Menopause Symptoms and Early Menopause | Prof. Dr. İkbal Kaygusuz

Menopause Symptoms: How to Recognise Early Menopause

In short: The first signs of menopause are usually irregular periods, hot flushes, night sweats and sleep problems in the mid-40s. Periods stopping for more than four months with these symptoms before age 40 should be assessed for premature ovarian insufficiency. Diagnosis requires two raised FSH results at least four weeks apart.

First signs of the transition

Changing cycles: periods may first shorten, then become infrequent; flow may change.
Hot flushes: sudden heat, flushing and sweating of the face, neck and chest lasting a few minutes.
Night sweats and poor sleep.
Mood changes: irritability, anxiety, low motivation.
Vaginal dryness and lower libido.
Forgetfulness and poor concentration.
Joint pain and palpitations.

Normal, early and premature menopause

Normal: 45-55.
Early: 40-45.
Premature ovarian insufficiency: before 40; affects about 1-3% of women.

Recognising premature ovarian insufficiency

Infrequent periods or no period for over four months before 40, especially with hot flushes and night sweats, need assessment. Diagnosis requires raised FSH on two tests at least four weeks apart; AMH is usually very low. The ovaries may not have stopped completely, and about 5% of women conceive spontaneously.

Why it matters

Early loss of oestrogen increases the risk of osteoporosis, cardiovascular disease and cognitive effects. Hormone therapy is therefore recommended at least until the natural age of menopause (about 50-51) unless contraindicated. It replaces missing hormones and does not carry the same risks as hormone therapy after natural menopause.

Looking for the cause

Chromosome analysis, fragile X (FMR1) premutation testing and screening for autoimmune disease (especially thyroid and adrenal) are recommended. Results matter for the woman and her female relatives.

If you want a pregnancy

With very low reserve, the chance of pregnancy with your own eggs is limited. If reserve is falling but not exhausted, treatment should be planned without delay. Young women with a family history of early menopause benefit from knowing their reserve early and considering egg freezing in time.

Easing symptoms

Regular exercise, stopping smoking, enough calcium and vitamin D, layered clothing and a cool bedroom help. If symptoms affect quality of life, hormone therapy or non-hormonal options are assessed individually.

Frequently Asked Questions

How do I know I have reached menopause?

Over 45, 12 months without a period is enough for the diagnosis. At younger ages hormone tests are needed.

Is pregnancy possible with premature ovarian insufficiency?

The chance of spontaneous pregnancy is low but not zero, around 5%. Options are discussed after assessing reserve.

Sources

ESHRE Guideline: Management of women with premature ovarian insufficiency, 2024.
The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause, 2022.

The information on this website is for general information only and does not replace a medical consultation.