If you are in your 30s or 40s and feel that something is changing in your body but aren’t sure how to define it – you are not alone. Around “menopause,” medical terms are often used that sound similar but describe very different situations. The distinction between them is not just a matter of wording – it has medical significance: It affects diagnosis, treatment, what is important for you to know to explain and request during a visit with your doctor, and your health over many years. So let’s take a moment to put things in order:
Menopause (menopausal transition) is not really an age. It is a defined biological point. Medically, “menopause” is currently defined as a single day – when 12 consecutive months have passed without menstruation. Only in retrospect can it be said that a woman “entered menopause” – not based on feelings or symptoms, but according to a clear physiological definition. This is an irreversible stage in which ovarian activity – egg production and the production and secretion of hormones (estrogen and others) – stops, ovulation disappears, and estrogen levels remain permanently low.
For most women this occurs between the ages of 46 and 55 (the average age in the Western world is 51). However, in some women the process occurs much earlier, and this is early menopause.
So what is early menopause?
Early menopause (Early Menopause) is the same biological state, but at a significantly earlier-than-expected timing. It is defined as cessation of ovarian activity before age 45, with disappearance of menstruation, cessation of ovulation, and estrogen levels that remain low.
When impairment of ovarian function occurs before age 40, this is an extreme condition called Premature Ovarian Insufficiency (POI). This is an endocrine disorder in which ovarian activity is impaired but does not necessarily stop completely. There may be long periods without menstruation and without hormone production, alongside temporary return of ovarian activity, ovulation, and even spontaneous pregnancies in rare cases.
Studies show that about 3–4% of women will contend with POI, and about 12% of women will experience early menopause. The causes are varied: Sometimes it is a genetic or familial background, sometimes autoimmune diseases such as type 1 diabetes or thyroid disorders, and sometimes cumulative factors such as smoking, exposure to environmental toxins, or prolonged physiological stress. However, in many cases it is not possible to point to one clear cause, but rather to a combination of risk factors and natural biological variability among women.
Whether it is early menopause or POI, for many women this is a significant medical and emotional event. Sometimes it occurs at a life stage when the Desire for more children still exists, and professional and family life are in full swing.
“It’s important that every woman understand that this is not just a period that disappears or an absence of the ability to conceive naturally,” emphasizes Dr. Gideon Kopernik, chairman of the Israeli Menopause Society. “When ovarian activity stops or is impaired at a young age, the meaning is a significant shortening of the period during which a woman’s body produces and is exposed to estrogen. Estrogen has receptors in almost every organ in the body, and therefore plays a critical role in supporting and maintaining the function of all body systems.”
While during a ‘normal’ lifespan a woman is exposed to estrogen for about 40 years, in situations of early menopause or POI this exposure may be shortened by a decade or more. The result is earlier appearance of symptoms, sometimes across a broader range, with greater intensity and greater resistance to treatment compared to those that appear in a ‘normal’ menopausal process. Symptoms may include hot flashes and night sweats, sleep disturbances, mood changes, decreased concentration and memory (“brain fog”), impairment of sexual function, vaginal dryness and pain, recurrent urinary tract infections, increased abdominal fat, and joint pain.
“But the impact does not stop at symptoms,” Dr. Kopernik elaborates. “Estrogen has a protective role for the heart, bones, and brain, and when exposure to it is significantly shortened – sometimes many years earlier than expected – the risk of cumulative health damage increases. Among other things, this includes an increased risk of cardiovascular disease, osteoporosis and fractures, cognitive impairment, depression, and acceleration of aging processes in various organs.”
There are situations in which cessation of ovarian activity occurs not only earlier than expected, but also abruptly – for example after surgery to remove the ovaries (such as in BRCA1/2 carriers) or following chemotherapy treatments and pelvic radiation. In these cases, a sharp halt in estrogen production occurs, and the transition may be particularly intense and difficult, with a broader range of symptom types and a greater challenge in providing effective medical treatment.
“One of our community members described surgical menopause as ‘a slap in the face,’” says Dasy Mandel, founder of the #Medabrot_Peri community. “At age 38 she underwent surgery to remove her ovaries and found herself in menopause in one day. They told her that her period would stop, that she would not be able to conceive naturally, but they did not prepare her for the broad impact on the body, the mind, and long-term health.”
It’s important not to get confused: This is not ‘perimenopause’
Don’t be confused. Early menopause and POI are not the same as perimenopause. In perimenopause, estrogen levels begin to decline gradually, sometimes already around age 35, but the ovaries are still active: menstruation continues (more or less regularly), and the ability to conceive exists. This is an expected and gradual process that leads to menopause, usually after age 46.
“As part of our community activity we identify a great deal of confusion between the conditions,” says Dasy Mandel. “It’s important to remember that in all of them, including perimenopause, diagnosis and treatment are required, but in early menopause (for any reason, POI or surgical), due to a longer-lasting estrogen deficiency from a relatively young age, the health implications may be broader.”
Not only symptom relief, but protection for many years
The correct treatment approach cannot be satisfied with symptom relief alone, but must also include preventive medicine – aimed at preserving a woman’s health over the coming years.
According to Dr. Kopernik, “Hormone replacement therapy, sometimes at a relatively high dose, can reduce symptoms, protect the heart, bones, brain, and additional systems, and significantly improve quality of life. Sometimes there is also a need for local vaginal treatment and lifestyle adjustments – physical activity, nutrition, sleep, and emotional support. Proper treatment of one symptom can create a ‘chain effect’: for example, treating hot flashes that disrupt sleep can also improve fatigue, brain fog, daily functioning, and preserve brain health and cognitive activity for many years.”
So what is important for you to know and do?
1. Remember: It’s not just ‘unpleasant symptoms’ – so don’t delay
“Early diagnosis makes it possible to understand what is happening in the body, bring order, and choose timely, tailored treatment – one that not only relieves symptoms, but also supports long-term health,” notes Dasy Mandel. “Therefore, if you feel that something has changed or isn’t entirely right, it is recommended to consult a doctor with knowledge and experience in the field of menopause, not out of pressure or fear, but out of responsibility and care for yourself.”
2. Check fertility early
If the Desire for children exists, it is important to raise the issue with your doctor as early as possible, even before treatments or surgeries that could harm ovarian activity. In some cases, fertility preservation can be considered.
3. Get to know the treatment options
Make sure you receive a full explanation of the range of possible treatments – hormonal and non-hormonal, cognitive-behavioral therapy (CBT), and complementary treatments – according to your medical condition.
4. Adopt a supportive lifestyle
Tailored nutrition, physical activity, and tools for stress management are an integral part of treatment and improving quality of life.
5. You are not alone: Join places that provide knowledge and support
Beyond medical treatment, access to research-based information and emotional and social support can make a significant difference in coping. We invite you to join communities such as #Medabrot_Peri, to receive reliable information, open discussion, and guidance, or the ‘Good Genes’ association, which supports women with BRCA carrier status, who sometimes contend with surgical menopause, and helps them cope with the medical and personal implications of the process.
Bottom line: Even when it happens early – today there is knowledge, tools, and treatments that make it possible to preserve health and quality of life.
Dasy Mandel is the founder of the #Medabrot_Peri community, and Dr. Gideon Kopernik is chairman of the Israeli Menopause Society