Early menopause and premature ovarian insufficiency (POI): signs, causes and treatment

Name: Early menopause and premature ovarian insufficiency (POI): signs, causes and treatment
Creator: MenoWoman

Menopause before 40 is called premature ovarian insufficiency (POI), and menopause between 40 and 45 is called early menopause. International guidelines recommend hormone replacement until about the usual age of menopause, unless there is a medical reason not to, so discuss your options with a doctor.

Researched by the MenoWoman team. Edited by Marcela Sat. Updated 7 November 2026. We may earn from links.

See a doctor if your periods stop or become irregular for several months before 45, or if you have hot flashes, night sweats or vaginal dryness at a young age. Get help quickly if a POI diagnosis leaves you feeling hopeless or unable to cope. If you use hormone therapy, get urgent help for a painful, swollen leg, chest pain or sudden breathlessness, which can be signs of a blood clot.

Early menopause vs premature ovarian insufficiency

The average age of natural menopause is about 51.¹ Doctors call menopause before 40 premature, and menopause between 40 and 45 early.¹ Many specialists now prefer the term premature ovarian insufficiency, or POI, for loss of ovarian function before 40.¹

POI is not just menopause arriving a little sooner. One review describes it as a medical condition in its own right, with its own long-term health effects.³ Ovarian function can also come and go in POI, which is why periods sometimes return.

POI is more common than many people think. The 2024 international guideline puts it at about 3.5% of women, higher than once thought.² Older studies suggested about 1%, and early menopause before 45 is estimated at about 12% worldwide.³ For the normal range of ages, see what age menopause starts.

Symptoms and causes

The first sign is usually periods that become irregular or stop. Many women also notice the same symptoms as at a typical menopause:

Hot flashes (hot flushes in the UK) and night sweats
Sleep problems and tiredness
Low mood or anxiety and brain fog
Vaginal dryness and low sex drive

In about 90% of cases, no cause is found.³ Known causes include chromosome or gene changes, autoimmune disease, removal of both ovaries, and radiotherapy or chemotherapy.¹ A family history of early menopause and smoking raise the risk.³ If your menopause followed surgery, see our guide to surgical menopause.

How POI is diagnosed

Periods need to have been irregular or absent for at least four months. After that, the 2024 guideline says one raised blood test for follicle-stimulating hormone (FSH) is enough.² A repeat test 4 to 6 weeks later is only needed when the diagnosis is uncertain.² Doctors usually also test estradiol and do a pregnancy test.³

After diagnosis, specialists may check for causes. This can include a chromosome test, a fragile X test, thyroid and adrenal antibody tests, and a bone density scan.¹ Home hormone kits cannot diagnose POI. See are at-home menopause tests accurate.

Why guidelines recommend hormone replacement

Without treatment, an early loss of estrogen raises the risk of thin bones, heart disease and other long-term problems.^1,3 One review cites Australian data showing a 37% higher risk of osteoporosis and a 45% higher risk of fracture.³ The American Heart Association links menopause before 45 with a higher risk of coronary heart disease.⁵

For these reasons, the 2024 guideline from ESHRE, the International Menopause Society and partners recommends hormone therapy, unless there is a reason not to. It advises against delaying treatment and recommends continuing until the usual age of menopause.² European guidance says either menopausal hormone therapy or a combined hormonal contraceptive can be used, and both help protect bone.¹ Guidance takes a similar view when the ovaries are removed young: replacing estrogen is usually recommended before 45, and above all before 40.⁷ UK guidance on ovary removal suggests continuing to about 51.⁶

The large trials that raised fears about hormone therapy studied older women. One review says their results do not apply to women with POI and should not be used to withhold treatment.³ Even so, only about half of women with POI in one study had ever used hormones.³

Hormones are not suitable for everyone, for example after some hormone-sensitive cancers.¹ Treatment choice, form and length are decisions to make with your doctor. See estrogen patch vs pill vs gel for how the forms differ.

Questions you may want to ask your doctor:

Is hormone therapy suitable for me, and if not, why not?
Would HRT or a combined contraceptive suit me better?
How long do you expect me to stay on treatment?
When should I have a bone density scan?
Should I see a menopause or fertility specialist?

Your doctor will choose the type and amount of hormone for you. Talk to them before making any change to your treatment.

Fertility and contraception

POI lowers fertility a lot, but it does not always end it. Between about 5% and 10% of women with POI become pregnant without treatment.^3,4 This means contraception still matters if you do not want to get pregnant.³ HRT is not a contraceptive.

The guideline covers fertility options and asks doctors to make clear that HRT is not a contraceptive.² European guidance suggests discussing referral to fertility specialists.¹ Options that a charity for women with POI lists include IVF with donor eggs, adoption, and choosing a life without children.⁴ Fertility rules, costs and access to donor eggs vary a lot between countries.

Emotional support and living with POI

A POI diagnosis can be a shock, especially when it comes young and unexpectedly.⁴ The 2024 guideline says POI can have a big effect on wellbeing and quality of life. It asks doctors to give the diagnosis with compassion, offer a check of your psychological health, ask sensitively about sexual wellbeing, share decisions with you and refer you to support groups.²

Support can include:

Talking therapy, such as CBT, for low mood, anxiety or symptoms.
Peer support groups. The Daisy Network is a UK charity with online communities for women with POI.⁴
Habits that protect bone and heart, such as strength training and enough vitamin D.
Stress relief and a steady sleep routine.

Partners and family may not understand what POI means. Sharing reliable information, such as this page or a charity leaflet, can help them support you. Some women find it helps to grieve the loss of a future they had expected, and that is a normal reaction.

Ask for a review each year so your doctor can check your treatment, bone health and heart risk. For long-term heart health, see menopause and heart health.

What it is used for: evidence rated

Option	Evidence	What the research shows
Hormone therapy until the usual age of menopause	Strong evidence	Recommended by the 2024 international POI guideline unless there is a reason not to, for symptoms and long-term health.^2,3
Vaginal estrogen	Strong evidence	NICE advises offering it for vaginal dryness and urinary symptoms, for as long as symptoms need relief.⁸
Combined hormonal contraceptive	Some evidence	European guidance lists it as an alternative that protects bone and also prevents pregnancy; it is not suitable for everyone.¹
Fertility specialist referral	Some evidence	Guidance advises discussing fertility wishes and referral; donor egg IVF is one option.^1,4
Psychological support and peer groups	Some evidence	Guidelines ask doctors to check mental and sexual wellbeing because POI is linked to distress.^2,4
Exercise and strength training	Some evidence	General advice for bone, muscle and heart health rather than a tested POI treatment; it does not replace estrogen.

Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.