Early menopause: signs, causes and diagnosis

Ovarian function stopping before 40 is premature ovarian insufficiency, and affects around 1 to 2% of women; between 40 and 45 it is called early menopause. Both sit well below the French average of about 51. It shows up as cycles becoming irregular then absent, often with hot flushes, disturbed sleep and vaginal dryness, and is confirmed by hormone testing read alongside the clinical picture.

The difficulty with early menopause is rarely the symptoms. It is that nobody, including the woman herself, is expecting them at that age — so they get attributed to stress, to overwork, to anything else first.

What early menopause means

Two terms get used interchangeably and should not be. Premature ovarian insufficiency (POI) describes ovarian function stopping before the age of 40, and affects around 1 to 2% of women — recent studies suggest more. Early menopause describes the same thing arriving between 40 and 45. Both sit well below the average age at natural menopause in France, which is around 51. The distinction matters practically: it decides which term to search, and which one to bring to a consultation.

The signs to know

A cycle that becomes irregular, then spaces out progressively before stopping. Hot flushes. Disturbed sleep. Vaginal dryness. Sometimes difficulty concentrating or shifts in mood. It is a picture close to classic menopause, arriving earlier — which is precisely what makes it harder to recognise, because it is not expected at that age.

The possible causes and how it is diagnosed

In a significant share of cases no precise cause is identified — what is called idiopathic. Known causes include genetic ones, Turner syndrome and the FMR1 premutation among them, both of which can be tested for; previous medical treatment (chemotherapy, radiotherapy, ovarian surgery); and autoimmune disease. Diagnosis rests on four months or more of absent or irregular cycles together with a raised FSH, interpreted with a professional rather than from a single result. And it is worth knowing before that consultation that hormone therapy until the usual age of menopause is the standard recommendation here — for bone and cardiovascular protection as much as for symptoms.

Do not automatically put irregular cycles after 35 down to stress if other signs are stacking up alongside.
If you want to conceive and your cycles are irregular before 40, do not wait to be seen — time matters specifically here.
Know that early menopause has implications beyond fertility — bone and cardiovascular health — that justify dedicated follow-up.
Ask about hormone therapy until the usual age of menopause — it is the standard recommendation in this situation, and it is about long-term protection as much as symptom relief.

Reviewed by the OVEA medical committee

Frequently asked questions

At what age is menopause considered early?

Before 40 it is called premature ovarian insufficiency; between 40 and 45, early menopause. Both sit below the French average age at natural menopause of around 51.

Is early menopause hereditary?

A genetic factor exists in some cases, which makes knowing your mother's or sisters' age at menopause useful, though it is not systematic.

Can I still get pregnant with early menopause?

It is harder but not always entirely excluded depending on the stage — a prompt specialist assessment is recommended if you want to conceive.

How is early menopause diagnosed?

By four months or more of absent or irregular cycles together with a raised FSH, interpreted in the full clinical context by a professional rather than from one result.

Why does it matter beyond fertility?

Because oestrogen also protects bone and cardiovascular health. That is why hormone therapy until the usual age of menopause is the standard recommendation, whether or not symptoms are troublesome.