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Early menopause happens before 45, and before 40 it is called POI. Learn the causes, how it is diagnosed, why hormone therapy matters and where to find support.
Early menopause is menopause between 40 and 44. Before 40, it is called premature ovarian insufficiency (POI). Recent studies suggest POI affects about 3.5% of women. It can follow surgery or cancer treatment, be linked to genetic or autoimmune conditions, or have no identifiable cause. Hormone therapy until around 51 is recommended to protect bone, heart and brain health.
Two terms are used, depending on age:
The distinction matters because POI is not always permanent. A 2024 international guideline from ESHRE, ASRM, the International Menopause Society and partners notes that ovarian activity can return intermittently, giving a chance of natural pregnancy. With early menopause after 40, periods are less likely to return.
For how early menopause compares with other ages, see menopause at 40, 45, 50 and beyond.
According to the 2024 guideline, estimates of how many women have POI range from about 1% in older studies to 3.5% in recent ones, and may vary by ethnicity. Early menopause between 40 and 44 is more common. A UK study reports that around 10% of White women in high-income countries reach menopause before 45.
Often, no cause is found. The 2024 guideline advises that clinicians explain the known causes and the limits of current testing, and that a cause may not be identified.
Known causes include:
Female relatives, such as sisters and daughters, of someone with POI without a known medical cause have a higher risk themselves. The guideline recommends they are told about the signs and offered support.
Symptoms are similar to those of menopause at any age, but can feel more abrupt and more distressing when unexpected:
Some people have few symptoms and only notice that their periods have stopped. The guideline advises clinicians to consider POI in anyone under 40 with irregular or absent periods or symptoms of low estrogen.
The 2024 international guideline recommends diagnosing POI when there are:
This is simpler than before: previous guidance required two raised FSH results. The FSH test can be repeated after four to six weeks if the result is unclear, and AMH testing may help in uncertain cases. Clinicians should also:
If both ovaries were removed before 40, POI is diagnosed without further tests.
NICE suggests an FSH blood test may be considered in people aged 40 to 45 with menopause symptoms, including changes to their cycle. See perimenopause tests. Other conditions can cause similar symptoms, so your clinician may also check for thyroid problems or pregnancy. See perimenopause or something else.
For POI without an obvious medical cause, the guideline recommends:
Estrogen protects many body systems. Losing it early means more years without that protection. The 2024 guideline highlights:
These risks are why treatment is recommended even for people without troublesome symptoms.
The 2024 guideline strongly recommends hormone therapy for women with POI until the usual age of menopause, whether or not they have symptoms. The aim is to reduce the risk of heart disease, osteoporosis and dementia, and it may benefit muscle health too. The Menopause Society similarly recommends hormone therapy until at least the average age of menopause for people with POI or early menopause, unless there is a contraindication. Key points from the guideline:
For people aged 40 to 44, NICE advises that the benefits and risks of HRT likely lie between those for POI and those for people over 45.
POI substantially reduces the chance of natural conception, but the 2024 guideline notes that ovarian activity can return, giving a chance of pregnancy. It advises:
Pregnancy after egg donation is higher-risk and needs specialist care. See pregnancy during perimenopause for general contraception guidance.
An early menopause diagnosis can bring grief, shock and worry, especially about fertility. The 2024 guideline recommends that the diagnosis is shared compassionately and that people are referred to support groups and mental health care. Patient organizations such as the Daisy Network, a UK charity for people with POI, offer information and community.
It is also worth telling your clinician if you are struggling. Support is part of treatment, not an extra.
For more questions, see your first menopause appointment.
See a doctor if:
- Your periods stop for 4 months or more and you are under 40, after ruling out pregnancy
- You are under 45 and have menopause symptoms
Seek urgent help if low mood includes thoughts of harming yourself. Contact emergency services or a crisis line in your country straight away.
Not quite. POI means loss of ovarian function before 40 and may not be permanent. Early menopause is menopause between 40 and 44.
It is less likely, but possible. The 2024 international guideline notes that ovarian activity can return intermittently, so contraception is advised if you want to avoid pregnancy.
International guidance recommends hormone therapy for people with POI until the usual age of menopause, even without symptoms, to protect bone, heart and brain health.
According to the 2024 guideline, there is no evidence that hormone therapy increases breast cancer risk for women with POI compared with women of the same age without POI.
If POI has no known medical cause, female relatives have a higher risk. They should know the signs, and genetic counseling may be offered if a genetic cause is found.
Editorial status: evidence-based educational article; not individually medically reviewed. Last evidence check: September 10, 2026.
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