Early menopause is associated with higher overall mortality, yet in 85% to 90% of cases its cause is unknown.
Dr. Monica M. Christmas is an associate professor of obstetrics and gynecology at University of Chicago Medicine. She presented 'Early menopause and the impact on all-cause mortality' at The Menopause Society 2026 Annual Meeting, held October 20 to 24, 2026, in San Diego, California. Her talk was part of the 'Presidential Symposium: The toll of estrogen avoidance.' She reviewed the causes of early menopause, its association with mortality, and strategies to reduce risk.
Premature ovarian insufficiency (POI) occurs before age 40 years and affects 3.7% of women globally. Early menopause occurs between 40 and 44 years and affects 12.2%. Dr. Christmas pointed to 'a significant discrepancy' by income: POI affects 2% of women in high-income countries vs 7.1% in low- and middle-income countries, and early menopause affects 7.6% vs 14.4%.
Known causes include surgical, genetic, and autoimmune conditions, and many risk factors are sociodemographic. Early menopause is associated with bothersome symptoms, mood disorders, long-term disease, and higher overall mortality, as well as 'the grief associated with loss of fertility.'
What cohort studies show about early menopause and all-cause mortality
Among 19,731 Norwegian women followed for 37 years, all-cause mortality decreased as age at menopause increased. In a three-decade Chilean cohort, 34.7% of women with POI had died vs 19.3% of women with menopause at the usual age. In the Canadian Longitudinal Study on Aging, women with premature menopause had 2.5 times the odds of having 3 or more chronic conditions.
Is early menopause a marker or a cause of higher mortality? Possible explanations include hypoestrogenism, accelerated biological aging, and shared risk factors. In the Mayo Clinic cohort, bilateral oophorectomy before age 45 years was associated with higher mortality, cognitive impairment, and parkinsonism, and the excess mortality was seen mainly in women not taking estrogen. A 2025 meta-analysis found no evidence that hormone therapy changes dementia risk in these women.
How hormone replacement and prevention may reduce risk after early menopause
For women with non-iatrogenic POI who want to avoid pregnancy, continuous combined oral contraception can be used, although only hormone replacement increased lumbar spine bone density in the trials she presented.
A guideline she presented recommends hormone replacement, aimed at a physiologic range, until the usual age of menopause. She described hormone replacement and lifestyle modification as complementary: 'It really needs to go hand in hand.' Her strategies start with recognizing women at risk and reducing elective oophorectomy in premenopausal women. She recalled a residency attending who treated abnormal uterine bleeding by removing the ovaries.
She closed with the scale of the problem: 1 in 27 women live with POI, and an estimated 32 million women are not receiving appropriate care. Early menopause may signal increased vulnerability to long-term disease and mortality, which makes early recognition and preventive care essential. She called it a 'women's health equity issue.'
Abbreviations: POI, premature ovarian insufficiency.