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10 Signs You Could Be Headed for Early Menopause

Even if you haven’t started getting hot flashes yet, these risk factors could mean you’re in for “the change” earlier than you expected.

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Your mom went through menopause early

The average age of menopause is 51, according to the National Institute on Aging, but for some women, it can start in their forties or even younger. While early menopause occurs between 40 and 45, “we define premature ovarian failure as menopause before age 40,” says Patricia Pollio, MD, director of the department of ob-gyn at Good Samaritan Hospital land a member of the Westchester Medical Center Health Network, in Suffern, New York. “There are some genetic or inherited risk factors,” she says. One National Institutes of Health study found a significant connection between lower levels of ovarian reserve, as marked by the follicle-stimulating hormone (FSH), in women whose mothers went through early menopause. “If your mother had an early menopause, you are six times as likely to have the same experience,” says Sharmila Makhija, MD, MBA, chair of the Department of Obstetrics & Gynecology and Women’s Health at Montefiore Health System in the Bronx, New York. Pay attention to these symptoms of perimenopause.

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You’ve had surgery on your uterus or ovaries

Not surprisingly, removing both ovaries causes immediate surgical menopause, because they are responsible for the release of hormones. But “even removing one ovary can result in a decrease in the total production of the hormones estrogen and progesterone,” Dr. Makhija says. When women have hysterectomies (removal of the uterus), their ovaries are often left in place to prevent menopause—but Dr. Makhija says that may not be enough to stave it off. “The removal of the uterus can cause this same surgical menopause since the blood supply to the ovaries is modified,” she explains. Make sure you learn the truth about these hysterectomy myths.

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You still smoke—or live with someone who does

If you’re a smoker, you already know it’s not good for you. “Smoking can lead women to transition to menopause up to two years earlier than expected,” Dr. Makhija says. “This is a result of the anti-estrogen effects of nicotine.” Researchers led by the Roswell Park Cancer Institute in Buffalo, New York, found that women who’d smoked 100 cigarettes or more in their lives had a 26 percent greater chance of hitting menopause before 50. Plus, the study also found that women who were exposed to the toxins of secondhand smoke on a regular basis at home or work also had a higher rate of earlier menopause.

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You had problems getting pregnant

If you were diagnosed with diminished ovarian reserve (DOR) while going through infertility treatments, you’re unfortunately on the path to an earlier cessation of fertility. DOR means that your ovaries have fewer follicles left that will become eggs, so it will be harder to conceive and a quicker road to menopause. If you are still in the midst of family building, time is of the essence. The American College of Obstetricians and Gynecologists recommends pursuing “more aggressive treatment options to achieve pregnancy,” including IVF, for patients with DOR. IVF itself, Dr. Makhija notes, is not a risk factor for early menopause.

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You are very underweight

When it comes to early menopause, not weighing enough is a greater risk factor than being obese. “Estrogen is stored in fat tissue, so being overweight or obese increases the likelihood of having a later onset of menopause since there is more estrogen,” Dr. Makhija says. “Being thin, as a result of either poor nutrition or having an eating disorder, means there is less fat, and thus less estrogen, and a higher likelihood of having an early menopause.” Dr. Pollio notes that women who are involved in excessive physical training, such as marathon runners or ballet dancers, may also be at risk if their body fat is too low. Read up on these highly personal questions about menopause you’ve been too embarrassed to ask.

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You were treated for cancer

Early menopause can be a side effect of chemotherapy or radiation for cancer. “Cancer treatments, such as chemotherapy and pelvic radiation, often damage ovarian tissue, resulting in premature ovarian failure and thus, causing menopause,” says Dr. Makhija. According to the American Society of Clinical Oncology, symptoms of menopause from cancer treatments can be worse than natural menopause because the decrease in hormones happens more quickly. Also, even if cancer treatments don’t necessarily cause menopause right away, the damage that’s been done can lead to menopause sooner than normal.

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You have an autoimmune condition

The very definition of “autoimmune” means that your body is attacking itself. So for women who have conditions like lupus, rheumatoid arthritis, thyroiditis, or Addison’s disease, damage to their eggs by their own immune cells is possible. “Certain types of autoimmune disease produce antibodies that may mistakenly attack ovarian tissue, resulting in premature ovarian failure,” Dr. Makhija says. Some autoimmune conditions also cause harm to glands that produce hormones. According to the National Institute of Child Health and Human Development, recent studies suggest that up to 20 percent of women with premature ovarian failure also have an autoimmune disease. This is why some women get depressed during menopause and others don’t.

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You have a chromosome irregularity

You probably already know if you have Turner’s Syndrome, in which a woman is missing part or all of one of her two X chromosomes. The ovaries of women with Turner’s Syndrome don’t function well and often don’t even produce the hormones needed to start puberty. But you could be a carrier of another chromosomal condition, Fragile X, without even knowing it. In women who carry the Fragile X premutation, one of their X chromosomes has some extra gene repeats—not enough to give them the full genetic syndrome, but enough to potentially affect their ovarian function. Research from the Emory University School of Medicine shows that 21 percent of premutation carriers lose ovarian function early, as opposed to one percent of the general population.

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You have epilepsy

Menstrual cycles can trigger seizures in women who have the neurological condition epilepsy, so it seems that there is some connection with hormone changes. The Epilepsy Foundation says that there is evidence menopause may occur a decade earlier in some women with epilepsy—it’s not clear why, but doctors think it might have to do with the effect of seizures on certain parts of the brain that regulate hormones. “The risk is about ten times higher than the average population,” Dr. Makhija says, noting that the medications to treat epilepsy are unrelated.

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You are very stressed

While stress alone doesn’t cause early menopause, it might help it along. “Extreme psychological stress may result in impaired ovarian function,” Dr. Pollio says. “As I explain to my patients, from an evolutionary standpoint, reproductive function will be switched off or suppressed if the body senses extreme stress of any sort.” Recent research from the University of California San Francisco has shown that stress may, in fact, play a part in when a woman enters menopause. The good thing is that stress, along with smoking and weight, can be altered. These lifestyle factors are “all correctable by modifying the behavior,” Dr. Pollio says. “That said, unfortunately, a woman can do everything right, and still have an early menopause due to factors beyond her control.” Next, read about these health risks that can happen after menopause.