Menopause is technically when your stock of egg-producing ovarian follicles falls below a certain threshold and you've gone 12 consecutive months without getting your period. Check out the forces that can trigger this change to happen sooner.
1. Smoking
A 2015 study in The British Medical Journal shows that both "active and passive smokers," meaning those who smoke or used to smoke and those who have lived with a smoker for 10-plus years, likely start menopause 1 to 2 years earlier than people who live relatively smoke-free. "When you smoke, especially a pack a day or more, you're constantly damaging cells on every level," explains Diana L. Bitner, MD, assistant professor at Michigan State University's College of Human Medicine and author of I Want to Age Like That! Healthy Aging Through Midlife and Menopause. "And when you damage the ovarian follicles, you run out of them more quickly." If you're interested in preserving your fertility—and your overall health and longevity—seriously consider kicking the habit.
2. Stress
In findings that aren't terribly surprising, a Boston University School of Public Health study found that women who live with economic hardship are 80% more likely to undergo menopause early, and stress is partly to blame. "We know there's a connection between the immune system and stress but we don't know exactly what it is," says Bitner, who is also director of the Women's Health Network at Spectrum Health in Grand Rapids, Michigan. In the case of financial hardship, there are likely many factors at work: "These women are potentially overweight, diabetic, eating like crap and not sleeping," Bitner says. "It's a constellation of issues that take a toll on the body, including the ovaries." Regular sleep and solid nutrition can go a long way toward easing some of these stressors.
3. Being too skinny
Being anorexic, bulimic, or an elite athlete can cause the ovaries to sputter. "It's not true menopause, where the ovaries are pooping out, however," Minkin explains. "In really lean women, it's the hypothalamus that's pooping out." And if very thin women get injections of hypothalamic extract or if they gain weight, ovulation may kick back in. And yet studies do link eating disorders with earlier onset of menopause, according to Julia Schlam Edelman, MD, clinical instructor at Harvard Medical School and author of Menopause Matters: Your Guide to a Long and Healthy Life. According to the CDC, a healthy body mass index (BMI) is between 18.5 and 24.9. Below 18.5 is considered underweight and could potentially monkey with the timing of menopause. Visit the CDC website to calculate your BMI.
4. Alcoholism
Women with a drinking problem may find their periods become irregular and eventually stop. It's partly a nutrition issue. "These are people who are drinking their calories, which means they're not getting their vitamins, fiber, and healthy proteins," Bitner explains. "I've seen patients drink themselves into early menopause." A National Institutes of Health study shows that chronic heavy drinking can lead to irregular periods, stopping of periods and early menopause, likely by interfering with reproductive hormones and by triggering other disorders, like liver disease, pancreatic disease, and malnutrition. "Even moderate alcohol consumption can decrease ovarian reserve and bring menopause earlier," Bitner adds. A study from Harvard Medical School confirms that these problems may crop up even among "social drinkers," who down about three drinks per day.
5. Autoimmune diseases
In autoimmune diseases the immune system goes haywire and starts attacking its own tissue—including possibly the ovaries and/or estrogen receptors, putting them out of business. Rheumatoid arthritis, scleroderma, and connective tissue disease have all been associated with earlier menopause. A Swedish study of some 18,000 women found that those who entered menopause at age 45 or younger were more than twice as likely to develop rheumatoid arthritis compared to women who started menopause later, suggesting a link. Though the National Institutes of Health consider premature ovarian failure from autoimmune disease to be a "rare disorder," a 2011 research review links them to up to 30% of cases of premature ovarian failure. "Any autoimmune disorder can be associated with risk for early menopause," Minkin says, "but it's not super common."
6. Epilepsy
Women with this seizure disorder, which stems from the brain, are more likely to go into premature ovarian failure (POF), which leads to menopause. A Georgetown University study found that in a group of women with epilepsy, about 14% had premature menopause, compared with 1% of the general population. Although it's not clear exactly why, it might have something to do with low estrogen, Bitner says, which is known to lower the threshold for seizures. "Women who have a seizure disorder could be at risk for having more seizures before their periods or during the transition into menopause," she adds.
7. Chemotherapy
It's designed to obliterate fast-dividing cancer cells, so it's not a shock that chemotherapy takes down ovarian follicles along the way, especially in women over 40, studies show. "Chemotherapy in general zaps the ovaries and can shut down ovarian activity," Minkin says. This "medical menopause" may be temporary or permanent, depending largely on your age. Studies suggest that anywhere from 0 to 40% of women under age 40 go into permanent menopause after chemotherapy, whereas for women over 40, that figure is 70 to 90%, according to breastcancer.org. "Even if the ovaries don't poop out right away, they're at risk for quitting early," Minkin adds.
8. Surgery
If you have severe endometriosis, a potentially cancerous cyst, or another issue in that neighborhood, like pelvic inflammatory disease (a complication of a sexually transmitted infection, where the ovaries can get encased in fibrous tissue), you'll likely need your ovaries surgically removed. Without ovaries, the reproductive show cannot go on. "Surgical removal of the ovaries produces immediate permanent postmenopause," Edelman says. That's not the case with surgery to remove the uterus, though it can stop menstrual bleeding, so it's not always clear when menopause begins. If you're a candidate for surgical removal of the ovaries, Bitner urges you to talk to your doctor about saving even a remnant of your ovaries, which can continue to produce natural estrogen and delay menopause.
9. Genetic disorders
If you find yourself launching into menopause early, you may be a carrier of Fragile X Syndrome, the most common inherited form of mental retardation, Minkin says. Some 1 in 250 women carry the permutation, according to the American College of Obstetricians and Gynecologists, and it can hike your risk of premature ovarian failure or ovarian insufficiency (when the ovaries don't make the right amount of estrogen or release eggs regularly) by 20%, a 2006 study showed. Scientists are increasingly discovering genetic mutations that could be responsible for shutting ovaries down. But rest assured, most of them are extremely rare.
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