Early menopause, POI and surgical menopause: "Too young for this?"

Most women reach menopause between 45 and 55 (WHO), and a 2012 study of Filipino women found an average age of 48.9. When it comes sooner, doctors use two labels:

• Early menopause: your periods stop for good before age 45.
• POI (premature ovarian insufficiency): your ovaries slow down or stop before age 40. WHO calls this premature menopause. With POI, the ovaries can still work on and off, so periods may return now and then, and about 5% of women conceive naturally after a POI diagnosis (RACGP 2023). If you do not want to get pregnant, ask about contraception.

The Philippine Society of Climacteric Medicine (PSCM) uses the same cut-offs in its patient materials. Some women hear "too young for menopause" from friends or even doctors. You are not too young to be taken seriously.

Not sure if this applies to you? Our early menopause check asks about your age, periods and any surgery or cancer treatment, and tells you what to bring to a doctor.

WHO lists several causes:

• Surgery that removes both ovaries.
• Cancer treatment, such as chemotherapy or radiation, that stops the ovaries from working.
• Chromosomal conditions and autoimmune disorders.
• Unknown causes. For many women, no clear reason is ever found. That is frustrating, but it does not change the treatment.

If your periods stop before 40 and you are not pregnant, see a doctor rather than waiting to "see if it comes back".

This is where many women get confused, so let us be precise.

Oophorectomy (removal of both ovaries) causes surgical menopause straight away. WHO lists it as a cause of induced menopause. Because estrogen drops suddenly rather than over years, symptoms such as hot flashes, night sweats and poor sleep can come on quickly.

Hysterectomy (removal of the uterus) with the ovaries kept stops your periods, but it is not menopause. Your ovaries keep making hormones. WHO notes that women who have had a hysterectomy may stop menstruating before menopause, which means you lose the easiest clue for tracking your stage. You may still go through perimenopause later, with hot flashes and mood changes but no periods to tell you why.

Hysterectomy plus removal of both ovaries means surgical menopause.

If you are scheduled for gynaecological surgery, ask your surgeon three questions before the operation:

1. Will my ovaries be removed, one or both?
2. If both, will I go into menopause right after surgery?
3. Should I start hormone therapy afterwards, and who will manage it?

Surgical menopause in Filipino women has been studied locally: a Philippine knowledge, attitude and practice study is listed in the POGS research database. If you have had both ovaries removed before natural menopause age, the advice on hormone therapy below applies to you.

The symptoms are the same as at the usual age: hot flashes, night sweats, changing or missing periods, sleep problems, mood changes, brain fog, vaginal dryness and lower libido. WHO lists hot flushes and night sweats, cycle changes, vaginal dryness and painful sex, incontinence, insomnia, and changes in mood, depression and anxiety.

What is different is the context. At 37 you may not suspect menopause, your friends will not be going through it, and you may be thinking about pregnancy.

Browse every symptom on our symptoms hub, or use the symptom checker for a summary to show your doctor.

This is the main reason early menopause needs a doctor and not just patience.

Estrogen protects your bones and blood vessels. The Menopause Society (2022) states that women with primary ovarian insufficiency and premature or early menopause have higher risks of bone loss, heart disease, and cognitive or mood disorders linked to estrogen deficiency. WHO adds that bone loss at menopause is a significant contributor to osteoporosis and fractures, and that women's advantage over men in heart disease gradually disappears after menopause. Going through menopause early simply means more years without that protection.

What helps:

• Hormone therapy (see the next section).
• Bone checks. Ask your doctor whether you need a DXA scan. A spine and hip scan costs ₱2,400 per scan (Exact Check). Prices checked October 2026. More on our bone density test page.
• Heart checks. Blood pressure, cholesterol (₱520 per test (Exact Check)) and blood sugar (₱475 per test (Exact Check)).
• Strength training and activity. The 2025 UP Manila menopause symposium recommended strength training 2 to 3 times a week plus 150 minutes of activity weekly.

For women going through menopause early, hormone therapy is not just about symptoms. It replaces hormones your body would normally still be making.

The Menopause Society (2022) recommends that women with POI or premature or early menopause use hormone therapy until at least the average age of menopause, unless there is a contraindication. In practice that usually means until around age 50.

What this looks like:

• If you still have a uterus, estrogen is paired with a progestogen to protect the womb lining.
• If you have had a hysterectomy, estrogen alone is usually enough. The Menopause Society (2022) notes that estrogen alone may even lower breast cancer risk.

Hormone therapy for menopause is prescription only in the Philippines. See HRT for menopause for the registered options and costs for what they cost at Watsons. If HRT is not suitable for you, ask about non-hormonal treatments and how to protect your bones another way.

Over 45, most women do not need blood tests to diagnose perimenopause or menopause. Under 45 is different.

NICE (NG23) suggests considering an FSH blood test to diagnose menopause in women aged 40 to 45 with symptoms, including a change in their periods, and in women under 40 when POI is suspected (NICE NG23 and QS143). For POI, older criteria asked for two raised FSH results 4 to 6 weeks apart; the 2024 international POI guideline says one raised result (above 25 IU/L) after at least 4 months of missed or irregular periods can be enough, with a repeat test or an AMH test if the result is unclear. Because FSH swings, your doctor may still repeat it.

Your doctor may also check:

• Pregnancy, first.
• Thyroid (TSH), because thyroid problems can stop periods and mimic menopause. See perimenopause or thyroid?.
• Other hormones, depending on your history.

Typical costs: FSH ₱855 per test (Exact Check) or ₱1,000 per test (Hi-Precision via Hati Health), TSH ₱490 per test (Exact Check). Prices checked October 2026. More on our FSH test page.

Early menopause and POI usually mean fertility is much lower, but not always zero. With POI the ovaries can still work occasionally, so an unplanned pregnancy is possible. If you do not want to be pregnant, ask your doctor about contraception. If you do want a baby, ask for a referral to a fertility specialist early.

Our sister site Birth Control Philippines covers contraception options in your late 30s and 40s.

See a doctor if:

• you are under 40 and your periods have stopped for several months or become very irregular
• you are 40 to 45 with hot flashes, night sweats or changing periods
• you have had both ovaries removed and have not discussed hormone therapy
• you have had chemotherapy or pelvic radiation and your periods have changed

See a doctor soon for bleeding after 12 months without a period, a breast lump, chest pain, leg swelling, a sudden severe headache, or thoughts of harming yourself.

Find a menopause-literate OB-GYN on our find a doctor page, and bring your early menopause check results.