Early, Premature and Surgical Menopause: When It Comes Before You’re Ready

You are 38. Your periods have gone strange, then gone altogether. You’ve been told it’s stress, then your weight, then, kindly, that you’re a bit young for all that. Then a blood test comes back, a doctor says the word, and you will remember that room for years.

Or you are 44, and you went into hospital for an operation that was meant to end the pain, and came out into a menopause nobody had really explained. The hot flushes started on the ward.

In either case, you are not overreacting. Reaching menopause years before your friends, and often before you’d made your own decisions about children, is a loss in its own right.

Premature menopause, also called premature ovarian insufficiency or POI, is menopause before the age of 40. Early menopause is menopause between the ages of 40 and 45. Surgical menopause happens overnight when both ovaries are removed. All three arrive years before the UK average age of 51, and all three deserve medical care and the grieving that usually goes unspoken.

The three kinds of early menopause

The stages of menopause still apply to you; what changes is when, and how fast, you move through them.

Premature menopause, or POI. When the ovaries stop working before 40, the medical name is premature ovarian insufficiency, and the NHS says it affects around 1 in 100 women under 40. Sometimes there’s a known cause: genetics, an autoimmune condition, or cancer treatment that stops the ovaries, which doctors call medical menopause. Often no cause is found, and that “we don’t know why” is one of the hardest things the women I see have to sit with.

Early menopause. Menopause between 40 and 45: earlier than average rather than medically abnormal, but don’t let anyone tell you that makes it easy. Menopause at 51 comes with company, whereas at 42 your friends are still complaining about PMT, not night sweats, and being years ahead of your peers is lonely in a way the age bands don’t capture.

Surgical menopause. If both ovaries are removed, an operation called a bilateral oophorectomy, menopause begins the same day, whatever your age. No perimenopause, no gradual adjustment, no warning. A hysterectomy on its own, where the womb is removed but the ovaries are kept, does not cause menopause, although the NHS notes some women reach it earlier afterwards, so if you’re not sure what was removed, ask.

Why this grief is different

I wrote in the perimenopause series about the grief of perimenopause: the mourning of fertility, identity and the woman you were. Everything there applies here, and the timing adds a loss of its own.

You didn’t get to finish. A woman I worked with was diagnosed with POI at 36 after a year of being told she was anxious. She hadn’t decided whether she wanted children. That was the point: she was still deciding, and the deciding was taken from her. Grief for a choice you hadn’t made yet is real grief, and almost never acknowledged, because people only know how to console you for a baby you were definitely planning.

The decision was made without you. This is what sits under the anger in the searches for “surgical menopause ruined my life”. Your ovaries stopped, or a surgeon removed them, and either way you had no say in something that changed your whole body. In grief work we call a loss that other people don’t recognise disenfranchised grief, and it is the loneliest kind.

You got the ending without the transition. Perimenopause, for all its misery, gives you years to notice what is happening, adjust and grieve a little at a time. Surgical menopause and POI give you no time at all. One woman I worked with had her ovaries removed at 42 for severe endometriosis, felt nothing but relief for a fortnight, then found herself sobbing in a supermarket on an ordinary Tuesday. She wasn’t getting worse; the grief had simply waited until the relief wore off.

The medical conversation you need to have

I’m a counsellor, not a doctor, so this is a signpost rather than advice. But this is the one part of menopause where the medical conversation cannot wait.

The NHS and NICE treat early and premature menopause differently from menopause at the usual age, because the body goes without oestrogen for many more years. NICE guidance is that women with POI are usually advised to take HRT or the combined pill until at least the average age of natural menopause, unless there’s a specific reason not to; the British Menopause Society says the same. That is not a claim from me about what you should do. It is a reason to make sure the question is on the table, and to ask why not if it hasn’t been. The conversation with your GP applies here with more urgency.

If you’re under 40 and your periods have stopped or become very irregular, the guideline is that you should be investigated, not reassured: usually blood tests, sometimes a specialist referral. Between 40 and 45, your GP may test rather than diagnose on symptoms alone. Whatever your age, your bones and heart deserve a long-term plan; I’ll cover that in bones, heart and weight after menopause.

For POI specifically, the Daisy Network is a UK charity run by and for women with premature ovarian insufficiency. They are the people who will never tell you that you’re a bit young for that, and I’d encourage you to find them.

The grief of an early menopause

The grief still needs somewhere to go, and this is my work. Everything in the 12 stages of grief applies here, with two things underlined.

Name the specific loss, out loud, to someone. “I’ve got early menopause” is a diagnosis. “I’m grieving the children I hadn’t decided about” and “I’m angry that a surgeon changed my body and I had no say” are losses, and losses can be mourned. The women who move through this best are not the ones who feel least; they are the ones who have somewhere to say it.

Anger is allowed, and it passes. The “ruined my life” rage is a stage of grief, not a verdict on your future. Its job is to protect you until you’re ready for the sadness underneath. Then, in time, the later stages: reconstruction, meaning, and a self that is chosen rather than inherited. The women I’ve walked alongside through POI and surgical menopause tend to become the clearest people I know about what they want, and that clarity comes from having grieved honestly.

If you’re still waiting out the twelve months to know whether your periods have really finished, how long menopause lasts comes before this article. And when “why me” becomes “who am I now”, the next one, has menopause changed who I am, is written for that.

Frequently asked questions

What are the signs of early menopause?

The same signs as menopause at any age, arriving before 45: periods becoming irregular, lighter, heavier or stopping, alongside hot flushes, night sweats, poor sleep, low mood or anxiety, brain fog, vaginal dryness and lower sex drive. At 35, 37 or 40 these are routinely put down to stress, depression or thyroid trouble. If your periods change noticeably before 45, ask your GP to investigate rather than wait.

What happens if you go into early menopause?

Your ovaries stop producing oestrogen years earlier than average, which is why the NHS and NICE advise a GP conversation about HRT or the combined pill until at least the usual menopause age, unless there’s a reason not to, mainly to protect bones and heart. Emotionally, you face menopause without company your own age, often with fertility questions still open, and that combination is a real bereavement deserving proper support.

What is the earliest age you start menopause?

There is no lower limit. Premature ovarian insufficiency can happen in the twenties or even the teens, though it becomes rarer the younger you are; the NHS puts POI at around 1 in 100 women under 40 overall. Surgical menopause can happen at any age, the day both ovaries are removed. If your periods stop for several months before 40 and you’re not pregnant, breastfeeding or on hormonal contraception, see your GP.

Is surgical-induced menopause worse than natural menopause?

It is usually more abrupt, and many women find that harder. Natural menopause gives you years of gradual change; surgical menopause removes your oestrogen overnight, so flushes, sweats and mood changes can begin within days and hit harder at first. The grief is different too, because there is no time to adjust and often no choice. Whether it is worse depends on the woman; what is true for all of them is that it is sudden and deserves more support than it usually gets.

How long will surgical menopause last?

Menopause after both ovaries are removed is permanent; there is no perimenopause and periods do not return. The symptoms, though, are not permanent for most women. As with natural menopause they tend to be most intense in the first years and then ease, and the NHS notes that HRT, where appropriate, can help manage them, especially for women younger than the usual menopause age.

Grief is my life’s work, and menopause that arrives early is one of the least acknowledged griefs I see in my practice. If this article named something you’re carrying, book a free discovery call here. Next in the series: Has Menopause Changed Who I Am? Personality, Worth and the Woman Who Comes After.

This article is part of The Menopause Journey, an eight-part series.
Previous: part 2 · Next: part 4