What Is Considered ‘Early’ for Menopause?

A woman’s period can stop for a variety of reasons. Here is how you know it’s menopause.

By Jen Gunter

Short Take

Before the age of 40.

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The defining phenomenon of menopause is cessation of ovulation (producing an egg), which results in a drastic reduction in the levels of the hormones estrogen and progesterone. A woman is considered menopausal when she is one year from her last menstrual period, or had her ovaries surgically removed before her periods stopped. For women who have had a hysterectomy (and hence have no menstrual cycle to follow) a clear transition from perimenopause (the onset of symptoms that are associated with menopause, such as hot flashes, vaginal dryness or sleep disturbance) is not possible to define without a blood test. Typically that testing is not necessary because we do not treat any symptoms of menopause based on hormone levels.

The average age of menopause is 51, but many women will enter menopause a few years before and some a few years afterward. When ovaries stop functioning before the age of 40, the diagnosis is primary ovarian insufficiency. We used to call it premature menopause, however, medically that terminology is not accurate as the varied reasons ovulation can stop with primary ovarian failure are typically different from the cause of menopause. Another reason to not use the term premature menopause is that this condition can affect women in their teens and 20s and insinuating their ovaries are “old” is not just medically incorrect, it is insensitive. Ovarian function in this situation can also be sporadic (meaning the ovaries “wake up” intermittently and may ovulate) and between 5 to 10 percent of women with primary ovarian insufficiency will get pregnant. By comparison, when you are menopausal you cannot get pregnant.

The causes of primary ovarian insufficiency are diverse and include genetic reasons, infections, chemotherapy or radiation therapy, and autoimmune conditions. If a woman under the age of 40 has symptoms of menopause (for example, hot flashes or vaginal dryness) or has an irregular period or misses more than three periods while not taking hormonal birth control (a very common reason for period shenanigans), then testing for primary ovarian insufficiency is recommended (assuming pregnancy has been excluded as a cause).

Dr. Jen Gunter, Twitter’s resident gynecologist, is teaming up with our editors to answer your questions about all things women’s health. From what’s normal for your anatomy, to healthy sex, to clearing up the truth behind strange wellness claims, Dr. Gunter, who also writes a column called, The Cycle, promises to handle your questions with respect, forthrightness and honesty.

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