Despite what the pamphlets and primetime drug ads suggest, menopause isn’t always a mid-50s milestone. For some women, it comes much sooner—bringing not only hot flashes, but confusion, misdiagnosis, and often silence. Let’s break that silence and take a hard look at early menopause: the biology, the symptoms, the cultural blind spots, and what you can do to understand and support your body.

What Is Early Menopause?

Menopause is officially defined as the absence of menstrual periods for 12 consecutive months. The average age in the U.S. is about 51. Early menopause is when this transition occurs before the age of 45. When it happens before age 40, it’s considered premature menopause or premature ovarian insufficiency (POI).

While about 5% of women naturally enter menopause before 45, POI affects roughly 1% of women under 40 (Nelson, 2009).

Early menopause can happen spontaneously, or be triggered by medical interventions like chemotherapy, radiation, or surgical removal of the ovaries (oophorectomy). We explain these procedures in more depth, here.

Why Does Early Menopause Happen?

The causes of early menopause can be elusive, but several key factors are involved:

• Genetics: Family history is one of the strongest predictors. If your mother or sister experienced early menopause, you’re more likely to as well.
• Autoimmune conditions: Disorders like Hashimoto’s or Addison’s disease can mistakenly attack ovarian tissue, disrupting hormone production.
• Chromosomal abnormalities: Turner syndrome and Fragile X premutation carriers often experience ovarian failure.
• Medical treatments: Chemo, radiation, or pelvic surgeries can damage ovarian function.
• Lifestyle factors: Smoking, chronic stress, and low BMI have all been associated with earlier onset of menopause.

The Symptoms: Familiar, But Often Missed

While many of the symptoms mimic typical perimenopause or menopause, they often go unrecognized in younger women—by both patients and clinicians.

Common symptoms include:

• Irregular or skipped periods
• Hot flashes or night sweats
• Sleep disturbances
• Mood swings or irritability
• Vaginal dryness
• Low libido
• Brain fog or memory issues
• Anxiety or depression
• Joint pain
• Fatigue

But here’s the kicker: many women don’t associate these symptoms with menopause because of their age. They’re more likely to be diagnosed with depression, anxiety disorders, or even ADHD before anyone checks their hormones.

Why It Gets Missed: Cultural Blind Spots

Let’s be honest—our culture still doesn’t know what to do with menopause. It's either a punchline or a pharmaceutical ad. And when you throw age into the mix, the confusion only deepens.

There’s a prevailing myth that menopause is for “older women.” So when a 34-year-old complains of night sweats and brain fog, it’s not uncommon for them to be told they’re just overwhelmed, postpartum, burned out, or hormonal in the “it’s probably PMS” kind of way.

Early menopause doesn’t “look like” what people expect, and because of that, it’s chronically underdiagnosed. As one study in The Lancet put it, menopause care has been historically "neglected, underfunded, and under-researched" (Harding et al., 2022). That’s even more true for women who don’t fit the stereotypical profile.

Explore the cultural history of menopause, here and here.

What Early Menopause Might Masquerade As

Because estrogen and progesterone affect nearly every system in the body—from the brain to the bones—early menopause can present like:

• Chronic fatigue syndrome
• Depression or anxiety disorders
• IBS or gut dysregulation
• Thyroid dysfunction
• Fibromyalgia
• Sexual dysfunction

Doctors might run iron or thyroid panels (good!), but if they stop there, they can miss the deeper picture—hormonal decline.

The Role of Saliva Testing: A Closer Look at Hormone Health

Bloodwork is often the first stop in evaluating hormones—but it doesn’t always tell the whole story. Saliva testing offers a unique window into bioavailable, or active, hormone levels—not just what’s floating around in your bloodstream.

For early menopause, saliva testing can help assess:

• Estradiol (E2)
• Progesterone
• Testosterone
• DHEA
• Cortisol (to assess adrenal involvement)

Because early menopause often overlaps with adrenal fatigue or HPA axis dysfunction, this kind of nuanced testing can clarify whether symptoms stem from low ovarian hormones, chronic stress, or both.

Bonus? It’s non-invasive, easy to collect at home, and tracks the circadian rhythm of hormones like cortisol—something a single blood draw just can’t do. You can learn all about salivary hormone testing here.

You can also check out what a saliva panel looks like in a 36-year-old, here.

Early Menopause and Mental Health: The Invisible Impact

It’s not “just hormones”—it’s your brain chemistry too.

Estrogen and progesterone play a powerful role in modulating neurotransmitters like serotonin, dopamine, and GABA. When levels drop suddenly, as they often do in early menopause, women may experience:

• Heightened anxiety
• Increased risk of depression
• Loss of cognitive clarity
• Mood instability

Research shows that women who experience early menopause are at significantly greater risk for depression, particularly within the first five years of diagnosis (Georgakis et al., 2016).

The emotional toll can also be deeply personal—grieving fertility, feeling “too young” for what’s happening, or struggling with identity in a culture that prizes youth and vitality. We dive into the mental health of menopause more in this blog.

So, What Can You Do?

• Track your symptoms. Don’t gaslight yourself. If something feels off, it probably is.
• Get a full hormone panel, including estradiol, progesterone, FSH, LH, and thyroid markers—and consider adding saliva testing for a deeper dive.
• Ask about hormone replacement therapy. Bioidentical options (like topical progesterone or estriol) can help replenish what’s lost and bring back stability to mood, sleep, and libido.
• Support adrenal health. Low DHEA, elevated cortisol, and chronic stress are common in early menopause.
• Advocate for yourself. If your provider brushes you off, find one who won’t.

Early menopause can feel like a betrayal. Like your body has skipped a chapter you weren’t ready to finish. But knowledge is power—and with the right tools, testing, and support, you can take control of your hormonal health and rewrite the narrative.

If you’re nodding along to these symptoms or suspicions, don’t wait.

👉Because you’re not too young to need hormone support. You’re just too smart to be ignored.