When the menopause arrives before 45

The international guidelines distinguish two cases. Early menopause, when the last period happened before the age of 45. And premature ovarian insufficiency, when it happened before 40 — which affects about 1% of women and has its own follow-up.

The difference between the two is not one of tone, it is one of management: before 40 there is a specific approach set out in the guidelines; between 40 and 44 there is a fact to take into account when prevention is discussed.

The international guideline on premature ovarian insufficiency, written jointly by four scientific societies, gathers what is known. A menopause at 45 or earlier is associated with a fracture risk between one and a half and three times that of a menopause after 50.

For the heart the signal is quieter but real: in women with premature ovarian insufficiency, cardiovascular events appear about 1.3 to 1.4 times more often than in those whose menopause came between 50 and 54.

These are associations from population studies, not an individual verdict. What they justify is attention, not worry.

The first step is the simplest and the most forgotten: tell your doctor the age at which your periods stopped. It is a fact that is rarely asked for and that changes how your risk reads.

From there, three topics are worth raising: bone health, cardiovascular health, and — where the menopause came before 40 — hormone therapy, which the international guidelines recommend considering until the usual age of menopause, unless contraindicated. That decision belongs to your doctor and is individual; your part is making sure the topic reaches the table.

It is worth keeping this in proportion: