Does early menarche (first menstrual period) always cause early menopause?

From the Guidelines

No, early menarche does not always cause early menopause. While there is some research suggesting a potential association between the timing of menarche and menopause, the relationship is not straightforward or deterministic. Many women who experience early menarche (before age 12) will have a normal timing of menopause (typically between ages 45-55). The timing of menopause is influenced by multiple factors including genetics, smoking status, body mass index, ethnicity, and various lifestyle factors. Some studies have actually found that early menarche might be associated with later menopause in certain populations. The reproductive lifespan (time between menarche and menopause) is regulated by complex hormonal mechanisms and the initial number of ovarian follicles a woman is born with, as well as the rate at which these follicles are depleted throughout her reproductive years. According to a recent study published in 2024 1, early menopause (before 45 years of age) is a risk factor for stroke, but there is no direct evidence to suggest that early menarche always causes early menopause. In fact, the study suggests that the relationship between menopause and stroke is complex, and it may be that women at increased risk for cardiovascular disease experience menopause at an earlier age. Another study published in 2023 1 discusses the consequences of early menopause, including increased risk of cardiovascular disease, osteoporosis, and neurocognitive effects, but does not provide evidence that early menarche always causes early menopause. While tracking your menstrual history is important for understanding your reproductive health, having an early first period should not cause undue concern about experiencing an early menopause. It is essential to consider individual factors and consult with a healthcare provider to assess personal risk and develop a plan for reproductive health. Key factors to consider include:

• Genetics
• Smoking status
• Body mass index
• Ethnicity
• Lifestyle factors
• Menstrual history
• Family history of early menopause or other reproductive health issues. Overall, the relationship between early menarche and menopause is complex, and more research is needed to fully understand the association. However, based on current evidence, early menarche does not always cause early menopause.

From the Research

Early Menarche and Menopause

• Early menarche (first menstrual period) is not always a direct cause of early menopause, but it can be a risk factor 2, 3.
• Studies have shown that women with early menarche (≤11 years) are at a higher risk of premature menopause (final menstrual period, FMP <40 years) and early menopause (FMP 40-44 years) 2.
• The risk of early menopause is also influenced by other factors such as nulliparity (never having given birth), with women who have early menarche and are nulliparous being at a higher risk of premature and early menopause 2.

Health Consequences of Early Menopause

• Early menopause, whether spontaneous or induced, can have significant health consequences, including an increased risk of overall mortality, cardiovascular diseases, neurological diseases, psychiatric diseases, osteoporosis, and other sequelae 4.
• The risk of adverse outcomes increases with earlier age at the time of menopause, highlighting the importance of monitoring women with early menarche for preventive health interventions 2, 4.

Menstrual Cycle Characteristics and Early Menopause

• Menstrual cycle characteristics in adolescence and early adulthood, such as shorter and more regular cycles, have been associated with an increased risk of early natural menopause 3.
• The relationship between menstrual cycle characteristics and early menopause may be influenced by factors such as anti-Müllerian hormone (AMH) levels, which can indicate oocyte depletion 3.

Hormone Replacement Therapy and Early Menopause

• Hormone replacement therapy (HRT) may be considered for women with early menopause to alleviate symptoms and potentially mitigate long-term health consequences 5.
• However, the decision to use HRT should be made on an individual basis, taking into account the potential benefits and risks, as well as the woman's medical history and lifestyle factors 5.