Causes of spontaneous early menopause

Tests for the cause of spontaneous early menopause (EM) or premature ovarian insufficiency (POI) are often undertaken after diagnosis of EM (see Seeking help and diagnosis for spontaneous early menopause and Delivery of diagnosis and emotional impact of early menopause: Health Practitioners’ perspectives). However, most cases of spontaneous EM or POI are ‘idiopathic’, meaning there is no known cause . Genetic factors that can cause EM or POI include Turner Syndrome or Fragile X syndrome, although these conditions affect a small minority of women (as gene carriers or as people diagnosed with the condition). Other factors associated with EM or POI include a family history of EM/POI, autoimmune conditions such as thyroid disease, or galactosaemia. There is mixed evidence that smoking, not having children, HIV infection, hysterectomy, environmental toxins, and emotionally stressful life events may also be associated with earlier menopause. For more information please see the Box at the end of this Talking Point.

Cause of spontaneous EM/POI: What women described being told by health practitioners

Among the women we interviewed who experienced spontaneous EM or POI, only Vicki, who was diagnosed with Turner Syndrome, had received a clear explanation of the cause of her POI. Some women recalled having tests to try to find out the cause of spontaneous EM/POI after their diagnosis, but none recalled receiving a clear result. Melinda recounted what she was told about the results of her test to see if she was a carrier for Fragile X syndrome: ‘They found a very, very slight indication that there might have been something that had led to EM, but it was not conclusive. So they really said it was early menopause with no known cause.’

Lorena did ‘all sorts of medical exams’ in her home country in South America to find out why she had experienced spontaneous EM, but no cause was found.

Women’s own beliefs about the cause of EM

A few women described their own ideas about what had caused or ‘pushed along’ spontaneous EM. Some women talked about one potential cause, while others speculated on several different possibilities including a short menstrual cycle, IVF, a family history of EM, autoimmune conditions, and stressful life experiences. There is no definitive research evidence that all of these factors can cause spontaneous EM – see the Box at the end of this Talking Point.

Family-related factors

A family history of spontaneous EM/POI was mentioned by some women as a possible cause for EM. Finding out that her grandmother had experienced menopause in her mid-30s prompted Anna to do ‘a bit more research’ to find out if her difficulties conceiving a third child and other symptoms she experienced in her early 30s were indications of EM.

Jessica wondered if her early menopause was genetic and reflected on what this might mean for her daughter. 
Autoimmune conditions

A couple of women wondered if past or co-existing autoimmune conditions were linked to spontaneous EM, including thyroid conditions.

From what she had read online, Sonia thought that her Hashimoto’s Disease (a form of hypothyroidism) and early menopause were linked.
Stressful life experiences

Traumatic experiences earlier in life were mentioned by a couple of women as possibly contributing to spontaneous EM. Melinda, who unexpectedly lost a very close family member in her 20s, speculated on the ‘mind-body connection’ and felt that stress had ‘played a part’ in her experience of spontaneous EM.

Coping with unexplained EM

Some women found it took time to ‘make peace’ with not having an explanation for the cause of EM, including Debra: ‘it seems to be spontaneous and no reason why, and I guess that’s been hard.’

Having had ‘answers’ for other health conditions, accepting that there was no known cause for spontaneous EM was ‘very hard’ for Kirsty

Others were more accepting about the fact that no reason for their spontaneous EM/POI had been found.

Because early menopause was ‘really sudden’ for Maddy, at first she thought it might have been caused by an illness. However, when health practitioners could not identify a cause, she concluded she had only been born with a certain number of eggs.

Cause of spontaneous EM/POI: Clinical research evidence

In up to 90% of women with spontaneous premature ovarian insufficiency, the cause is unexplained. Genetic causes include Turner syndrome, and Fragile X syndrome carrier.

POI can be associated with autoimmune disorders. Autoimmune thyroid disease is the most common autoimmune association with POI; however, adrenal, parathyroid, type 1 diabetes mellitus, pernicious anaemia, myasthenia gravis and connective tissue disorders are also associated. Rare metabolic causes include galactosaemia and rarely some viral infections such as mumps may be associated with POI. Chemotherapy and radiotherapy including the ovaries (pelvic or total body irradiation) are associated with POI. Older age, greater cumulative dose and chemotherapy regimens containing cyclophosphamide are associated with greater risk of POI. Factors associated with an earlier menopause include smoking, never having had children, hysterectomy, HIV infection, illicit drug use, a family history of early menopause and adverse life events. There is no evidence that early menopause is associated with the use of oral contraceptives, fertility drugs or artificial hormones in the environment. Childhood caloric restriction, emotional stress at a young age, lower socioeconomic position and environmental toxins are factors identified in some but not all studies.

(Source: Australasian Menopause Society HP Information Sheet ‘Spontaneous POI)

Further information:

Talking Points (Women)

Talking Points (Health Practitioners)

Other resources