The Impact of Air Pollution, Direct Smoke Exposure, Endocrine Disrupting Chemicals (EDCs), Coffee Consumption and Early Puberty Onset on Menopause Timing and Premature Perimenopause Across Ethnic Groups

September 1, 2023

This comprehensive analysis aims to investigate the associations between various factors and the timing of menopause and perimenopause. Menopause, a natural biological process marking the end of a woman’s reproductive years is characterized by the cessation of menstrual periods for 12 consecutive months. The average age of natural menopause is around 51 years, but considerable variability exists due to genetic and environmental factors including but not limited to genetic predisposition, smoking, body mass index (BMI), socioeconomic status and exposure to endocrine-disrupting chemicals (EDCs), dietary factors like coffee consumption and air pollution particularly fine particulate matter (PM2.5). Early onset of menopause before the age of 45 is associated with increased risks of health conditions such as cardiovascular diseases, osteoporosis and cognitive decline. Additionally the timing of puberty, which has been trending earlier for all ethnic groups over the past several decades is associated with an earlier onset of menopause and linked to several adverse health outcomes including increased risks of breast and ovarian cancer, cardiovascular disease and metabolic syndrome.

This chapter aims to provide robust and comprehensive analyses of the available evidence on the associations between these factors and menopause timing, considering potential mechanisms and confounding factors. There is growing interest in understanding the associations between coffee consumption, characterized by its complex mixture of bioactive compounds and reproductive health, particularly the onset of menopause. Additionally, exposure to high levels of air pollution, smoke from generators at music festivals, bonfires and fire performances may increase the risk of early onset menopause. This study aims to investigate whether women exposed to such smoke are at greater risk. Furthermore, this chapter will provide a comprehensive analysis of the available evidence on the association between the timing of puberty and menopause across different ethnic groups.

Lastly, the chapter will provide an overview of early or premature perimenopause, including its prevalence, symptoms, risk factors, diagnosis and management. Premature or early perimenopause refers to the onset of perimenopause before the age of 40 and is characterized by hormonal fluctuations, irregular menstrual cycles and other physical and psychological symptoms. Although it usually begins in the 40s some women start experiencing symptoms in their late 20s or early 30s. This phenomenon is concerning as it is associated with increased risks of various health conditions and can have significant physical, emotional and reproductive implications. This overview aims to outline the underlying causes, symptoms, diagnosis, management and implications of early or premature perimenopause with a specific focus on women in their late 20s.

Section 1: Causes of Early or Premature Perimenopause

The primary cause of early or premature perimenopause is a decrease in the production of estrogen and progesterone hormones by the ovaries. Several factors can contribute to the onset of early perimenopause, including:

Genetic Factors: A family history of early menopause or perimenopause increases the risk.

Autoimmune Diseases: Conditions like rheumatoid arthritis or lupus can affect the ovaries and induce early perimenopause.

Chromosomal Abnormalities: Conditions like Turner Syndrome can lead to premature ovarian failure and, consequently, early perimenopause.

Lifestyle Factors: Smoking, excessive alcohol consumption and extreme stress can contribute to the onset of early perimenopause.

Cancer Treatments: Chemotherapy and radiation therapy can damage the ovaries and induce early perimenopause.

Symptoms of Early or Premature Perimenopause

The symptoms of early perimenopause are similar to those experienced during regular perimenopause and can vary from woman to woman. Common symptoms include:

Irregular Menstrual Cycles: Periods may become irregular, heavier or lighter.

Hot Flashes and Night Sweats: Sudden feelings of heat, followed by sweating, usually occurring at night.

Vaginal Dryness: Decreased estrogen levels can lead to vaginal dryness and discomfort during intercourse.

Mood Swings: Emotional changes, including irritability, anxiety and depression, are common.

Sleep Disturbances: Difficulty falling asleep or staying asleep.

Decreased Libido: A decrease in sexual desire.

Cognitive Changes: Difficulty concentrating or remembering things.

Diagnosis of Early or Premature Perimenopause

Diagnosis of early perimenopause involves a combination of physical examination, medical history and laboratory tests. A thorough evaluation of the symptoms, menstrual history and family history is essential. Blood tests to measure the levels of follicle-stimulating hormone (FSH) and estradiol can help confirm the diagnosis. Additionally, a pelvic ultrasound may be performed to assess the ovaries’ condition.

Management of Early or Premature Perimenopause

The management of early perimenopause focuses on relieving the symptoms and preventing long-term health risks associated with decreased estrogen levels, such as osteoporosis and heart disease. Treatment options include:

Hormone Replacement Therapy (HRT): This involves taking estrogen and progesterone to relieve symptoms and prevent bone loss. However, HRT has associated risks and should be discussed thoroughly with a healthcare provider.

Non-Hormonal Medications: Certain antidepressants, blood pressure medications and anti-seizure medications can help manage hot flashes and mood swings.

Lifestyle Changes: Regular exercise, a healthy diet, stress management techniques and quitting smoking can help manage symptoms and reduce the risk of long-term health problems.

Implications of Early or Premature Perimenopause

Early perimenopause can have significant implications for women in their late 20s, including:

Fertility Issues: Early perimenopause can lead to decreased fertility and challenges in conceiving.

Emotional Impact: The diagnosis of early perimenopause can be emotionally challenging, leading to feelings of sadness, anxiety and loss of self-esteem.

Long-Term Health Risks: Early perimenopause increases the risk of osteoporosis, heart disease and other health problems associated with decreased estrogen levels.

Perimenopause Discussion

Exposure to PM2.5 is associated with earlier menopause as seen in studies from the United States and China involving over 3,900 women. Each 10 µg/m³ increase in PM2.5 was associated with 1.3 to 1.9 years earlier onset of menopause. Some cross-sectional studies involving over 2,300 women from Italy and the United States suggest that higher coffee or caffeine consumption is associated with earlier menopause and decreased estradiol levels. Several studies involving over 30,000 women from the United States, China and the United Kingdom report associations between earlier menopause onset and higher levels of endocrine-disrupting chemicals (EDCs) like phthalates, BPA and PCBs in urine or blood, as well as earlier onset of puberty. Each year earlier onset of menarche was associated with a 0.9 years to 3-4% increased risk of earlier menopause across all ethnic groups, though the strength of the association may vary slightly among different groups. The prevalence of early or premature perimenopause ranges from 1% to 10% among women under 40, with symptoms including menstrual irregularities, hot flashes, sleep disturbances, mood swings and vaginal dryness. Risk factors include smoking, obesity, physical inactivity, family history of early menopause, exposure to endocrine-disrupting chemicals, chemotherapy and radiation therapy.

Evidence suggests that exposure to high levels of PM2.5 associated with systemic inflammation, oxidative stress and endothelial dysfunction leads to hormonal imbalances and accelerated ovarian aging. PM2.5 and other harmful particles in smoke can affect the hypothalamus-pituitary-ovarian axis, regulating menstrual cycle and reproductive function. Women exposed to smoke from generators at music festivals, bonfires and fire performances may be at greater risk of early onset menopause due to the inhalation of harmful particles and toxins, including PM2.5, VOCs and PAHs which have endocrine-disrupting properties. Moreover, exposure to loud noise, common at music festivals is associated with increased stress hormones potentially affecting menopause timing. Caffeine can inhibit cytochrome P450 1A2, leading to increased estradiol levels but also increases COMT activity leading to decreased estradiol levels. The net effect of caffeine on estradiol levels and menopause timing may vary due to individual differences in enzyme activity and overall estrogen metabolism. Other factors include inter-individual variability in caffeine metabolism, differences in coffee type and preparation and reliance on self-reported consumption, introducing recall bias. Exposure to EDCs, including phthalates, BPA, PCBs and DDT, is associated with earlier menopause onset. Phthalates reduce estradiol secretion and increase FSH secretion, BPA binds to estrogen receptors and disrupts normal estrogen signaling pathways, PCBs alter gene expression involved in ovarian function and steroidogenesis and DDT induces oxidative stress and apoptosis in ovarian cells, all leading to hormonal imbalances. Early onset of puberty is associated with earlier menopause across ethnic groups, possibly due to earlier ovarian follicle pool depletion, higher lifetime sex hormone levels accelerating reproductive system aging or common genetic or environmental factors like EDC exposure. Early or premature perimenopause associated with adverse health outcomes may be influenced by genetic factors as a family history of early menopause increases risk. Lifestyle factors like smoking, obesity and physical inactivity as well as exposure to EDCs, chemotherapy and radiation therapy may accelerate reproductive system aging, leading to earlier ovarian damage and follicle pool depletion.


Exposure to high levels of air pollution, particularly PM2.5, toxins from generators, bonfires, fire performances and Endocrine Disrupting Chemicals (EDCs) like phthalates, BPA, PCBs and pesticides like DDT, is associated with earlier onset of menopause. These pollutants can interfere with hormone regulation, induce oxidative stress and apoptosis in ovarian cells, potentially leading to accelerated ovarian aging. Furthermore, early puberty is associated with early menopause across ethnic groups possibly due to earlier ovarian follicle depletion, higher lifelong sex hormone levels or common genetic/environmental factors. Understanding these associations and minimizing exposure to pollutants and the adverse effects of early puberty is crucial for overall health.

Early or premature perimenopause although relatively rare is linked with adverse health outcomes and can have significant physical, emotional and reproductive implications, particularly for women in their late 20s. A thorough understanding of the underlying causes, symptoms, diagnosis and management options is essential for providing comprehensive care. Lifestyle modifications, such as quitting smoking, managing weight and regular physical activity, can help delay the onset of perimenopause. Hormone therapy may also be considered for symptom management and reducing the risks of osteoporosis and cardiovascular diseases. Addressing the emotional impact and long-term health risks associated with early perimenopause is crucial for promoting the overall well-being of affected women.

More research is needed to understand the mechanisms underlying early menopause and premature perimenopause and to develop more effective prevention and management strategies. Efforts should be made to minimize exposure to all these risk factors to reduce early onset menopause and its associated health risks.