Early menopause: symptoms, causes, HRT and support in the UK

Menopause is when periods stop because of lower hormone levels. The NHS says it usually affects women between 45 and 55, and that it can affect anyone who has periods. NICE describes it as the time when the body stops producing eggs, and notes that it can happen as part of ageing, usually between 45 and 55, but sometimes earlier.

When it happens before 45 it is called early menopause, and before 40 it is called premature menopause. Both can come about naturally, or as a result of treatment or surgery. Because, as the NHS notes, an early start brings a higher chance of problems with bones and heart, an early start has consequences beyond the symptoms people notice day to day, which is why diagnosis and treatment matter.

You may also hear the term premature ovarian insufficiency, which describes ovaries that stop working normally before 40. It is covered in a separate guide linked below.

The NHS says the main symptom is not having your period regularly, or periods stopping completely before 45. NICE adds that periods may become heavy or irregular before they stop, and that symptoms can vary from barely noticeable to strongly affecting everyday life.

• Hot flushes and night sweats.

• Vaginal dryness.

• Difficulty sleeping.

• Low mood or anxiety.

• Reduced sex drive.

• Problems with memory or concentration.

According to the NHS, you have a higher chance of early or premature menopause if it runs in your family. It is also more likely if you started your periods early, smoke or are underweight. For many people no clear reason is found.

Treatment for other conditions can bring on menopause. The NHS lists radiotherapy or chemotherapy, certain hormone medicines and surgery to remove the ovaries. NICE also mentions an inherited condition or an unknown reason. When menopause follows surgery or cancer treatment it can start abruptly, and symptoms are often more sudden. The surgical menopause guide linked below covers this in more detail.

The NHS advises seeing a GP if you think you have menopause symptoms. It says that if you are under 45 and having menopause symptoms, a GP may sometimes do blood tests. A GP will usually ask about your periods, symptoms, medical history and family history and may consider other explanations for missed periods.

Being told that menopause has started when you are in your 30s or early 40s can be a shock, especially if you had hoped to have children. It is reasonable to ask for time to take in the information and for a follow-up appointment to discuss the next steps.

The NHS says the main treatments are medicines such as the combined contraceptive pill or hormone replacement therapy (HRT) to replace hormones that are at low levels. It stresses that this is important if menopause starts before 45, because of the higher chance of problems with bones and heart.

The NHS notes that if you have had certain types of cancer, such as certain types of breast cancer, you may not be able to have hormone treatments. In that case your specialist team can discuss other ways to manage symptoms and protect your health.

Lifestyle changes can support treatment. The NHS suggests exercising regularly and eating calcium-rich food such as yoghurt. NICE encourages shared decisions: your healthcare professional should explain the benefits and risks of each option so you can work out together what suits you, taking into account your age, medical history and preferences.

If treatment and lifestyle changes do not help and you still have symptoms, the NHS says you can be referred to a specialist menopause centre, and points to the British Menopause Society website for NHS and private specialists.

The NHS says early or premature menopause means you may find it harder to get pregnant. You may be able to have children through IVF using your own frozen eggs or donor eggs, and there are other routes such as surrogacy or adoption. The Human Fertilisation and Embryology Authority provides information about fertility treatment.

The NHS recognises that early menopause can affect mental health as well as physical health, and says you can refer yourself to NHS talking therapies for anxiety and depression without seeing a GP first. The Daisy Network, named by both NHS and NICE, is a charity specifically for premature menopause.

On the NHS, early menopause is usually managed by a GP, with referral to a specialist menopause service or gynaecology or endocrinology if needed.

Some people also see a private menopause specialist, usually for a quicker appointment or more time to discuss options. The British Menopause Society lists both NHS and private specialists. In either setting, ask how often your treatment will be reviewed, because needs can change over time.