Early menopause symptoms: the signs, what POI means and why seeing a GP matters

Your periods have gone strange. Maybe they've become irregular, or stopped for a few months. Perhaps you've had a hot flush or two and thought, "surely not yet, I'm only 37." And now you're wondering if these could be early menopause symptoms.

You're not imagining it. Menopause can come early, and sometimes much earlier than you'd expect. The NHS says early menopause is when your periods stop before the age of 45. When it happens before 40, the NHS calls it premature menopause. Doctors often use another name: premature ovarian insufficiency (POI).

The main sign is a change to your periods. The other symptoms are much the same as at the usual age. This guide explains the signs of early menopause, what causes it, how it's diagnosed, and why getting it checked really matters.

What is early menopause?

Menopause is when you haven't had a period for 12 months. For most women it happens between 45 and 55, the NHS says. The average age is 51, according to the Menopause Charity.

When it happens sooner, it has a different name:

Name	When periods stop
Menopause at the usual age	45 to 55
Early menopause	40 to 45
Premature ovarian insufficiency (POI), or premature menopause	Before 40

POI means the ovaries stop working normally before you're 40. They stop making normal amounts of hormones, especially oestrogen. That's how a patient leaflet from University Hospital Southampton puts it.

The word "insufficiency" matters. The ovaries don't always shut down completely. The Daisy Network, the UK charity for women with POI, explains that POI can come and go. So some women still have the odd period after they're diagnosed.

How common is it?

The British Menopause Society estimates that about 1 in 100 women reach menopause before 40. It's about 1 in 1,000 before 30. The Daisy Network gives a higher figure of 4 in 100. Estimates vary, but either way you're far from alone.

Early menopause symptoms

The main symptom is your periods becoming irregular, or stopping, before you're 45. The NHS lists these other signs of early menopause:

• hot flushes and night sweats
• vaginal dryness
• trouble sleeping
• low mood or anxiety
• a lower sex drive
• problems with memory or concentration (often called brain fog)

The Southampton leaflet adds irritability, mood swings, joint pain, and itching or burning around the vagina or vulva. The British Menopause Society also mentions low energy, which can feel a lot like fatigue.

Two things make early menopause easy to miss:

• Symptoms can come and go. Because the ovaries may still work on and off, symptoms can stop and start, the British Menopause Society says.
• Some women have no symptoms at all. The same report says about 12 to 14 in 100 women with POI don't get menopause symptoms. For them, the only sign may be their periods.

That's why period changes on their own are worth taking to a GP. Our page on perimenopause period changes has more on what's normal and what isn't.

Signs of early menopause in your 30s

The signs of early menopause in your 30s are the same as at any age. Periods that become irregular or stop are the main one. Hot flushes, night sweats, poor sleep and mood changes are common too.

What's different is that they can be overlooked. The Menopause Charity notes that health professionals may not think of hormones as the main cause of symptoms in women in their late 30s or early 40s. Yet it's not unusual for symptoms to start this early for some women.

So it helps to be clear. If you're worried, say so: "I think this could be early menopause or POI." Keep a note of your periods and symptoms for a few months, and take it with you.

Signs of early menopause in your 20s

Early menopause in your 20s is rare, but it does happen. The signs are the same: periods that become irregular or stop, sometimes with hot flushes, night sweats or vaginal dryness.

It's worth knowing about family history. The Southampton leaflet says POI can sometimes run in families. This might be the case if a relative went through menopause very young, in her 20s or early 30s. If that's true for you, tell your GP.

What causes early menopause?

Often, no cause is found. The British Menopause Society says most cases of POI have no clear cause.

When there is a cause, it can include:

• Surgery to remove both ovaries. Women's Health Concern, the patient arm of the British Menopause Society, says menopause is then immediate.
• Cancer treatment, such as chemotherapy and radiotherapy.
• Some hormone medicines, the NHS says.
• Autoimmune conditions, such as thyroid or adrenal disease.
• Some infections, such as mumps.
• Genetic conditions, such as Turner syndrome. The British Menopause Society says some women who carry a gene change linked to Fragile X are also at higher risk.
• Endometriosis affecting the ovaries, and surgery for it.

The NHS also lists things that make early menopause more likely: a family history of it, starting your periods early, smoking, and being underweight.

How is early menopause diagnosed?

The NHS says there's no routine test for menopause. Over 45, your doctor will usually go by your age and symptoms. Under 45, a GP may sometimes do blood tests.

For POI, the British Menopause Society says diagnosis is based on two things together:

1. Periods that have been missing, or very infrequent, for more than 4 months.
2. Raised levels of a hormone called FSH, on at least two blood tests taken 4 to 6 weeks apart.

You may also have tests to look for a cause, such as other hormone tests or genetic tests. The British Menopause Society says a bone density scan (called a DEXA scan) should be considered when POI is diagnosed.

Why treatment matters for your bones and heart

This is the most important part of this guide. Early menopause isn't just about symptoms. It's about your health for years to come.

Oestrogen helps protect your bones and heart. When it falls years earlier than usual, those protections fall away early too. The British Menopause Society says women with POI are at higher risk of:

• heart and blood vessel disease
• osteoporosis, where bones become thin and break more easily
• problems with memory and thinking

It says hormone replacement is likely to lower the long-term risk of heart disease, protect against osteoporosis and help with thinking and memory. So it advises women with POI to take hormone replacement until the natural age of menopause, which it gives as 51, unless there's a medical reason not to. It gives women with early menopause (40 to 45) much the same advice.

The NHS agrees. It says replacing hormones is recommended if menopause starts before 45, because of the higher risk of bone and heart problems. The main options are HRT or the combined contraceptive pill.

Many women worry about HRT and breast cancer. The British Menopause Society says the risks found in studies of women over 50 should not be applied to women with POI. It adds that HRT doesn't appear to increase breast cancer risk in women under 50.

Some women can't take hormones, for example after certain breast cancers. This is something to talk through with your GP or a menopause specialist. They'll weigh up what's right for you.

Looking after your bones day to day

Alongside any treatment, the NHS suggests regular exercise and eating calcium-rich foods such as yoghurt. The British Menopause Society also mentions a balanced diet, enough vitamin D, not smoking and keeping alcohol down.

Can you still get pregnant with early menopause?

It's harder, but sometimes possible. The British Menopause Society says the ovaries can still work now and then, and puts the chance of a natural pregnancy at around 5 to 10 in 100 for women with POI.

Two things follow from that:

• If you don't want to get pregnant, you may still need contraception. HRT is not a contraceptive.
• If you do want a baby, ask about a referral to a fertility team. The NHS mentions options including IVF with your own frozen eggs or donor eggs, surrogacy and adoption.

How early menopause can feel

Finding out your menopause has come early can be a lot to take in, especially if you'd hoped for children or simply weren't ready. The NHS notes that early menopause can affect your mental health. You can refer yourself to NHS talking therapies without seeing a GP first.

If low mood is hanging around, our page on perimenopause depression explains when to get help.

You don't have to go through this alone. The Daisy Network is a UK charity, running since 1995, just for women with POI. It offers a peer support network, information about treatment and fertility, and live chats. The British Menopause Society says women with POI should be told about support groups like this.

When to see a GP

See your GP if:

• your periods stop or become irregular before 40
• your periods change before 45 and you have other menopause symptoms
• you've had cancer treatment or surgery on your ovaries and notice menopause symptoms
• a close relative had an early menopause and your periods are changing
• your mood is low or you feel anxious most of the time

You don't need to be sure. Saying "I'm worried this might be early menopause" is enough to start the conversation. If you need more help, the NHS says you can be referred to a specialist menopause centre.

For the full list of what can happen around the change, see our plain-English guide to perimenopause symptoms. And if you're trying to work out whether this is too young for perimenopause, read what age does perimenopause start.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.