What Causes Menopause and Early Menopause?

Menopause is a phase of life in people with ovaries that marks the end of their reproductive years. People in menopause no longer get their period. It’s part of the normal aging process for people assigned female at birth, but some factors can cause menopause to occur earlier than average. 

Menopause typically begins between ages 45-55, with most people experiencing it at 52. During menopause and the years leading up to menopause—called perimenopause—many people experience different symptoms, including menstrual cycle changes, hot flashes, sleep problems, and mood swings.

Menopause occurs when there is a decline in natural female hormones and loss of ovarian follicular function. While this is often due to normal biological aging, menopause can sometimes occur early or due to other factors that affect hormones and ovarian function. 

The ovaries are female organs responsible for making and releasing eggs and female reproductive hormones. People assigned female at birth are born with about 1-2 million eggs in their ovaries. By puberty, this number decreases to about 300,000-400,000 eggs. After puberty, an egg gets released each month in people with regular cycles.

As you age, the egg quality declines. Around the menopausal age, there are fewer than 1,000 eggs left, and your ovaries stop releasing eggs. This change ushers in menopause and also means you can no longer get pregnant.

As the ovaries stop releasing eggs, they also produce less progesterone and estrogen. These two hormones are vital for pregnancy and regulating the menstrual and ovarian cycles. 

Low levels of progesterone and estrogen cause menopause symptoms and various changes in the body, such as vaginal dryness and thinness, increased risk of vaginal yeast infections, loss of bone density, and changes in the urinary system.

Surgery to remove the ovaries—called oophorectomy—can cause you to go into menopause instantly. This is known as surgical menopause, and it only occurs if both ovaries are removed. One ovary is enough to produce the hormones needed to avoid menopausal symptoms and preserve reproductive function. 

The ovaries produce the eggs and hormones needed to regulate the female reproductive cycle. Removing the organs automatically stops reproductive function, causing menopause even in people who have not reached the typical menopausal age.

Surgical menopause symptoms start more suddenly and are more severe than menopause not brought on by surgery.

Cancer treatments like chemotherapy and radiation therapy can induce menopause by causing the stoppage of ovarian function. 

The induced menopause may be permanent, depending on factors like treatment dosage and your age. In some cases, it’s temporary, with regular menstruation resuming from several months to two years after the cancer treatment.

Primary ovarian insufficiency (POI) is when the ovaries stop working as they should before a person reaches the age of 40. This condition is linked to problems with the ovarian follicles, the small sacs in the ovaries where eggs grow and mature before being released. 

POI causes the body to produce little to no estrogen and progesterone and causes reduced fertility, irregular ovulation, and irregular periods. 

POI is not the same as premature menopause. It’s still possible to get pregnant with POI, while the chances of pregnancy are almost zero with premature menopause. POI can cause loss of ovarian function, and the decline in estrogen hormone can cause people with the condition to experience symptoms of menopause, including night sweats, hot flashes, vaginal dryness, and sleep disturbances.

Menopause itself is a natural biological process that everyone with the female reproductive organs experiences as they get older, irrespective of genes or ethnic and racial descent. However, the age at which you experience menopause may have some hereditary components.

Research has indicated that early or premature menopause has strong genetic components. Estrogen receptor 1 (ESR1) is one of the genes that may impact the age when menstruation begins. ESR1 plays an important role in sexual development and reproductive function. 

Health experts also believe you are more likely to have menopause before age 45 if you have a family history of menopause at a younger age.

Everyone with female reproductive organs experiences menopause when they get older. This typically occurs between the ages of 45-55.

Menopause that occurs before age 40 is called premature menopause. Menopause that occurs between the ages of 40-45 years is called early menopause. 

About 1% of females experience premature menopause, while early menopause occurs in about 5% of females. Both may occur gradually and naturally in some people or may be induced by events like chemotherapy or removal of the ovaries.

While menopause is a natural process, certain factors can increase the risk of experiencing menopause at a younger age. These include people who:

• Were young (less than 8 years old) at the time of their first period
• Are underweight
• Smoke
• Have a family history of early or premature menopause
• Have never been pregnant
• Undergo cancer treatments
• Live with certain health conditions like autoimmune diseases, HIV/AIDS, and chronic fatigue syndrome (a condition marked by extreme tiredness and muscle and joint pain)

Menopause is part of the natural biological process that occurs as people with ovaries age. It typically happens around age 52 but can occur earlier in some people.

Menopause is caused by a decline in ovarian function and little to no production of female reproductive hormones. While menopause typically occurs gradually and naturally with age, certain cancer treatments and the removal of the ovaries will cause earlier and more immediate menopause.

Menopause can cause discomforting symptoms and be challenging to deal with. If you are experiencing menopause symptoms or have concerns regarding transitioning into menopause, consider speaking with your healthcare provider. They can help you manage symptoms and navigate this phase of life.