Does Early Menstruation Mean Early Menopause?
By: Holly L. Thacker, MD • Posted on February 10, 2017
Does early menopause matter?
Yes, both premature menopause (before the age of 40) and early menopause (ages 40-45) matter!
The average age of menopause is 51.3 years. A later menopause is associated with a longer life span. An earlier menopause is associated with a higher degree of disease burden and potentially a shorter life span.
Women frequently ask me and assume that having an early age of first period means an earlier age of menopause. We previously told women that it wasn’t usually a correlation. However, a recent large observational study from several countries looked at age of menarche (first menstruation) and whether a woman had ever been pregnant and the risk for premature menopause and early menopause.
Early Menstruation Age May Mean Early Menopause
Classically, it has been taught that the age of menarche does NOT portend the age of menopause. However, in this pooled analysis women having menarche before the age of 11 and women who had never been pregnant (called nulliparity) were at a five-fold increased risk for premature menopause and two-fold risk for early menopause, compared with women with menarche after age 12 who had given birth to two or more children.
Premature menopause and early menopause are of concern in terms of higher risks for developing the following chronic diseases:
- Heart disease
- Neurologic conditions including memory loss and Parkinson’s
- Depression and anxiety
- Psycho-sexual problem
- Dry eyes
Determining When Menopause Will Occur
The bottom line is that we still are unable to determine when menopause will occur, which is what many women in the reproductive years want to know. Although, basal antral follicle counts (looking at egg follicles on pelvic ultrasound), drawing the following routine blood work helps to assess reproductive capacity:
- Follicle Stimulating Hormone level (FSH) with estradiol (estrogen) level on cycle days 2 to 3, and Anti-Müllerian hormone (AMH)
However, a diminished ovarian reserve does not signify an absolute inability to conceive. In general, the best surrogate marker for egg quality is age. Egg freezing for fertility preservation is recommended around age 32, if a woman wants to be a biological mother and does not have current plans and a partner to start conception.
Why You May Experience Early or Premature Menopause
There are many known established factors associated with early or premature menopause:
- Previous ovarian surgery (including removal of both ovaries which causes surgical menopause)
- History of cancer treated with gonadotoxic therapy or irradiation
- Family history of early menopause
- Genetic conditions, such as Turner syndrome
- X permutation carrier, remain the standard risk factors for diminished ovarian reserve
I do not think that early menarche with nulliparity will yet debut on this list. However, women ask this question, and many in my practice have assumed the earlier they begin menstruation the sooner they stop.
The major take-home point is that all women, regardless of menarche and the number of children bore, need premature menopause and early menopause diagnosed and treated, and in most cases treated with hormone replacement therapy.
Be Strong. Be Healthy. Be in Charge!
-Holly L. Thacker MD
Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Her special interests are menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health. Dr. Thacker is the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause.
- Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause
- Hormone replacement therapy in young women with surgical primary ovarian insufficiency
- AHAH! Advancing Health After Hysterectomy
- Early Menopause Linked With Heart Risk