Women veterans may face more than twice the odds of early menopause
Veterans Day is a time to honor service members — and an opportunity to recognize the health challenges some face long after their service ends. For women veterans, emerging evidence suggests that certain military-related experiences and exposures may be associated with earlier menopause.
Neither VA clinicians nor civilian OB-GYNs routinely consider the possible impact of military service on reproductive health. That care gap leaves women veterans who experience earlier menopause to face both the discomfort of untreated perimenopause symptoms and a higher long-term risk of cardiovascular disease, osteoporosis, and cognitive decline.
“Military service history should be part of a woman's reproductive and hormonal health history,” explains Hone Health-affiliated OB-GYN Shelly Chvotzkin, M.D. “PTSD and environmental exposures may have implications for ovarian function and reproductive aging, and more research is definitely needed to establish these relationships. Women should not have to wait until their periods become irregular or stop before their symptoms are taken seriously.”
Hone Health, a physician-led longevity platform, explains how military service may be associated with earlier menopause in women veterans and when to discuss symptoms with your doctor.
Key Takeaways
- PTSD and PFAS exposure may increase risk of earlier menopause.
- Gaps in menopause training and uneven VA menopause care can leave that risk overlooked.
- Earlier menopause is associated with higher risks of cardiovascular disease, osteoporosis, and cognitive decline.
- Veterans with perimenopause symptoms before age 45 should share their service history — including PTSD and potential PFAS exposure — and ask whether hormone testing is appropriate.
How PTSD May Be Linked to Earlier Menopause
Women veterans have a 13% lifetime rate of PTSD — more than twice the 6% rate among male veterans.
Both combat exposure and military sexual trauma have been linked to PTSD in women. In a study in the journal Women’s Health Issues, women who experienced military sexual assault had about six times the odds of developing PTSD even after accounting for combat exposure.
A 2025 study of 668 Gulf War-era women veterans found that those with probable PTSD had 2.45 times the odds of reporting possible menopause before age 45 compared with those without probable PTSD.
Researchers are still trying to understand whether and how PTSD might affect menopause timing. One possibility involves changes in the hypothalamic-pituitary-adrenal (HPA) axis, the body’s main stress-response system, which interacts with hormones that regulate reproduction. Inflammation may also play a role.
Chvotzkin says she has observed a similar pattern in her practice over the past decade, particularly among women with chronic PTSD.
How PFAS Exposure May Affect Ovarian Function
Exposure to PFAS (per- and polyfluoroalkyl substances, or “forever chemicals”) has been linked to earlier menopause in civilian women. Some younger veterans may have higher exposure.
Firefighting foam and contaminated groundwater at military installations can expose service members to PFAS. A 2026 analysis of national survey data (NHANES) found that blood levels of certain PFAS in veterans aged 20 to 39 were 13% to 24% higher than those of civilians of the same age.
A 2026 population-based analysis of U.S. women linked higher levels of certain PFAS with younger reported age at menopause.
Researchers are investigating whether PFAS interfere with hormone signaling, which may alter follicle development and reduce ovarian reserve.
The PACT Act requires the VA to screen enrolled veterans for possible toxic exposures, but the screening relies on a veteran questionnaire rather than blood tests or other medical evaluations, leaving some exposures potentially unidentified.
Why Earlier Menopause Matters
When menopause begins earlier, the body spends more years with lower estrogen levels. Studies link earlier menopause to higher risks for the heart, bones, and brain.
- In a 15-year cohort study of more than 46,000 women, menopause before age 40 was associated with 36% higher odds of cardiovascular disease; menopause at ages 40–44 was associated with 15% higher odds compared with menopause at ages 50–52.
- An Australian study found that women with premature ovarian insufficiency or early menopause (before age 45) had 37% higher odds of osteoporosis and 45% higher odds of fractures than those who reached menopause at age 45 or older.
- A 2026 observational study of 2,603 older women in JAMA Network Open found an association between earlier menopause and faster declines in overall cognitive function and episodic memory, as well as earlier onset of Alzheimer's disease.
“Estrogen protects the brain, the bones, the cardiovascular system, and metabolic health,” says Hone-affiliated physician Anastasia Jandes, M.D. “We want that protection for as long as possible.”
Recognizing early menopause gives women a chance to address symptoms and long-term health risks sooner. Research suggests hormone replacement therapy (HRT) has a more favorable benefit-risk balance when started before age 60 or within 10 years of menopause onset, with potential cardiovascular and other possible health benefits as well.
How the Healthcare System Misses the Risk
Gaps in menopause training may leave both VA clinicians and community OB-GYNs without the context to connect service and reproductive health, Jandes says. Some women veterans may go from provider to provider looking for answers.
Menopause care is available through the VA, but recognition, treatment, and patient education vary widely across facilities. In 2024, documented diagnosis rates among women ages 45–64 ranged from 6% to 20%, while hormone-therapy prescription fills ranged from 3% to35%.
VA officials have said that time constraints and providers’ discomfort managing menopause may contribute, and that patients may not feel comfortable raising symptoms. In a survey of 348 women veterans, 3 in 5 reported that they had not encountered any VA menopause resources.
In Jandes’ view, the VA’s toxic exposure screening is a good start but doesn’t go far enough. “It might bring attention to a possible exposure,” Jandes says, “but there’s no actionable protocol that then leads to blood work or a referral to someone who will ask the right questions to see if a woman's symptoms suggest hormonal abnormalities.”
Community OB-GYNs may not have the context to connect perimenopause symptoms with aspects of military service that may affect hormones. “If you have exposures like PFAS or have had PTSD, no matter your age, providers need to ask about menstrual cycle changes, vaginal dryness, painful sex, and other symptoms that may indicate perimenopause or early menopause,” says Jandes.
Veterans with menopause symptoms or unexpected cycle changes before age 45 should share their service history — including PTSD and possible toxic exposures — with their physician and ask whether evaluation for early menopause, including hormone testing, is appropriate.
This story was produced by Hone Health and reviewed and distributed by Stacker.
