Why do some women experience premature menopause?

Published October 2024 | 5 min read
Expert contributors Dr Marita Long, Vic/Tas director, Australasian Menopause Society; Professor Roger Hart, gynaecologist, endocrinologist and fertility specialist, Menopause Alliance Australia
Words by Beth Wallace

Many women experience menopause before age 45. Here are some of the premature menopause signs to watch for and strategies to manage your wellbeing during this time. 

In Australia, the average age of menopause – when a woman hasn’t had a menstrual period for 12 months – is 51. Yet some women have their final period much earlier.

Early menopause is when menopause occurs between the ages of 40 and 45, which affects roughly 12 in every 100 women. This is still preceded by a period of perimenopause, which on average lasts from four to six years.

Meanwhile, up to 4% of women experience spontaneous premature menopause (the medical term is primary ovarian insufficiency), which causes their ovaries to stop functioning in the way they should before the age of 40.

Risk factors of premature menopause

Primary ovarian insufficiency (POI) can occur if it runs in your family, you’ve been exposed to toxins (like chemotherapy and radiotherapy) or you have an autoimmune disorder like Addison’s disease, thyroid disease, type 1 diabetes, Crohn’s disease or coeliac disease.

Women who’ve had chemotherapy or ovarian surgery in the past are particularly susceptible to POI, though the cause of most cases is still unknown, explains Professor Roger Hart, a gynaecologist, endocrinologist and fertility specialist, and spokesperson for the Menopause Alliance Australia.

“It is likely to be connected with undetected genetic mutations related to the ovary and eggs,” he says.

Signs of premature menopause

For women in their 20s and 30s, the signs of POI (or early menopause, for those in their 40s) are the same as those experienced during perimenopause: the stage leading up to your final period. This usually begins in your 40s and lasts, on average, from four to six years.

“Besides the tell-tale signs of loss of periods or changing periods, it’s those symptoms that we're all familiar with: hot flushes, night sweats, low energy, mood change, poor sleep, vaginal dryness, low libido,” says Dr Marita Long, the Vic/Tas representative on the board of the Australasian Menopause Society.

Not all women experience menopausal symptoms, other than changes to their period. According to data from Jean Hailes for Women's Health, about 20% of women have no symptoms at all, while 60% have mild to moderate symptoms – however more recent data is needed.

This was not the case for mother-of-three Meg Terrill, who began noticing symptoms shortly after she turned 40.

“I always assumed I might go through menopause early as I had required a hysterectomy to survive the birth of my third child,” she explains. “They managed to save one ovary, but a lot of damage was done.”

Though she noticed the occasional hot flush and some weight creep (despite exercising regularly and making no changes to her diet), it was the night waking and insomnia so often linked to menopause that she found most debilitating.

“I started waking up every night between 2am and 4am for no reason, and then being unable to get back to sleep for hours, if at all,” she says. “I have averaged five hours sleep a night for the last eight years.”

After several years of doctors’ appointments and trialling different treatments, Meg found a GP who specialises in women’s hormonal health and started on hormone replacement therapy (HRT), which made an immediate difference.

Nevertheless, years of poor sleep have taken their toll. “I don’t think I even know what it feels like to not feel exhausted all the time,” she says. “I also experience brain fog, although I find it hard to pull that apart from the impact of extreme fatigue.”

Dr Long says she often hears stories from women like Meg who turn down promotions or otherwise step back from their career because they’re unable to concentrate or have lost confidence in their ability to perform as they used to.

“During this phase, some women honestly think they're getting dementia because the brain fog is so bad,” she says.

To learn more about managing your career during menopause, listen to episode four of our Menopause Matters podcast, hosted by Alison Brahe-Daddo, Menopause and the Workplace: starting the conversation.

Premature menopause treatment options

Diagnosing POI can be difficult and time-consuming, not only because some women don’t show any symptoms, but also because doctors need to rule out other potential causes.

If you do notice anything out of the ordinary, it’s essential that you seek medical advice, says Professor Hart, both to manage your symptoms and reduce your risk of developing chronic health problems like osteoporosis and heart disease, which is heightened by POI.

“That often includes the prescription of hormone therapy to alleviate these symptoms and provide protection for your bones and heart,” he explains.

Menopausal hormone therapy (MHT), also known as HRT, is available as tablets, patches, gels or vaginal treatments, it replaces hormones, including oestrogen and progesterone, which decrease during the transition time before menopause.

Though MHT isn’t suitable for everyone – and any potential side effects should be discussed with your doctor – Dr Long says it’s the most effective treatment for most menopausal symptoms and can be tailored to suit your needs. For example, treatments will differ depending on whether you’ve had a hysterectomy, as well as your age.

“The younger you are, the more likely we are to encourage hormones for health benefits,” she says. “Post-menopause, we're really giving it to treat the symptoms, and we prescribe the lowest dose that’s effective. But in younger women, we tend to prescribe higher doses to replace the hormones they should have up until about age 50.”

Managing premature menopause symptoms

While there’s no way to reverse menopause, you may be able to manage the symptoms by making a few lifestyle adjustments, as well as any treatment recommended by your doctor.

“The things we encourage all women to do at this point, which will help with menopausal symptoms, are eating well, making sure you’re getting optimal sleep, exercising and reducing alcohol to the minimum amount you’re able to,” says Dr Long.

In addition, the following lifestyle changes can help.

• Identifying and avoiding anything that may trigger hot flushes, like hot drinks, smoking and spicy foods.
• Reducing stress, possibly through cognitive behaviour therapy, yoga or breathing and relaxation techniques.
• Staying cool by dressing in layers of lightweight, loose-fitting clothing that can be easily removed.
• Preventing night sweats by wearing light, breathable clothes to bed; sleeping either with a window open, or a fan or air conditioner on; and using separate bed covers from your partner.
• Managing aches and pains by using hot and cold packs and taking over-the-counter pain relief medication and/or dietary supplements for calcium, vitamin D and magnesium.

Seeking support for your mental and emotional health in a “caring, supportive environment” is also essential, adds Professor Hart, especially if you’re experiencing feelings of grief linked to loss of reproductive capability.

If you have any concerns, Dr Long recommends booking an extended appointment with your GP, ideally someone who is well-versed in women’s health. They may then refer you to a psychologist or other specialist for further support. Through our partnership with GP2U, all HCF members with health cover can access a standard online video GP consultation (up to 10 minutes) for a fee of $50.

Eligible members with hospital cover^* can get a free, annual HealthyMinds Check-in with a psychologist from PSYCH2U. This is a confidential telehealth session about how you’re feeling. Your psychologist can offer you tailored support and direct you to appropriate health programs, or to a GP for a mental health treatment plan and ongoing psychology sessions.

HCF members with eligible extras cover can now also claim on an expanded range of mental health services, including consultations with a psychologist, an HCF-approved counsellor and an accredited mental health social worker.

Lastly, Professor Hart urges women to “be kind to themselves, talk with other women about what they’re going through and remember the symptoms won’t last forever”.

How to thrive in menopause

The journey through perimenopause and menopause can be a challenging but also a liberating time – physically, mentally and emotionally.

HCF’s Perimenopause and Menopause hub is filled with useful information, career tips, guides and expert-led advice, as well as our Menopause Matters podcast, hosted by Alison Brahe-Daddo.