Premature, early and medical menopause

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Premature and early menopause can be caused by a range of factors, and can be spontaneous or medically induced.

Premature menopause or premature ovarian insufficiency (POI) is the term used when menopause occurs before 40. Early menopause is used when menopause occurs between the ages of 40 and 45.

People who experience premature or early menopause can be at a greater risk of:

  • depression, anxiety and mood changes
  • a sense of loss, sadness and grief around fertility, body image and sexuality.

Premature and/or early menopause also increases the time spent in the post-menopausal phase, which in turn increases impacts on other health outcomes including:

  • 2-3-fold increased risk of osteoporosis1,2
  • increased risk of type 2 diabetes3
  • 50% greater risk of cardiovascular disease.4,5,6

Spontaneous premature and early menopause

Up to 4% of women younger than 40,7 and 12% of women aged 40-45,8 experience spontaneous premature or early menopause. In about 90% of women, the reason for spontaneous POI is unexplained.7 Diagnosis can be difficult or delayed.

Recent research has identified some genetic causes of POI,9 including the following possible causes to consider and investigate via referral for genetic testing:

  • Turner syndrome and mosaic Turner syndrome
  • X chromosome rearrangements
  • Fragile X permutation carriers
  • other rare monogenic or syndromal causes.9

Premature and early menopause can also be associated with rare metabolic causes and autoimmune disorders.9

Medical menopause

Medically induced menopause includes menopause that is caused by medical treatment for cancer and other diseases or disorders. This can include surgery to remove ovaries, hormone therapy and therapies such as chemotherapy and radiation.

When cancer treatments induce menopause, the impact on the patient can be complex and challenging. A cancer diagnosis is often a life-changing event,10 which can be compounded when treatment causes menopause. For women wishing to have children, especially those who experience medically induced menopause at a young age, loss of fertility can add another level of complexity.

Managing menopausal symptoms in individuals with a history of cancer can be intricate, with symptoms that can overlap and compound one another. Additionally, treatment options can be complex when considering menopausal hormone therapies in someone with a history of cancer, due to the potential associated risk of cancer recurrence or exacerbation.

Resources

Clinician resources

Early and premature menopause for health professionals
Fact sheets for clinicians and consumers.
Source: Australasian Menopause Society

Experiences of early menopause
Consumers' and health practitioners’ experiences of early menopause, and resources to guide assessment and management.
Source: Healthtalk Australia

Genetics education resources
Resources supporting health professionals with genetics and genomics, including a genetic service finder.
Source: Centre for Genetics Education

Consumer resources

Experiences of early menopause
Consumers' and health practitioners’ experiences of early menopause, and resources to guide assessment and management.
Source: Healthtalk Australia

What is early menopause?
Brief video describing early menopause for consumers.
Source: Monash Centre for Health Research and Implementation (MCHRI), Monash University, Monash Health

Ask early menopause
Resources for consumers with early and premature menopause
Source: MCHRI, Monash University, Monash Health

Living well after cancer: Menopause
Consumer resources including fact sheets and podcasts for people with early menopause related to cancer treatments.
Source: Cancer Council of Australia

My Journey: Breast cancer and menopause
Free online platform with information to support people with a breast cancer diagnosis.
Source: Breast Cancer Australia

References

  1. Xu X, Jones M, Mishra GD. Age at natural menopause and development of chronic conditions and multimorbidity: results from an Australian prospective cohort. Hum Reprod. 2020 Jan 1;35(1):203-211. DOI: 10.1093/humrep/dez259
  2. Anagnostis P, Siolos P, Gkekas NK, et al. Association between age at menopause and fracture risk: a systematic review and meta-analysis. Endocrine. 2019;63(2):213-224. DOI: 10.1007/s12020-018-1746-6
  3. Anagnostis P, Christou K, Artzouchaltzi AM, et al. Early menopause and premature ovarian insufficiency are associated with increased risk of type 2 diabetes: a systematic review and meta analysis. Eur J Endocrinol. 2019;180(1):41-50. DOI: 10.1530/EJE-18-0602
  4. Davis, S, Lambrinoudaki, I, Lumsden, M et al. Menopause. Nat Rev Dis Primers. 2015;1:15004. DOI: 10.1038/nrdp.2015.4
  5. Zhu D, Chung HF, Dobson AJ, et al. Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data. Lancet Public Health 2019;4(11): e553-e64.
  6. Muka T, Oliver-Williams C, Kunutsor S, et al. Association of age at onset of menopause and time since onset of menopause with cardiovascular outcomes, intermediate vascular traits, and all-cause mortality: a systematic review and meta-analysis. JAMA Cardiol. 2016;1(7):767-776. DOI: 10.1001/jamacardio.2016.2415
  7. Webber L, Davies M, Anderson R, et al. ESHRE Guideline: management of women with premature ovarian insufficiency. Hum Reprod. 2016;31(5):926-37. DOI: 10.1093/humrep/dew027
  8. Golezar S, Ramezani Tehrani F, Khazaei S, et al. The global prevalence of primary ovarian insufficiency and early menopause: a meta-analysis. Climacteric. 2019 Aug;22(4):403-411. DOI: 10.1080/13697137.2019.1574738
  9. Australasian Menopause Society. Spontaneous premature ovarian insufficiency. Healesville: Australasian Menopause Society; September 2020 [cited June 2024].
  10. Cancer Council NSW. Emotions and cancer. Woolloomooloo: Cancer Council NSW; November 2021 [cited Feb 2024].
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