information on symptoms and treatments for menopause our information booklets as this information applies to early menopause and POI too.
Getting a diagnosis
It can take several months (or even years) before a diagnosis of POI is confirmed as your irregular or missing periods may initially be put down to stress, weight changes or other gynaecological conditions such as polycystic ovarian syndrome (PCOS).
If your periods have stopped or are infrequent for more than 4-6 months, your GP may want to do some of the following tests:
- Follicle Stimulating Hormone (FSH) levels blood test. If FSH levels are raised to what would be considered the menopausal range, the test should be repeated 4-6 weeks later, and if levels are raised again, a diagnosis of early menopause or POI may be given.
- Other blood tests. It is common to check a range of other tests to exclude other causes of a change in periods and menopause symptoms. This will largely depend on your individual circumstances.
- Pelvic ultrasound scan may be suggested to rule out other causes for your symptoms and/or to see whether there are a low number of follicles in the ovaries.
You may be referred to a specialist and they may wish to carry out further investigations, particularly if you are under 35 years. These may be genetic testing, antibody screening, and/or having a bone density scan called a DEXA (or DXA) scan. This can be useful to assess the current strength of your bones and be used as a baseline measure of bone density to help monitor any changes over the upcoming years.
Fertility options
Having POI can make it difficult to conceive naturally. However, the ovaries don’t necessarily stop working completely and ovarian function can still fluctuate over time. This may result in an occasional period and release of an egg. For this reason, there is still a 5-10% chance of a pregnancy in women with POI who are trying to conceive.
If a pregnancy does not happen naturally, there are different ways fertility can be supported if there is a strong desire to have children who share DNA with one or both parents, and these include IVF, donor egg, and/or surrogacy options.
There’s a lot to think about when embarking on a fertility journey. Treatments can involve complex processes, a significant financial cost, cultural and religious considerations, and often physical and emotional stress. Criteria for accessing fertility treatments on the NHS varies depending on your geographical region.
The complex reproductive choices you may be faced with need support from experienced specialists who can talk you through all your options, explain what’s involved and the implications of each option, and support you to make a decision that’s right for you and your family.
Health risks
The hormones that the ovaries produce benefit many systems in the body, so a lack of them over time can take a toll, especially on your bones, your heart health and your genitourinary health.
Osteoporosis: without adequate estrogen, your bones can’t grow new bone tissue at a fast enough rate, and they become less dense and weaker, which makes them more likely to break. When there has been significant loss of bone tissue over time (and possibly fractures too), a diagnosis of osteoporosis may be given. You will have an added risk of developing osteoporosis if it runs in your family, you have certain other health conditions, or you smoke or drink significant amounts of alcohol. You can read more about protecting your bones our bone health guide
Cardiovascular disease: this refers to any disease affecting the heart and blood vessels, including heart attacks, stroke, and vascular dementia. Estrogen plays many roles in keeping blood vessels healthy and pumping blood through the body effectively. If you have POI, you have a greater risk of developing disease in your heart or blood vessels, and this risk is also increased if your weight is above a healthy range, you have high blood pressure, you smoke or you have family members with related conditions. You can read more about keeping your heart healthy our heart health guide
Genitourinary health: this relates to the health of your genitals and your urinary tract and function. Your vulva, vagina and bladder function all need estrogen to work effectively and feel comfortable. When there’s a lack of hormones, it can cause changes to your genital tissue that may make you feel sore, itchy and dry, and it may also cause you to wee more often, have leaks of urine, or have urinary tract infections or thrush. You can read more about these symptoms our GSM guide. There are effective treatments for these problems in the form of vaginal estrogen. These symptoms are a long-term consequence of a lack of estrogen, and they don’t tend to resolve without treatment.
Treatments
The most common treatment for POI or early menopause is HRT. This replaces the hormones your body is no longer making in adequate amounts. There are different types of HRT and you can choose what would suit you best. HRT helps relieve the symptoms you may be experiencing, and it helps reduce the chances of the health risks listed above too.
An alternative treatment option is to take the combined oral contraceptive pill as this contains both estrogen and progesterone and it does help stabilise these hormone levels in your body. Taking the pill may feel more comfortable and ‘normal’ for younger women compared to taking HRT, but it’s important to note the contraceptive pill doesn’t help reduce the health risks linked with POI as effectively as HRT.
Whichever medication you choose to take, it’s vitally important that you also look after your health and wellbeing through adopting a healthy lifestyle. This includes:
- staying active and exercising regularly
- eating nutritiously and maintaining a healthy weight
- reducing stress
- ensuring good quality sleep
- limiting the amount of alcohol you consume
- reducing your caffeine intake
- stopping smoking/vaping or the use of other addictive substances.
Coping with a diagnosis and getting support
The impact of being diagnosed with POI can be profound and should not be underestimated. You may experience a range of complex emotions such as grief, anxiety and feeling sad around a potential loss of fertility. You are perhaps having to rethink your ideas about the future.
It may be difficult to cope with a lack of understanding from family and friends, and society’s expectations surrounding motherhood and notions of womanhood. Talk to your friends and family about your diagnosis when you feel ready and find those who are willing to listen and provide emotional support for you.
It is important to seek help from a health professional who understands about POI and can provide accurate information about the treatments you need. They can also help you access counselling or fertility support if you would like this.
If you want to know some basic information about healthcare recommendations for POI, there is a section in the menopause guidelines from the National Institute of Health and Care Excellence (NICE) on diagnosing and managing POI. You can read this NICE guideline.
It can be really beneficial to talk to others who know what it’s like to live with POI to gain knowledge and know that you’re not alone. The Daisy Network is a charity for women with POI and they have a network of local volunteers across the UK who are there to help and offer support, as well as a website full of useful information.
Last updated: June 2026
