June 6, 2025, 10:47 am | Read time: 5 minutes
What many people don’t know: Not every woman enters menopause in her mid-50s. For some, it happens much earlier—sometimes even as early as their early 20s. What’s behind this? And what should you be aware of? We spoke with Dr. Heidi Gößlinghoff, a reproductive medicine specialist and gynecologist.
You’re in your early 30s, feeling sluggish, sleeping poorly, and suddenly your period only comes when it feels like it? You probably think of stress or a hormonal imbalance first–but hardly anyone would consider it could be menopause. Yet, that’s exactly possible. “The youngest patient who was definitely in menopause was just 21,” says Dr. Heidi Gößlinghoff, reproductive medicine specialist and gynecologist. A real wake-up call, as premature menopause is no longer a fringe issue–it’s something women should have on their radar earlier. In this article, you’ll learn everything you need to know about premature menopause–from the first symptoms to medical tests and effective treatment approaches.
Overview
- What Exactly Is Premature Menopause?
- Signs That Are Easy to Overlook
- How to Recognize Premature Menopause
- Why Estrogen Is Not a Luxury but a Necessity
- Hormones: Yes or No?
- And Without Hormones? What Diet and Lifestyle Can and Cannot Do
- Goodbye to Having Children? Not Quite!
- Smoking Harms Your Eggs
- Don’t Forget Check-Ups!
- Premature Menopause Is Not a Taboo but a Medical Challenge
What Exactly Is Premature Menopause?
The definition is clear: “When a woman enters menopause before the age of 40, it’s called premature menopause,” explains Dr. Gößlinghoff. It sounds theoretical–but in practice, it affects more women than you might think. A specific trigger? Usually, there isn’t one. “We don’t know why certain women enter menopause earlier. There seems to be a familial tendency,” says the expert. It’s also noticeable: “I often see women from the Mediterranean region–but maybe it just stands out more there because many think about family planning earlier.”
Signs That Are Easy to Overlook
The tricky thing about premature menopause: The symptoms are the same as with “normal” menopause–but in young years, no one associates them with it. Hot flashes? Sleep disturbances? Mood swings? “My youngest patient was 21,” says Dr. Gößlinghoff. “She never thought her fatigue could be related to menopause.”
Typical signs of premature menopause:
- Irregular or shorter cycles
- Hot flashes and night sweats
- Sleep problems
- Reduced performance
- Mood swings, irritability
- Dry skin and mucous membranes
How to Recognize Premature Menopause
If there’s suspicion, it’s time to head to the lab. The key hormones are FSH (follicle-stimulating hormone) and LH (luteinizing hormone). “If the ovary no longer responds to FSH, the FSH level rises. This can be an indication of premature menopause,” says the doctor. Another important marker is the anti-Müllerian hormone (AMH), which measures the egg reserve. The lower it is, the more likely the early onset of menopause.
Why Estrogen Is Not a Luxury but a Necessity
Premature menopause doesn’t just mean the end of fertility–it disrupts the entire metabolism. “Estrogens are responsible for the moisture of the mucous membranes–including the eyes–the stability of the bones, and much more,” emphasizes Dr. Gößlinghoff. A deficiency can lead to osteoporosis, susceptibility to dementia, and metabolic disorders in the long term. “If I enter menopause at 35 and don’t undergo hormone replacement therapy, I might have a hip fracture at 55–without even falling.”
Hormones: Yes or No?
The good news: Premature menopause can be well-treated with an individually tailored hormone replacement therapy. The less good news: The therapy carries–like the birth control pill–an increased risk of thrombosis. “You have to carefully check if the patient has an increased risk. If not, you can give the therapy–and should do so as early as possible,” advises Dr. Gößlinghoff. Studies show: Those who start at 70 have a significantly higher risk of complications.
And Without Hormones? What Diet and Lifestyle Can and Cannot Do
As much as we’d like to believe it: A balanced diet doesn’t replace estrogens. Still, it can help mitigate the effects–especially regarding bone health. Dr. Gößlinghoff recommends:
- Calcium-rich diet (e.g., green vegetables, dairy products, mineral water)
- Vitamin D for calcium absorption
- Vitamin K for directing it into bone tissue
- Muscle-building training (“Every muscle pulls on the bone–this stimulates bone formation”)
But: “Without estrogens, these measures cannot replace the missing hormone.”
Goodbye to Having Children? Not Quite!
Premature menopause usually also means: no more eggs, no pregnancy. For affected women, this is often a severe blow–especially if they’re in the prime of life. “What you can do is social freezing,” says Dr. Gößlinghoff. This means: extracting and freezing eggs early. Alternatively, you can use supplements to preserve the egg reserve as long as possible–”including omega-3 fatty acids, vitamin D, or DHEA–but only after prior level determination.”
Smoking Harms Your Eggs
Eggs are very sensitive–and unfortunately, they don’t regenerate. “Smoking, alcohol, and a sedentary lifestyle cause them to deteriorate faster,” warns Dr. Gößlinghoff. Those who consciously adjust their lifestyle can at least slow the progression of premature menopause–but preventing it entirely is only possible to a limited extent.
Don’t Forget Check-Ups!
Those affected should regularly check their bone density–preferably via ultrasound or special X-ray examination. “This way, you can counteract it in time before fractures occur,” advises the doctor.
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Premature Menopause Is Not a Taboo but a Medical Challenge
Premature menopause is more than “just a bit of early hot flashes.” It deeply affects the hormonal balance and impacts both body and mind. The earlier it’s recognized and treated, the better for health, fertility, and well-being. Dr. Gößlinghoff’s advice: “Don’t take it lightly–but also don’t panic. It’s important to be well-informed and medically guided.” Because knowledge is–especially in menopause–power. And sometimes also comfort.