When a woman hears the words “early menopause”, almost the same scenario appears in her mind every time. Sudden aging. Loss of femininity.
And the thought: “Something irreversible has happened to me”.
At appointments, I often see not so much a medical problem as intense fear.
Because early menopause is perceived as a verdict rather than the outcome of a process.
And here it is important to say the main thing right away.
Early menopause is not always a diagnosis.
And it is far from always something that happens “for no reason”.
In this article, I will explain the causes of early menopause the same way I explain them to my patients.
Without intimidation.
Without oversimplification.
And without illusions.
Early menopause – a diagnosis or the outcome of a process?
Menopause is the completion of reproductive function against the background of ovarian reserve depletion.
It is a process. Not a one-day event.
When menopause occurs before the age of 45, we speak of early menopause.
But before that point, the body almost always goes through a path.
First, the cycle changes.
Then ovulation disappears.
Hot flashes, sleep disturbances, and anxiety appear.
And only at the final stage do we see persistent hormonal depletion.
That is why the question “Do I have early menopause?” is rarely the first correct question.
A much more important one comes before it.
Why the question “why?” is more important than the question “what should I do?”
Because management depends not on the name of the condition, but on its cause. The same result – absence of menstruation – can have completely different origins.
And, accordingly, very different prognoses.
If the cause is not understood, it is possible to:
- treat something that is not actually present
- miss a reversible condition
- or, conversely, lose precious time where it truly matters
That is why I always start not with treatment prescriptions.
But with an analysis of the scenario that led the body to this point.
All causes of early menopause can be conditionally divided into several scenarios
This is not a list for the sake of a list.
It is a way to organize thinking and stop placing everything into one category.
Genetic scenario – when the body is “programmed” in advance
There are women whose ovarian reserve declines earlier due to hereditary factors.
Often their history includes:
- menopause in the mother before the age of 45
- early disappearance of the cycle in sisters
- low AMH already at a young age
There is no external mistake here.
This is a biological characteristic.
The important point is different.
If this scenario is recognized early, it allows for a strategy rather than living in constant unpredictability.
Medical scenario – when the ovaries have been directly affected
Sometimes the cause is obvious, but its long-term consequences are not immediately connected.
This scenario includes:
- ovarian surgeries
- chemotherapy
- radiation therapy
- severe autoimmune conditions
In these cases, the reserve may decline faster.
Not because the body “failed”.
But because ovarian tissue was damaged.
Functional scenario – when menopause is “suspected”, but it is not present
One of the most common scenarios of recent years.
The cycle disappears.
Hot flashes appear.
Sleep is disrupted.
The woman reads about early menopause – and recognizes herself.
But upon examination:
- AMH is preserved
- FSH is not elevated
- follicles are present on ultrasound
This is not depletion.
This is a functional reaction.
Most often in this situation, we are not dealing with menopause, but with functional hypothalamic amenorrhea – a condition in which the reproductive system temporarily “switches off” due to stress, exhaustion, or overload.
This condition is reversible. But it can be frightening if one is unaware of it and tries to interpret symptoms without understanding the underlying mechanism.
Depletion scenario – when several factors act together
Sometimes there is no single cause.
There is a combination.
Genetic predisposition.
Chronic stress.
Low body weight.
Smoking.
Sleep deprivation.
Individually – tolerable.
Together – they accelerate the process.
And it is precisely in this scenario that it is especially important not to look for a “magic pill”, but to honestly assess reality.
Why stress is often blamed for early menopause – and where the truth lies
Stress does indeed affect the reproductive system.
But not in the way it is commonly imagined.
It does not “burn out” follicles within months.
It affects regulation.
If the reserve is preserved – stress does not make menopause inevitable.
If the reserve is already reduced – stress can accelerate the manifestations.
So stress is not the root cause of depletion.
It is an amplifier.
How a Doctor Determines Which Cause Applies to You
Why Symptoms Almost Never Provide the Answer
Hot flashes, insomnia, anxiety, and absence of menstruation can occur both in functional conditions and in true ovarian depletion.
It is impossible to distinguish based on sensations alone.
Intuition does not work here.
Which Indicators Truly Matter
The decision is always based on a combination of data:
- AMH – as a marker of ovarian reserve
- FSH – as an indicator of ovarian load
- estradiol
- ultrasound with follicle count
- age and the dynamics of changes
A single number without context means nothing.
The overall picture matters more than one test result.
Clinical Case
Patient, 36 years old.
One year of constant stress: relocation, job change, insomnia.
Cycle absent for 4 months.
Hot flashes appeared along with fear of early menopause.
FSH – 9.
AMH – 1.6.
Ultrasound – follicles preserved.
After sleep restoration and workload reduction, the cycle returned within several months.
Without hormonal therapy.
This was not early menopause.
This was a functional scenario.
When Early Menopause Is Truly a Diagnosis, Not an Assumption
We speak of a diagnosis when:
- AMH is consistently low
- FSH is persistently elevated
- follicles are absent or minimal on ultrasound
- menstruation has been absent for more than 12 months
At this stage, it is important not to argue with reality.
But to work with it professionally.
Common Questions I Hear in Consultation
Can ovarian reserve be restored?
No. Lost follicles do not return.
Does early menopause always mean infertility?
Not always. It depends on the stage and timing of evaluation.
Should hormones be started immediately?
The decision is individualized. Not automatic.
Conclusion
Early menopause rarely begins suddenly. More often, it develops gradually. Step by step.
Sometimes it is biology that cannot be changed.
Sometimes it is the result of prolonged overload.
And sometimes it is a condition that frighteningly resembles a diagnosis – but is not.
The most common mistake I see is trying to answer the question “What is happening to me?” without understanding “Why is this happening specifically to me?”.
Yet it is the cause that determines everything: prognosis, strategy, and how much time you truly have.
Early menopause is not always about loss.
Sometimes it is about making decisions earlier than planned.
The most important point I want you to take from this article is this:
It is frightening not to know the diagnosis.
It is frightening to live in assumptions.
But it is far more dangerous to live in panic or denial.
When there are numbers, logic, and understanding of the cause – stability appears.
And stability almost always restores control.
Not over age.
Not over hormones.
But over decisions.
Clinical Guidelines and Sources
- European Society of Human Reproduction and Embryology (ESHRE). ESHRE Guideline on Premature Ovarian Insufficiency. 2024.
- European Society of Endocrinology. Clinical Practice Guideline: Management of Premature Ovarian Insufficiency. European Journal of Endocrinology, 2025.
- Nelson L.M. Primary Ovarian Insufficiency. New England Journal of Medicine, 2009.
- Panay N., Anderson R.A., Davies M. et al. Evidence-based guideline: Premature Ovarian Insufficiency. Human Reproduction Open, 2024.
