What Is Early Menopause or Premature Ovarian Insufficiency?

You’re 38, and your period was late. Then it didn’t come at all, and you took a test, and it was negative. You’ve been waking at 3 a.m. with your face hot. A friend says it’s stress. Your mother went through menopause at 52, so surely this is not that.

POI, and how it’s different

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)³ uses the term primary ovarian insufficiency (POI) for when ovaries quit working normally before age 40. Unlike menopause, it says, women with POI may still menstruate, irregularly, and may keep some fertility. It lists irregular periods and reduced fertility before 40 as the main sign.

What can cause it

The OWH² lists:

• Smoking. Women who smoke may reach menopause up to two years earlier.
• Cancer treatment, such as chemotherapy or pelvic radiation.
• Surgery that removes both ovaries, which causes immediate symptoms.
• Medical conditions, including autoimmune diseases, HIV/AIDS and chromosome conditions such as Turner syndrome.

The NHS¹ adds family history, early first period and being underweight. The NICHD³ names genetic factors, a family history of POI, autoimmune disease, viral infections and chemotherapy.

What it feels like

The NHS¹ lists the main sign as regular periods stopping before 45, along with hot flushes, night sweats, vaginal dryness, sleep difficulty, mood changes, reduced libido and trouble concentrating. The OWH² says women may have more severe menopause symptoms. See perimenopause, hot flashes, vaginal dryness and mood changes.

Late or missing periods have other causes too. See late or irregular periods and PCOS.

Why it matters beyond symptoms

The OWH² says women who go through menopause early face a higher risk of serious problems such as heart disease and osteoporosis, because they spend more years without estrogen. The NHS¹ says the same, noting a higher chance of problems with your bones and heart if you don’t treat it. For the bone side, see menopause and bones.

What treatment looks like

The NHS¹ says treatment is usually the combined contraceptive pill or hormone replacement therapy to replace the hormones that are low, along with lifestyle steps such as regular exercise and calcium-rich foods. A GP may do blood tests to check. Our article on hormone therapy explains the wider picture. Your own clinician can tell you how it applies at your age.

For fertility, the NHS¹ notes that IVF using frozen or donor eggs is an option, alongside other routes to a family. The NHS also says talking therapies are available for the emotional side, and the OWH² notes psychological effects such as depression linked to losing fertility.

The play

Try this: a cycle-and-symptom record

Write down the first day of each period for the last year if you can, any missed months, and symptoms: hot flushes, night sweats, sleep, mood, dryness.

Add your family history: when your mother and sisters went through menopause, and any autoimmune disease.

Note smoking, any cancer treatment and any surgery. Bring it to your appointment.

When to get checked

The NHS¹ says to see a GP if you have menopause symptoms and you’re under 45. The NICHD³ says women with irregular periods and reduced fertility before 40 should talk with a healthcare provider, particularly with a family history or genetic risk factors.

Book an appointment if any of these fit:

• Your periods have become irregular or stopped, and you’re under 45
• You have hot flushes, night sweats or vaginal dryness at a young age
• Your mother or sister went through menopause early
• You’ve had chemotherapy, pelvic radiation or ovarian surgery
• You have an autoimmune disease and your cycle has changed
• You’re trying to get pregnant and cycles have become unpredictable

Early menopause has treatments, and the NHS¹ says a GP may do blood tests. A late period at 38 is worth asking about.