If your periods have changed and you suspect you’re going through menopause earlier than you expected, you are not overreacting, and there is a clear clinical pathway for diagnosis and treatment in the UK.
Key Facts
Premature ovarian insufficiency (POI) is the loss of ovarian function before the age of 40.
Early menopause occurs between the ages of 40 and 45; the average UK age of natural menopause is 51.
NICE advises diagnosing POI according to menopausal symptoms plus two FSH blood tests taken 4 to 6 weeks apart, both above 30 IU/L.
HRT is recommended for women with POI or early menopause until at least age 51 to protect bone, heart and brain health.
Around 5 to 10% of women with POI have intermittent ovarian activity after diagnosis, so contraception is still advised to avoid any unexpected pregnancies.
In this article:
What is premature ovarian failure, and how does it differ from early menopause?
What causes early menopause and POI?
What are the first signs of early menopause?
How is early menopause diagnosed?
Is HRT necessary if I have early menopause or POI?
What are the long-term health risks of early menopause without HRT?
Does early menopause mean I can’t have children?
Where can I find UK support and specialists for early menopause?
Frequently asked questions about early menopause and POI
What is premature ovarian failure, and how does it differ from early menopause?
Previously called premature ovarian failure, Premature Ovarian Insufficiency (POI) is when your ovaries stop working before the age of 40.
In the UK, doctors tend not to use the term ‘premature ovarian failure’ anymore. Instead, the National Institute for Health and Care Excellence (NICE), the British Menopause Society (BMS) and the NHS use the term ‘premature ovarian insufficiency’. This is because 5 to 10% of people with POI will still have intermittent ovarian activity after being diagnosed, so ‘failure’ isn't really a correct description of what’s happening (1)(2)(5).
POI, early menopause, and natural menopause all sit on a spectrum. POI means losing ovarian function before the age of 40. Early menopause is menopause between 40 and 45, with the average age for menopause in the UK being 51. However, induced menopause can happen at any age and is due to both ovaries being removed (bilateral oophorectomy), chemotherapy or radiotherapy in the pelvic area (9,10,11).
If you have POI, doctors may suggest hormone replacement therapy (HRT) at least until you are 51 years of age, in order to decrease the chances of long-term issues with your bones, heart and brain. For people with POI, HRT is replacing the hormones your body would normally be making itself, rather than an elective treatment.
What causes early menopause and POI?
What brings on early menopause or primary ovarian insufficiency (POI) is unknown in roughly half of cases. The remaining cases are linked to genetics, problems with the immune system, surgical operations or medical treatments.
In up to half of POI cases, no underlying cause is found, and this is described as ‘idiopathic’ (13). Where a cause is identified, it typically falls into one of four groups:
Genetic: Turner syndrome, Fragile X premutation, or a family history of POI. Women whose mother or sister experienced early menopause have an increased likelihood.
Autoimmune: autoimmune ovarian insufficiency, often alongside thyroid disease, Addison’s disease, type 1 diabetes, coeliac disease or vitiligo.
Medical or surgical: bilateral oophorectomy, hysterectomy with oophorectomy, chemotherapy, or radiotherapy to the pelvic area.
Infection (rare): mumps, tuberculosis or severe pelvic infection.
Smoking is associated with bringing the menopause on a year or two earlier on average, but it won't by itself be the main cause of POI. If a very close family member (mother or sister) went through the menopause early, and you’re under 45 with menstrual changes, make sure to tell your doctor about this when you ask for an FSH test.
What are the first signs of early menopause?
Early menopause symptoms are the same as natural menopause symptoms – the only difference is when they happen. A woman under 45 with new menstrual changes plus any of the symptoms below should ask her GP for FSH testing.
If you’re under 45 and your periods have stopped or become irregular, and you're also getting hot flushes, brain fog, vaginal dryness or feeling anxious differently than before, it could be early menopause.
The symptoms of early menopause are broadly the same as those of natural menopause, the only distinction is when they start. Any woman under 45 experiencing changes to her menstrual cycle and any of the symptoms below should talk to a doctor and ask for an FSH test:
Menstrual changes: missed periods, cycles shorter than 21 days or longer than 35 days, 4 or more months without a period.
Vasomotor: hot flushes, night sweats.
Genitourinary: vaginal dryness, recurrent UTIs.
Musculoskeletal: joint aches, new back pain.
Cognitive: brain fog, difficulty finding words.
Mood: new anxiety, low mood, irritability.
Sleep: waking at 3 to 4am and struggling to fall back asleep.
Libido changes.
It may be worth speaking to your doctor if you think you are experiencing these symptoms and want to discuss possible treatment options.
How is early menopause diagnosed?
Early menopause is diagnosed in people under 45 according to their menopausal symptoms plus two FSH blood tests 4 to 6 weeks apart, both above 30 IU/L.
For POI (premature ovarian insufficiency) in women under 40, a diagnosis is typically based on menopausal symptoms and two FSH (follicle-stimulating hormone) tests with results over 30 IU/L, taken 4 to 6 weeks apart. An official diagnosis can usually be made based on the symptoms alone, although FSH is often checked anyway (1).
FSH increases as the ovaries become less responsive to signals from the pituitary gland. As FSH levels go up and down during a monthly cycle, two readings are necessary. AMH (anti-Müllerian hormone) isn't a test that NICE recommends to diagnose POI, although some doctors will test for it at the same time as FSH.
A menopause FSH home test can help give you an idea of your levels, but it doesn't replace the two tests your GP should do as recommended by NICE and you shouldn't use it to diagnose yourself.
After you’ve been diagnosed, you should be sent for some other initial tests. These will look at your thyroid function, adrenal antibodies, and sometimes your chromosomes (a karyotype), as well as a DEXA scan to measure bone strength, and you should have a conversation about possible treatments with your doctor.
Is HRT necessary if I have early menopause or POI?
Yes, for women who experience Premature Ovarian Insufficiency (POI) or early menopause, hormone replacement therapy (HRT) is advised at least up to the age of 51 to protect bone, heart and brain health (6).
Both NICE guidelines (NG23) and the British Menopause Society’s consensus suggest HRT or, in some cases, combined contraceptive pills for women with POI and early menopause, and it should be continued to around the average age for natural menopause in the UK (51 years of age) unless there’s a medical reason to not do so (1)(2).
Essentially, HRT gives these women the hormones their body would be making on its own, and it isn’t a lifestyle choice, it’s about replacing hormones that should have been there in the first place. The British Menopause Society usually prefers HRT over the combined oral contraceptive pill, as it works better for protecting bones (2).
HRT-associated excess risk rises with age/duration because the possibility of breast cancer increases as you get older. This perspective is important when deciding anything about HRT and a doctor prescribing it will decide which type of HRT to use (for example, whether a progestogen is required, or if a vaginal or systemic oestrogen is best).
Approved HRTs in the UK include tablets, patches, gels, sprays and vaginal oestrogens. All systemic HRT and most vaginal oestrogens (for example Vagifem and Vagirux) are prescription-only medicines. To discuss which HRT route and regime may be appropriate for you, speak to your GP, a menopause specialist, or start a free consultation with an Oxford Online Pharmacy pharmacist. For background reading, Oxford Online Pharmacy's blog posts on what are my HRT options? and body-identical hormones explained set out the clinical choices without recommending a specific product.
The HRT Prepayment Certificate (HRT PPC) covers unlimited NHS HRT for a flat annual fee (4). Depending on your circumstances, you may already be entitled to free NHS prescriptions.
What are the long-term health risks of early menopause without HRT?
If a woman reaches menopause early and doesn't take hormone replacement therapy (HRT), she may be at risk of osteoporosis, heart disease, and unfortunately, a shorter life expectancy, when compared to those who continue replacement until at least age 51.
Women who experience premature ovarian insufficiency (POI) and don't use HRT have significantly higher long-term risks in comparison to women who go through menopause at the typical age (1)(2)(5).
Bones: losing oestrogen before the average age of natural menopause (51) means extra years — potentially over a decade — of reduced bone protection unless it's replaced (7). In the UK, the usual approach is to have a DEXA scan when POI is first diagnosed and then to repeat it every 2 or 3 years.
Heart: oestrogen has a protective effect on cardiovascular risk. Going through menopause early is a risk for coronary heart disease on its own. The British Menopause Society advises continuing HRT to the average age of natural menopause to help with this (2).
Brain: there is a link between losing oestrogen too early and a higher chance of cognitive decline and dementia developing. Replacing oestrogen isn't proven to prevent dementia, but stopping HRT early has been linked to worse cognitive function in some research.
Sexual and urogenital health: vaginal dryness, pain during sex, and frequent urinary tract infections (UTIs) are typical if oestrogen isn't replaced. Luckily, these can be treated with oestrogen applied directly to the vagina. Most options, including Vagifem and Vagirux, require a prescription, although Gina 10 can be bought over the counter if you meet certain suitability criteria, whether or not systemic HRT is used.
Mental health: depression and anxiety rates are higher in women with POI. Early diagnosis, treatment support and appropriate HRT are associated with better outcomes.
This list isn't meant to worry you, but to explain why HRT may be a good idea to consider. For most women with POI, HRT significantly lowers these longer-term risks (1)(2)(5).
Does early menopause mean I can’t have children?
Stopping menstrual cycles early greatly reduces your ability to get pregnant. However, about 5 to 10% of women with primary ovarian insufficiency (POI) do become pregnant on their own (8). If you don't want to become pregnant, you’re advised to use birth control.
In fact, 5 to 10% of women with POI get pregnant after diagnosis, and so having a conversation about contraception should be done alongside discussing hormone replacement therapy (HRT) (5). HRT won't increase fertility, but if your ovarian activity returns intermittently, you may be able to get pregnant whilst on HRT.
For those wanting to conceive, donor egg IVF is the most successful assisted-reproduction route following a POI diagnosis. Egg freezing is generally too late after a diagnosis of POI because ovarian reserve is already low, but it should be considered before planned chemotherapy, radiotherapy or an oophorectomy. NHS fertility funding varies by area, and early referral is important because age and BMI criteria differ regionally.
Where can I find UK support and specialists for early menopause?
UK support for early menopause can be reached through your GP, NICE NG23, Daisy Network, the BMS specialist register and pharmacist-led HRT access.
Your first step would be to have a GP appointment. Most local NHS services will refer people diagnosed with POI to a menopause clinic, endocrinology or gynaecology department for initial management, with ongoing HRT then managed by a GP practice.
The British Menopause Society runs a searchable register of BMS-accredited menopause specialists, and Daisy Network runs POI-specific support groups (2). For fertility-specific support, Fertility Network UK is a great UK-based charity.
If you’re struggling with the psychological effects of getting a diagnosis, or how it feels to keep being told you are too young to be going through the menopause, then Oxford Online Pharmacy’s blog post on why this subject is so rarely discussed might be a useful starting point: why menopause is still a taboo.
Another option for getting a professional opinion is to see a pharmacist for a private consultation about the menopause, especially if your doctor isn't sure about prescribing hormone replacement therapy (HRT) to you if you’re under 40. This is to work alongside, not instead of, your doctor’s diagnosis. Importantly, any HRT you are prescribed should be reviewed by a qualified and independent prescriber. And if you’d like a pharmacist to explain the different HRT choices available to you, you can begin a no-cost consultation.
Frequently asked questions
What is the difference between early menopause and premature ovarian failure?
Premature ovarian failure is an outdated term for Premature Ovarian Insufficiency (POI), the loss of ovarian function before age 40. Early menopause is a separate term for menopause between ages 40 and 45 (3). UK clinical guidance (NICE, BMS, NHS) now uses POI because around 5 to 10% of women with POI still have intermittent ovarian activity, so ‘failure’ is not an accurate term (3).
What are the first signs of early menopause?
The first signs are missed or irregular periods in a woman under 45, usually alongside hot flushes, night sweats, vaginal dryness, new anxiety, brain fog, sleep disruption or joint aches (3). Periods shorter than 21 days, longer than 35 days, or 4 or more months without a period in under-45s is the threshold that should prompt a GP appointment and FSH blood testing (1).
What causes premature ovarian insufficiency?
In about half of POI cases, no cause is found (idiopathic). The remaining cases may be caused by genetic conditions (Turner syndrome, Fragile X premutation, family history), autoimmune disease (often alongside thyroid, Addison’s or coeliac disease), medical treatment (bilateral oophorectomy, chemotherapy, pelvic radiotherapy) or, rarely, severe pelvic infection (5). Smoking is associated with menopause coming on average 1 to 2 years earlier but it wouldn’t be the sole cause of POI.
Can early menopause be reversed?
No. Unfortunately, early menopause and POI can’t be reversed. HRT helps to replace the hormones that the ovaries would normally produce and protects long-term health, but it doesn’t restore ovarian function or increase fertility (2,5).
Is HRT necessary if I have early menopause?
Yes. NICE and the British Menopause Society both recommend HRT (or, where appropriate, combined hormonal contraception) for women with POI or early menopause until at least the average UK age of natural menopause (51 years old), unless contraindicated. For this group of patients, HRT is replacing hormones that the body would normally produce, and it helps to reduce the long-term risks of osteoporosis, heart disease and early mortality. HRT is prescription-only and requires a clinical assessment (1,2,4).
How is early menopause diagnosed, which blood tests?
NICE recommends diagnosing POI (under 40) according to menopausal symptoms plus two FSH blood tests taken 4 to 6 weeks apart. A diagnosis for under 45s can be made if symptoms are typical, although FSH is often used as well. AMH is not an NHS-recommended diagnostic test (1).
Does early menopause affect fertility permanently?
Early menopause reduces overall fertility but doesn’t always stop it completely. Around 5 to 10% of women with POI conceive spontaneously after diagnosis, so contraception is still advised if pregnancy is unwanted (2). For those wanting to conceive, donor egg IVF is the most successful assisted option. Egg freezing is generally too late after POI diagnosis but should be considered before planned chemotherapy or pelvic surgery.
What are the long-term health risks of early menopause?
Without HRT, women with POI or early menopause tend to be at increased long-term risk of osteoporosis and bone fractures, coronary heart disease and mortality, compared with women who go through menopause at a typical age (7,5). These risks are why NICE and BMS recommend continuing HRT to at least the age of 51. A baseline DEXA scan and repeat scans every 2 to 3 years are the UK standard (2).
References
National Institute for Health and Care Excellence. Menopause: identification and management. NICE guideline NG23. Published 2015 Nov 12; updated Nov 2024.
Hamoda H. Premature ovarian insufficiency. British Menopause Society consensus statement.
NHS Business Services Authority. NHS Hormone Replacement Therapy Prescription Prepayment Certificate (HRT PPC). NHSBSA.
Hamoda H, Sharma A. Premature ovarian insufficiency, early menopause, and induced menopause. Best Pract Res Clin Endocrinol Metab. 2024;38(1):101823.
Meczekalski B, Niwczyk O, Bala G, Szeliga A. Managing Early Onset Osteoporosis: The Impact of Premature Ovarian Insufficiency on Bone Health. J Clin Med. 2023;12(12):4042. (2)
Csehely S, Kun A, Orbán E, Katona T, Orosz M, Herman T, et al. Prevalence of Impaired Bone Health in Premature Ovarian Insufficiency and Early Menopause and the Impact of Time to Diagnosis. J Clin Med. 2025;14(12):4210. (3)
American College of Obstetricians and Gynecologists. Primary Ovarian Insufficiency in Adolescents and Young Women. Committee Opinion No. 605. Washington (DC): ACOG; 2014. (4)
Hamoda H, on behalf of the Medical Advisory Council of the British Menopause Society. Premature ovarian insufficiency. British Menopause Society; 2024.
NHS inform. Early and premature menopause. NHS Scotland; 2025.
NHS inform. Menopause. NHS Scotland; 2026.
Barts Health NHS Trust. Community Gynaecology Guidelines. North East London ICB; 2024.
Wang Y, Chen X, Xu Y, et al. Genetic insights into the complexity of premature ovarian insufficiency. Reprod Biol Endocrinol. 2024;22:96.