# Early menopause: signs, causes and treatment · Unpaused > Source: https://unpaused.cc/articles/early-menopause Perimenopause ## Early menopause The NHS calls menopause before 40 premature menopause, and menopause before 45 early menopause. HRT or the combined pill replaces the missing hormones, usually until at least 51, because bone and heart risks are higher when periods stop at these ages. By Ines Kovac. Published 20 October 2026\. 6 minute read. ### Menopause before 40 and menopause before 45 The NHS describes early menopause as periods stopping before 45, and premature menopause as periods stopping before 40 ([NHS: early or premature menopause](https://www.nhs.uk/conditions/early-or-premature-menopause/)). Premature ovarian insufficiency (POI) means normal ovarian function has been lost before 40 ([NICE Clinical Knowledge Summaries: causes of menopause](https://cks.nice.org.uk/topics/menopause/background-information/causes/)). Many health pages use POI and premature menopause interchangeably. Under 40, doctors follow the POI pathway. About 2 to 4% of women worldwide reach menopause before 40 ([NICE Clinical Knowledge Summaries: how common menopause is](https://cks.nice.org.uk/topics/menopause/background-information/prevalence/)). Leeds Teaching Hospitals gives approximate figures for younger ages: about 1 in 1,000 before 30, and about 1 in 10,000 before 20 ([Leeds Teaching Hospitals: premature ovarian insufficiency](https://www.leedsth.nhs.uk/patients/resources/premature-ovarian-insufficiency/)). If you are 45 or older, the [perimenopause or menopause stage checker](/articles/perimenopause-or-menopause-a-stage-checker-from-your-age-and-your-last-period) uses your age and the date of your last period. Under 40, the result tells you to see a GP about POI, and that visit is where a clinician decides the stage. The [perimenopause hub](/topics/perimenopause) covers symptoms in the years before periods stop. ### Early menopause signs and symptoms The main sign is irregular periods before the age of 45. Premature menopause symptoms are similar to the symptoms of menopause at the usual age. They can include hot flushes and night sweats, vaginal dryness, difficulty sleeping, low mood or anxiety, a lower sex drive, and problems with memory and concentration. You can note how often each symptom happens, and how much it bothers you, on the [menopause symptom checklist for your GP](/articles/menopause-symptom-checklist-to-print-and-take-to-your-gp). ### How doctors diagnose it Clinicians consider an FSH blood test in people under 40 when menopause is suspected, and in people aged 40 to 45 when symptoms include a change in the menstrual cycle ([NICE menopause guideline: recommendations](https://www.nice.org.uk/guidance/ng23/chapter/recommendations)). The stage checker sets out the separate approach from age 45. Under 40, POI is diagnosed when there are menopause symptoms, including no periods or infrequent periods, and follicle-stimulating hormone (FSH) is raised on two blood samples taken 4 to 6 weeks apart. The guideline includes women, trans men and non-binary people registered female at birth. If you have had a hysterectomy, there may be no periods to go on, and that history is taken into account. FSH has to be raised on both samples before POI is diagnosed. At ages 40 to 45, the same hormone test may be used to confirm menopause when the cycle has changed. Diagnosing POI under 40 requires both results. That is a separate clinical assessment from confirming menopause at 40 to 45. In primary care, the working level is an FSH of more than 30 IU/L on those two samples, when periods have been infrequent for more than 4 months ([NICE Clinical Knowledge Summaries: diagnosing POI](https://cks.nice.org.uk/topics/menopause/diagnosis/diagnosis-of-premature-ovarian-insufficiency/)). ### Causes and risk factors For many spontaneous cases, no underlying cause is identified. Clinicians call them unexplained. You are more likely to have premature or early menopause if it runs in your family, if your periods started early, if you smoke, or if you are underweight. Cancer treatments and surgery on the ovaries are on the NHS list as well. ### HRT, the combined pill, and how long to continue The main treatments are the combined contraceptive pill and hormone replacement therapy. Both replace hormones that are at low levels. For POI, the guideline says to offer a choice of HRT or a combined hormonal contraceptive, unless treatment is ruled out. Hormone-sensitive cancer is the example given. HRT is not a contraceptive, so a person who needs to avoid pregnancy would ask about the combined pill. Treatment continues until at least the age of natural menopause, unless it is contraindicated. For premature or early menopause, the NHS usually advises taking HRT until at least 51 ([NHS: when to take HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/when-to-take-hormone-replacement-therapy-hrt/)). That page also says it is particularly important to take either HRT or the combined pill. Bone and heart problems are more likely when menopause starts before 45, which is why the missing hormones are replaced. The [NHS benefits page](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/) says taking HRT is particularly important to help prevent osteoporosis if periods stop before 45. At ages 40 to 44, the benefits and risks of taking HRT, and of declining it, are likely to fall between the balance for people with POI and the balance for people aged 45 or over. Tablets, patches, gel and spray are covered in the guide to [hormone replacement therapy for menopause](/articles/hormone-replacement-therapy-for-menopause). The [bioidentical guide](/articles/bioidentical-hormone-replacement-therapy) sets out how a regulated prescription differs from a compounded mix. Extra cases of breast cancer, clots and stroke per 1,000 women are set out in [HRT risks in plain numbers](/articles/hrt-risks-in-plain-numbers-breast-cancer-clots-and-stroke-per-1-000-women). Eating for bone and heart health is covered in [diet and menopause](/articles/diet-and-menopause). The [hormone therapy hub](/topics/hrt) gathers those guides. ### Fertility after premature ovarian insufficiency Leeds Teaching Hospitals says the majority of people with POI will be unable to conceive naturally. Natural pregnancy remains possible, although it is rare. IVF usually uses a donor egg, fertilised with a partner's sperm, so you can carry the pregnancy. About half of those who try may have a baby, sometimes after more than one attempt. ### My take See a GP if your periods are irregular or have stopped before 45, or if you have the symptoms above. Complete the [checklist](/articles/menopause-symptom-checklist-to-print-and-take-to-your-gp) first, so the appointment has a written record. Some younger women say a GP dismissed menopause because they were still having periods. Infrequent periods already count in the POI assessment under 40, along with the two FSH samples. You can bring it up before your periods have stopped. If anxiety or low mood is the problem you most want help with, start with [HRT, anxiety and low mood](/articles/depression-and-hormone-replacement-therapy). That guide includes where to get urgent help for mental health. I would start with the checklist and a GP appointment as soon as periods become irregular before 45\. Under 40, I would judge the plan by two FSH tests several weeks apart, and by whether an agreed age has been set for staying on HRT or the combined pill. ### Sources * [NHS: early or premature menopause](https://www.nhs.uk/conditions/early-or-premature-menopause/) * [NHS: when to take HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/when-to-take-hormone-replacement-therapy-hrt/) * [NHS: benefits and risks of HRT](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/) * [NICE menopause guideline: recommendations](https://www.nice.org.uk/guidance/ng23/chapter/recommendations) * [NICE Clinical Knowledge Summaries: causes of menopause](https://cks.nice.org.uk/topics/menopause/background-information/causes/) * [NICE Clinical Knowledge Summaries: how common menopause is](https://cks.nice.org.uk/topics/menopause/background-information/prevalence/) * [NICE Clinical Knowledge Summaries: diagnosing premature ovarian insufficiency](https://cks.nice.org.uk/topics/menopause/diagnosis/diagnosis-of-premature-ovarian-insufficiency/) * [Leeds Teaching Hospitals: premature ovarian insufficiency](https://www.leedsth.nhs.uk/patients/resources/premature-ovarian-insufficiency/) Written by Ines Kovac Menopause guides: symptoms, HRT, sleep and everyday changes Ines Kovac writes the practical guides on Unpaused: perimenopause, symptoms, hormone therapy, sleep, hot flushes and weight. She builds each piece from NHS and NICE pages, The Menopause Society's position statements and the studies behind them, and links every claim a reader might want to check. She says plainly what the evidence supports and where it runs out, and she never tells a reader to start or stop a medicine. Corrections are added to the page that had the error. [ikovac@unpaused.cc](mailto:ikovac@unpaused.cc) Last checked 2026-10-20 --- Plain, practical menopause advice Plain, practical guides to perimenopause and menopause: symptoms, hormone therapy, sleep, hot flashes, weight and food, each checked against health services and medical societies. [desk@unpaused.cc](mailto:desk@unpaused.cc) ### Topics * [Perimenopause](/topics/perimenopause) * [Symptoms](/topics/symptoms) * [Hormone therapy (HRT)](/topics/hrt) * [Hot flashes](/topics/hot-flashes) * [Sleep](/topics/sleep) * [Weight and diet](/topics/weight-and-diet) * [All guides](/articles) ### About us * [About](/about) * [Authors](/authors) * [Editorial policy](/editorial-policy) * [How we make money](/how-we-make-money) ### Legal * [Terms](/terms) * [Privacy](/privacy) * [Contact](/contact) Unpaused © 2026 Unpaused. General health information, written from sources we link. It does not replace advice from your own doctor, nurse or pharmacist. [How we make money](/how-we-make-money) [Editorial policy](/editorial-policy) [Who writes here](/authors)