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Entering your 40s is a significant milestone for most women. You probably expect changes in your health and well-being by midlife, but it might seem early to experience menopause symptoms at 40.

Although the average age of menopause is 52, it can happen earlier for various reasons. Learn about the signs of early menopause and why it can happen in your 40s.

The Menopause Transition

Menopause is the point in your life when your periods end permanently, and you can no longer get pregnant. You are in menopause when you haven’t had a period for 12 months straight. For most people, that happens around the age of 52.

Perimenopause is the transition toward menopause. It starts earlier, often in your mid to late 40s, and lasts about four years on average.

About 5% of women experience natural early menopause between the age of 40 to 45. That means you may start perimenopause as early as your late 30s. Premature menopause happens before you turn 40.

Signs of Early Menopause

In perimenopause, your ovaries make less of the hormones estrogen and progesterone than usual. The changes in your hormone levels cause these signs and symptoms, which are similar, whether menopause is early or not:

• Changes in your sex drive.
• Hot flashes or night sweats.
• Missed periods.
• Mood changes, like irritability or mood swings.
• Periods that are heavier, lighter, shorter, or longer than usual.
• Sleep problems or insomnia.
• Vaginal dryness, which can cause pain during sex.

Talk to your doctor if you are in your 30s and have some or all of these symptoms. They can tell you if you’re approaching early menopause by:

• Assessing your symptoms.
• Doing a physical and pelvic exam.
• Doing bloodwork to check your hormone levels.
• Reviewing your family and medical history.

If you haven’t had a period in 12 months, it’s possible you are in menopause, even if you’re 45 or younger.

What Causes Early Menopause?

Early menopause (between ages 40 and 45) or premature menopause (before age 40) can happen for various reasons, including:

• Certain health conditions, like an autoimmune disease, chronic fatigue syndrome, or HIV.
• Chemotherapy or radiation treatments to your pelvic area. These may damage your ovaries, causing them to stop producing sex hormones.
• Family history of early menopause.
• Smoking. People who smoke reach menopause about two years earlier than nonsmokers.
• Surgery to remove your uterus or both ovaries. If you have your uterus removed but not your ovaries, you may transition into menopause a year or two earlier than average. Removing both ovaries causes a sudden drop in hormones and menopause symptoms immediately. Women who have this procedure (called an oophorectomy) may have severe menopause symptoms.

With the exception of having your ovaries removed, it’s impossible to predict when perimenopause and menopause will occur. Much of the time, early menopause happens for no apparent reason.

Managing Menopause Symptoms

Perimenopause symptoms are a normal part of the transition. They may worsen as you get closer to menopause. And once you have entered menopause, these symptoms can continue for as long as 14 years after menopause.

But there is no need to suffer if menopause symptoms keep you up at night or impact your life. Talk to your doctor about your symptoms. Depending on the risks and side effects, they may recommend these or other medications to help:

• Birth control pills to help regulate your periods and reduce hot flashes.
• Hormone replacement therapy for early or premature menopause.
• Vaginal estrogen to help with vaginal dryness.

Diet and lifestyle changes can also reduce some of your early menopause symptoms, especially hot flashes, night sweats, and sleep problems. These include:

• Dress in layers that you can easily remove if a hot flash strikes.
• Eat a healthy diet with plenty of high-fiber fruits, vegetables, whole grains, legumes, tofu, nuts, and seeds. Research suggests that a low-fat, plant-based diet may improve hot flashes.
• Limit alcohol, caffeine, and foods with added sugar. These are hot flash triggers, and they can affect sleep quality.
• Get at least 30 minutes of brisk exercise most days of the week to help maintain a healthy weight.
• Manage stress by doing yoga, meditation, or working with a behavioral health therapist. This may help with mood swings, sleep, and hot flashes.
• Quit smoking if you’re a smoker. People who smoke tend to have more severe menopause symptoms.
• Sleep in lightweight pajamas and blankets, and use a fan if you get night sweats.

Risks of Early Menopause

Whether it happens early or late, the hormonal changes that come with menopause can cause health problems. Estrogen helps keep your bones and muscles strong and protects your heart and blood vessels. Without it, women are at higher risk for:

• Heart disease.
• Muscle loss.
• Osteoporosis.
• Stroke.

Weight gain, especially in your abdomen, is also common during perimenopause and after menopause. Carrying excess belly fat can increase your blood sugar and blood pressure. That puts you at risk for diabetes and an even greater risk for heart disease or stroke.

When you go through menopause earlier, you have a longer time without the health benefits of estrogen. That increases your chances of developing these health problems as you age.

With early menopause, it’s also normal to feel sadness or depression over the loss of your fertility. Talk to your health care provider if you feel depressed. And if you still want children but are experiencing early menopause symptoms, ask them about your options which might include:

• In vitro fertilization (IVF) with donor eggs or your eggs if you freeze them.
• Surrogacy.

And if you’re sexually active and do not want children, you talk to your doctor about birth control options. You can still get pregnant during perimenopause.

Going through menopause is an adjustment for most women, and it brings some extra challenges and concerns when it happens early. If you think you’re experiencing menopause symptoms earlier than expected, talk to your health care provider. They can help you prepare and make the transition as smooth as possible.