Early menopause: 11 symptoms you can recognise

Early menopause means your ovaries start working less before you turn 40. The signals look like a normal menopause, but they arrive years sooner. About 1 in 100 women meet this before 40, and newer figures point to possibly more (Panay, 2025).

What strikes me: precisely because you are still young, you quickly put the complaints down to stress or a busy stretch. Below I set out 11 symptoms of early menopause in a row, with what each signal can mean. After that you read how to have it looked into together with your GP.

First the overview. Further down I explain each signal briefly.

What exactly is early menopause?

Early menopause, medically premature ovarian insufficiency (POI), means your ovaries make fewer hormones before you turn 40 and ovulation falters. Doctors look at your cycle and at a repeatedly raised FSH. According to the most recent guideline, a single reading above 25 IU/L is already enough to consider POI (Panay, 2025).

There is a difference with early-onset menopause. Premature menopause is before 40, while early menopause sits between 40 and 45. Reliable information is also available on Thuisarts.nl.

For a long time it was thought that premature menopause affects about 1 percent of women. Newer figures point to possibly more, up to around 3.5 percent (Panay, 2025). Knowing for sure is only possible with testing.

1. Your periods change or stop

A changing or absent period is usually the first sign. Your cycle becomes shorter, longer or irregular, or your period stays away for a while. Because you are still young, you do not quickly think of this yourself.

Behind this signal sits a faltering ovulation. Your ovaries make less oestrogen, so your cycle loses its rhythm.

Sometimes a period still turns up in between. That is exactly why early menopause is often recognised late.

2. Hot flushes

A hot flush is a sudden wave of heat, usually in your face, neck and chest. Such a wave often lasts seconds to minutes and can come with flushing and sweating. Hot flushes are linked to fluctuating oestrogen levels.

With early menopause, hot flushes stand out extra, because you do not expect them at a young age.

3. Night sweats

Night sweats are hot flushes that happen at night. You wake up drenched and sometimes have to change your bedding or nightwear. It can disturb your sleep quite a bit.

Not every sweaty night points to menopause. An infection, certain medicines or a warm bedroom can also play a part.

4. Poor sleep

Sleep problems are common around early menopause. You struggle to fall asleep, or you wake at night and cannot drift off again. That is partly due to night sweats, and partly because oestrogen and progesterone affect your sleep.

Poor sleep carries into the rest of your day. Fatigue, irritability and concentration problems grow stronger with it.

5. Vaginal dryness

With less oestrogen, the mucous membrane of your vagina becomes thinner and drier. That can give a burning or itching feeling, and pain during sex. Many women find this a difficult subject to raise.

It is a common signal that stands apart from your age. Your GP knows it and can think along about what may help.

6. Lower sex drive

A falling libido can belong to early menopause. Usually several things play at once: hormones, vaginal dryness, fatigue and sometimes a low mood. It is rarely a single cause.

Sex drive fluctuates for everyone. If it keeps bothering you, it is worth discussing.

7. Mood swings and irritability

Your mood can swing more than you are used to. You feel more easily irritated, anxious or low, without a clear reason. Fluctuating hormones play a part in this.

Early menopause is also linked to more psychological strain (systematic review, 2025). If you stay low or anxious, discuss that with your GP.

8. Concentration and memory problems

Many women notice a kind of brain fog: you lose your words more often or your focus slips. Oestrogen plays a role in your brain, so fluctuations can affect your concentration and memory. Usually this is temporary.

Poor sleep and stress make these kinds of complaints worse. So they are not always separate from each other.

9. Persistent fatigue

Fatigue that does not lift with a good night of sleep is common. It can be tied to poor sleep and to the hormone changes themselves. Still, fatigue is a broad signal.

A shortage of iron or a slow thyroid also causes fatigue. That is why it is useful to have those looked at during blood testing.

10. Joint and muscle pain

Stiff or painful joints and muscles can belong to early menopause. Oestrogen has an anti-inflammatory effect, and when it falls away you may feel more pain or stiffness. It is often clearest in the morning.

Joint pain has many possible causes. If it persists, have it checked.

11. Changes in skin and hair

Your skin can feel drier and your hair thinner or more lifeless. Oestrogen plays a role in collagen in your skin and in your hair growth. When it drops, you sometimes notice it in the mirror.

These changes happen gradually. On their own they are rarely a reason for concern, but together with other signals they give direction.

How do you know if you are in early menopause?

Knowing for sure is only possible with testing. Your GP looks at your cycle, your complaints and your age, and can have blood taken. A few hormone values together give a direction. One single reading says little, because your hormones fluctuate strongly.

An example. Two women of 36 have the same complaints: an irregular period and fatigue. In one, FSH is normal and the thyroid turns out to be the cause. In the other, FSH is twice above 25 IU/L, which fits early menopause. The same complaints, a different outcome.

The values below are often viewed together. They do not make a diagnosis, but they give context to your complaints.

Because your hormones differ per day, your GP sometimes repeats a reading. Read more about this test in our article on when an FSH test is worthwhile, and about your ovarian reserve in our piece on the AMH value by age.

Want these hormones measured? The Menopause Check looks at the values that play a part around menopause, among others. You then discuss an abnormal result with your GP. Which values you can have tested is set out in our overview of menopause and blood testing.

What can you do about early menopause?

Discuss your complaints with your GP, certainly if you are younger than 40 and your periods are changing. Early menopause sometimes asks for guidance, because a longer stretch with little oestrogen also touches your bones and your heart (Panay, 2025). What suits you is something you decide together with your doctor.

That long-term side is exactly why early recognition helps. With early menopause there are associations with bone, cardiovascular and cognitive health (systematic review, 2025). That sounds heavy, but it gives you something to keep an eye on together with your doctor.

More background on this phase is in our guide to perimenopause. If you want to know when menopause begins on average, read our article on the age at which menopause starts.

Frequently asked questions

At what age do you speak of early menopause?

You speak of premature menopause when your ovaries start working less before you turn 40. Between 40 and 45 it is called early-onset menopause. Both are earlier than the average, which sits around 51 years.

Early menopause or a thyroid problem?

The complaints resemble each other: fatigue, mood swings and changes in your cycle occur with both. Blood testing can help tell them apart. Alongside your hormones, your GP then often also looks at your thyroid value (TSH).

Can you still get pregnant with early menopause?

Early menopause often makes getting pregnant harder, but not impossible in every case. Sometimes there is still an occasional ovulation. If you have a wish to have children, discuss this with your GP or a fertility doctor.

References

1. ESHRE Guideline: management of women with premature ovarian insufficiency. Human Reproduction. 2016;31(5):926-937. PMID 27008889.
2. Panay N, et al. Evidence-based guideline: Premature Ovarian Insufficiency. Fertility and Sterility. 2025. PMID 39652037.
3. Lifestyle Management in Menopause: A Systematic Review of Women With Premature Ovarian Insufficiency. Clinical Endocrinology (Oxf). 2025. PMID 39989447.
4. Thuisarts.nl. I am going through menopause. Available via thuisarts.nl.

Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.