Early Menopause: What It Means for Your Heart and Bones
Early menopause means your final period comes between 40 and 45; before 40 is called premature menopause. One global meta-analysis put early menopause at about one woman in eight, and it is linked to higher heart and bone risks later. The North American Menopause Society recommends hormone therapy until about 52 unless there's a reason not to.
Most of what you read about menopause assumes it arrives around 51. When it comes years earlier, the usual advice — "only take hormones if symptoms are bad, and for as short a time as possible" — can actually point in the wrong direction. The research on early menopause tells a noticeably different story, and it's worth knowing before anyone hands you the standard script.
What actually counts as early menopause?
It depends on the age of your final period, and the North American Menopause Society draws two clear lines. Menopause between 40 and 45 is "early." Menopause before 40 is "premature." A third term, primary ovarian insufficiency, covers ovaries that stop working before 40 but may still switch back on now and then.
That last distinction matters more than it sounds. Menopause is, by definition, permanent. POI isn't always: periods can occasionally come back, and so can ovulation. If you were told you have POI, it's worth asking your doctor which of these labels actually fits your situation, because the practical advice on contraception and fertility differs.
How common is early menopause?
Far more common than the isolation most women describe would suggest. When researchers pooled 31 studies from around the world, early menopause turned out to affect roughly one woman in eight, and primary ovarian insufficiency more than one in thirty. This is not a rare medical oddity.
What causes menopause to come early?
Often, nobody can say for certain, and that uncertainty is part of what makes it frustrating. The North American Menopause Society lists the broad categories it can come from: genetic, autoimmune, toxic, metabolic, and "iatrogenic," meaning caused by medical treatment itself.
The medical-treatment causes it names are chemotherapy, radiation and surgery. Surgery is its own situation entirely: when both ovaries are removed, ovarian hormone production stops in a single day rather than winding down over years. If that's your path, our guide to surgical menopause covers what changes and what the long-term research shows specifically for that group.
Does early menopause affect your heart?
Yes, according to one of the largest studies to look at the question directly — and the effect follows a clear gradient. The earlier natural menopause arrived, the higher the risk of a first heart attack, angina or stroke, with the extra risk concentrated in the years before age 60.
Three details in this study are worth holding onto. First, the associations held even in women who had never smoked, so this isn't just smoking showing up twice. Second, the risk was strongest before 60 (HR 1.88 for premature menopause), weaker at 60–69, and not significant at all from 70 onward. Third, the study deliberately excluded women who'd had a hysterectomy or oophorectomy — these numbers are about natural early menopause specifically.
What to do with this. The authors' own conclusion is that women with earlier menopause "need close monitoring" and that age at menopause could be used in heart-risk assessment. In practice: make sure every doctor who checks your blood pressure or cholesterol knows how old you were at your last period. It's a real risk factor, and it's easy to leave off the form.
Should you take hormone therapy if menopause comes early?
For most women in this group, the guidance is clearer than it is for menopause at the usual age. The North American Menopause Society recommends hormone therapy at least until the age menopause would normally have arrived, unless there's a specific reason you shouldn't take it.
That second sentence is the one I'd underline. Much of the fear around hormone therapy traces back to the Women's Health Initiative, which studied women whose average age was well past menopause. The position statement is explicit that those results don't transfer to a 42-year-old whose ovaries stopped early. In this situation, hormone therapy is largely replacing what the body would otherwise still be making.
The same statement lists the risks that come with going without: women with POI and premature or early menopause "may be at increased risk for fracture, CVD, heart failure," diabetes, persistent hot flashes, bone loss, cognitive and mood changes, and more — and notes that, in observational studies, the bone, heart and cognitive or mood risks "appear to be mitigated" when estrogen is taken until the average age of menopause. It also notes younger women may need higher-than-standard doses to protect bone. For more on how hormone therapy works in general, see our guide to HRT.
Can you still get pregnant?
With true menopause, no. With primary ovarian insufficiency, occasionally yes — which surprises many women who were told their ovaries had "failed." Because POI allows intermittent return of ovarian function, the North American Menopause Society notes that spontaneous pregnancy may occur in about 5% of women with POI.
That's one reason oral contraceptives are offered as a form of hormone therapy for healthy younger women in this group: they replace hormones and prevent an unplanned pregnancy at the same time. If fertility is something you want to protect, raise it early and directly. Our article on pregnancy during perimenopause covers the broader fertility picture.
Where to go from here
If both ovaries were removed surgically, our surgical menopause guide is the more specific read. For the bone side of this story, our osteoporosis article covers what happens to bone density and what protects it. And if your doctor raised blood sugar alongside early menopause, our menopause and diabetes article covers that link in detail.
For how all of this fits into the bigger picture of midlife sleep, start at the complete perimenopause and menopause sleep guide.
Key takeaways
- Early menopause is a final period between 40 and 45; before 40 is premature menopause, and primary ovarian insufficiency (POI) is ovarian function stopping before 40 with the possibility of returning.
- It's common: a meta-analysis of 31 studies put early menopause at 12.2% of women and POI at 3.7%.
- Heart risk is real and graded: compared with menopause at 50–51, menopause before 40 was linked to a 55% higher risk of a first non-fatal cardiovascular event, and at 40–44 to a 30% higher risk, concentrated before age 60.
- Guidelines favor hormone therapy here: the North American Menopause Society recommends it at least until about age 52 unless contraindicated, and says the WHI results in older women don't apply to this group.
- POI isn't always permanent — about 5% of women with POI may conceive spontaneously, which is one reason oral contraceptives are an option.
- Tell every doctor your age at menopause. It's a genuine cardiovascular risk factor that's easy to leave out.
Frequently asked questions
What age counts as early menopause?
The North American Menopause Society defines early menopause as menopause between ages 40 and 45, and premature menopause as menopause before 40. Primary ovarian insufficiency (POI) describes ovarian function stopping before 40, but with the possibility that hormone production and periods can occasionally return.
How common is early menopause?
A 2019 meta-analysis of 31 studies estimated the global prevalence of early menopause at 12.2% and of primary ovarian insufficiency at 3.7%. It is far from rare, even though it often feels isolating when it happens to you.
Does early menopause raise the risk of heart disease?
In a pooled analysis of over 300,000 women, menopause before 40 was linked to a 55% higher risk of a first non-fatal cardiovascular event, and menopause at 40 to 44 to a 30% higher risk, compared with menopause at 50 to 51. The extra risk was concentrated before age 60 and was not significant after 70.
Should women with early menopause take hormone therapy?
The North American Menopause Society recommends hormone therapy at least until the average age of menopause, around 52, unless there is a reason not to, with oral contraceptives as an option for healthy younger women. It also states that the Women's Health Initiative results in older women do not apply to this group.
Can you still get pregnant with early menopause or POI?
With primary ovarian insufficiency, yes, occasionally: the North American Menopause Society notes spontaneous pregnancy may occur in about 5% of women with POI, because ovarian function can return intermittently. That is one reason oral contraceptives are sometimes used as the hormone therapy.
Sources cited
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
- Zhu D, Chung HF, Dobson AJ, et al. Age at natural menopause and risk of incident cardiovascular disease: a pooled analysis of individual patient data. Lancet Public Health. 2019;4(11):e553-e564.
- Golezar S, Ramezani Tehrani F, Khazaei S, Ebadi A, Keshavarz Z. The global prevalence of primary ovarian insufficiency and early menopause: a meta-analysis. Climacteric. 2019;22(4):403-411.
How this article was checked
The North American Menopause Society position statement was read in its full published text, not just its abstract — the definitions, the "until approximately age 52" recommendation, the line about the WHI not applying, and the 5% spontaneous-pregnancy figure all come from the body of the statement and are quoted as written. The heart-risk figures come directly from the Zhu et al. abstract, including its exclusion of women with hysterectomy or oophorectomy. The prevalence figures come from the Golezar et al. meta-analysis abstract; its full text was not available, so this article doesn't describe how each underlying study defined early menopause — which is why the "one in eight" figure is attributed to that meta-analysis rather than tied to the 40–45 definition. An independent fact-check also led to a few precision fixes before publishing, including narrowing which risks the guideline says estrogen appears to mitigate.
It has not been reviewed by a clinician. Ellen Hayes is a researcher and writer, not a doctor, and nothing here is a diagnosis or a substitute for being seen by one.
Ellen Hayes
Health & Wellness Writer and Researcher
Hi — I'm Ellen. What struck me most here was how much the advice flips once menopause comes early. "As little hormone as possible, for as short as possible" is the line most of us hear — and for this group, the major guideline says close to the opposite. That felt worth spelling out plainly.
I'm not a doctor. I'm not an expert — and I'm never going to talk down to you like one. I'm a woman in the middle of perimenopause who got tired of vague answers, started reading the actual research, and writes it down here in plain English, the way I'd explain it to a friend over coffee. More about Ellen →