Are your periods changing as you get older?  Maybe they’re getting lighter, coming less frequently, and are more irregular.  This can be disheartening when you’re trying to get pregnant.  Does this mean you’re headed into early menopause?

Menopause is defined by the lack of getting your period for 12 months along with hormone level changes.  According to WomensHealth.gov, the average age in the US that women go through menopause is 52.

Early menopause, which happens before age 46, affects about 5% of women. Some health professionals break it down further and apply the term ‘premature menopause’ to women who go through these changes before age 40.

No matter how you define it, when menopause happens earlier than expected, there can be lasting health effects and a heartbreaking inability to conceive naturally.

Causes of Early and Premature Menopause:

Often doctors will apply the term ‘idiopathic’ to early menopause, indicating that the cause is unknown. Digging into the root of this condition shows that, for most women, the underlying cause usually falls into one of the following categories:

• Smoking
• Environmental toxins
• Genetics
• Metabolic
• Autoimmune
• Infection

Smoking:

Studies have shown that smoking increases the risk of early menopause.

The longer a woman smokes and the more packs of cigarettes smoked, the higher the risk.

Current smokers are considered to be at a doubled risk of premature and early menopause. Someone with a 15 – 20 year history of smoking will have a seven-fold increase in the risk. (study)

Environmental Exposure and Toxins:

There are several common environmental toxins linked to early menopause caused by ovarian failure.

Phthalates, a component of plastics, have been shown in animal studies to decrease reproductive lifespan. (study) Human studies on phthalates show an association in women with higher urinary phthalate levels with a decrease in ovarian reserve. (study)

Perfluorooctanoate (PFOA) and perfluoroocatane sulfonate (PFOS) have both been associated with an increased risk of early menopause in several studies. These compounds are found in non-stick cookware, stain resistant fabrics and carpet, and some food packaging. One of the largest source, though, is through drinking groundwater that has been contaminated by the compounds. (study)

It’s not just your exposure to toxins that impacts early menopause risk, what you were exposed to in-utero actually still matters! Women whose mothers took the medication diethylstilbestrol (DES) are two times more likely to experience early menopause. (study) If your mother smoked while pregnant with you, it may also add a little to the risk of early menopause. (study) Researchers are still trying to figure out all of the effects on fertility from BPA, flame retardants, diesel fumes, and more. (study)

Genetics:

Genetic variants, both rare and more common, affect the onset of menopause.  Researchers estimate that genetics drive about 70% of the variation in the normal age of menopause.

Numerous genes associated with DNA repair, immune function, and mitochondrial production are linked to the minor variations in the age at which women reach menopause.(study)

The importance of these genetic pathways makes sense when you think about how important mitochondrial health and DNA repair is for healthy eggs.  Check out the article on CoQ10 and on DHEA for suggestions on improving egg quality through mitochondrial health.

For a small percentage of women who have early menopause, chromosomal abnormalities may play a role. Women who are missing an X chromosome or who have a partial deletion of an X chromosome are at an increased risk of early menopause and reproductive problems.

Fragile X syndrome is another genetic player in early menopause. This is caused by a repeated part of the MFR1 gene, and a higher number of repeats has been shown to increase premature ovarian insufficiency risk by 20%. This is not something that is normally tested by 23andMe or other direct to consumer testing. (study)(study)

If you do have genetic information from 23andMe or another testing company, there is a gene that is linked to earlier menopause timing that you can check.

The MCM8 gene codes for a protein that is important in cell replication – especially in egg cells.  The studies have linked the variant to earlier menopause; if combined with other factors such as environmental toxins, smoking, or other genetic variants, the MCM8 variant could play an important role in early menopause. (study)

Check your genetic data for rs16991615:

• AA: increased risk of early menopause, almost 2-year earlier menopause on average
• AG: almost one year earlier menopause on average
• GG: normal

Another gene that is tied to problems with ovarian insufficiency or early menopause is the XPO5 gene. This gene codes for a microRNA that is essential in regulating the processes needed for egg cell formation. (study)

Check your genetic data for rs2257082:

• AA: 2-fold increased risk of the loss of ovarian function before age 40
• AG: increased risk of the loss of ovarian function
• GG: normal

Variants in the MTHFR gene (read all about it here) have also been linked to an increase in the risk for premature ovarian failure.

Metabolic Causes:

There are several metabolic disorders, such as 17 alpha- hydroxylase deficiency and galactosemia, that have been linked to early menopause. (study) These are rare disorders caused by genetic mutation.

Researchers have also investigated how weight impacts the age at which women reach menopause. Being overweight or obese is not a risk factor for early menopause, but being underweight (BMI <18.5) can increase the risk of early menopause by 30%. (study)

While being underweight is a risk factor, a large study of over 100,000 women found that physical activity level – whether low or high – was not a factor in early menopause. (study)

Autoimmune and Infectious Causes:

The studies on autoimmune conditions and early menopause show a variety of conclusions with some studies linking diseases such as lupus to decreased ovarian reserve and other studies showing no statistical link.(study)(study)(study)(study)(study)

Some studies even hint at a direct cause of autoimmune antibodies specifically causing premature ovarian insufficiency.(study)

Prior exposure to infectious diseases such as mumps or HIV can also cause early and premature menopause. (study)(study)

Action Steps and Treatment Options:

Knowing the possible causes of early menopause can help you decide on actions you could take.

If you are a smoker or exposed to second hand smoke, eliminating this risk factor is an obvious first step.

Exposure to environmental toxins such as PFOAs and phthalates can be reduced by filtering your water and carefully choosing what you expose yourself to.

Simple steps like avoiding cooking in plastics or using artificial air fresheners can help to cut down on phthalate exposure. A recent study also found that PFAO and PFAS levels were increased in women who used Oral-B Glide floss or lived in a house with stain resistant carpet and furniture. (study)

Autoimmune conditions such as lupus and autoimmune thyroiditis can sometimes be helped and even reversed through making dietary changes. Eating fresh, whole foods and eliminating most packaged foods and fast foods are an excellent start.  (study)

In-vitro fertilization is still an option for some women with premature menopause. Sometimes donor eggs are used, while for others ovulation may still be induced. (study)(study) Hormone replacement therapy may also be an option. (study)

For premature menopause caused by ovarian failure, acupuncture may be a solution. A small study with 31 participants receiving acupuncture treatment three times per week resulted in 20% of the women resuming their menstrual cycle. (study)

All of the different causes and variety of possible treatments should drive home the fact that premature and early menopause is unique to the individual and should be treated as such. Individual answers that are specific to you!