Out of synchrony with the imagined self: A scoping review of self-concept in premature ovarian insufficiency and early menopause.

Lisa M. Seberry: Conceptualization; methodology; data curation; formal analysis; investigation; writing – original draft; writing – review and editing; software. Subhadra Evans: Writing – original draft; writing – review and editing. Antonina Mikocka‐Walus: Writing – original draft; writing – review and editing. Leesa M. Van Niekerk: Conceptualization; methodology; software; data curation; investigation; formal analysis; supervision; writing – original draft; writing – review and editing.

As research into POI and EM remains limited, several areas warrant further attention. Future studies could incorporate measures that capture the multidimensional nature of self‐concept. The Tennessee Self‐Concept Scale (TSCS‐2; Fitts & Warren,  1996 ) may be particularly appropriate for adults with POI or EM, as it assesses self‐concept across interrelated domains (e.g., physical, personal and social self). Women with POI and EM are known to experience overlapping disruptions in body image, identity and psychological wellbeing. As such, the TSCS‐2 is well aligned with the complex, multidimensional nature of self‐concept in this group and may support more targeted clinical assessment and intervention. The diagnostic experience and ongoing care also require further investigation, as many studies highlight negative diagnostic encounters and limited psychological support. Improving these aspects of health care should be a key focus. Additionally, given evidence that connections with other women with shared experiences can reduce feelings of isolation and otherness, future research could explore the development and efficacy of peer‐based or group interventions. Such approaches may help address impacts on self‐concept and reduce internalized shame in POI and EM populations.

This research did not receive any specific grant from funding agencies in the public, commercial or non‐profit sectors.

A scoping review was conducted in line with the Joanna Briggs Institute (JBI) protocol for scoping reviews (Peters et al.,  2020 ). The review was registered with the Open Science Framework on 14 January 2025 ( https://osf.io/mce56/ ). Table  1 details the information sources, inclusion and exclusion criteria and associated search terms for the scoping review. Information sources and scoping review inclusion criteria. The preliminary search strategy was formulated by the research team, with subsequent iterative consultation with a research librarian from the University of Tasmania to support selection of refined search terms. A three‐step search strategy was utilized. First, a search of two online databases (Scopus, Medline) aided an initial identification of articles relating to POI, EM and self‐concept. Second, titles and abstracts of relevant studies provided relevant text words. Index terms/subject headings were identified through article descriptions, and MeSH terms were identified via the PubMed MeSH (Medical Subject Headings) database. The search terms were applied to four scientific databases between November 2024 and January 2025: Scopus, Medline, Web of Science and PsycINFO, with no date restrictions applied. Third, reference lists of full‐text articles were screened for additional studies that may have been overlooked in the initial online search. Following search completion and removal of duplications, two researchers independently screened all titles and abstracts and full texts via Covidence Systematic Review Software (Veritas Health Innovation,  2021 , Melbourne, Australia, 2024; available at www.covidence.org ). The researchers were blinded to each person's inclusion and exclusion decisions. Discrepancies were automatically identified by Covidence and were resolved via verbal discussion and consensus, with reference to the predefined eligibility criteria. In line with PRISMA‐ScR guidelines, the study characteristics and findings are presented in table format. A narrative synthesis was undertaken to answer the scoping review questions. As both qualitative and quantitative studies were eligible for inclusion, a convergent integrated approach was used. All findings were synthesized using content analysis, with data grouped into categories based on conceptual similarity rather than study design (Peters et al.,  2020 ). Quantitative results were summarized descriptively and integrated with qualitative findings within a shared thematic framework. Regular team discussions were conducted to refine categories and reach consensus on the final themes.

Database searches identified 473 manuscripts. After 271 duplicates were removed, 202 studies remained for screening. See Figure  1 for the PRISMA‐ScR flow chart, indicating the study selection process. The characteristics of the 12 included studies are outlined in Table  2 . The studies included exclusively female participants, with age at time of study ranging between 19 to 65 years, with most studies predominantly including participants from white western backgrounds (i.e., Australian, British, Canadian, Irish), with minor inclusion of other backgrounds (i.e., Asian, Hispanic, Māori, Italian). One study focused solely on Iranian women and another on Korean women. PRIMA‐ScR flowchart of study selection (Page et al., 2021 ). Overview of general study characteristics. 96% with POI, 97.4% with EM, and 98.4% with NM were married, 92% with POI, 93% with EM, and 97% with NM had at least one child. Information pertaining to HRT was not reported Note : Study design terminology was standardized; ‘cross‐sectional’ and ‘cross‐sectional observational’ were considered equivalent. Abbreviation: NM, natural menopause. Related constructs inferred/alluded to in the study are presented in italics. Sample information refers to subject sample, unless indicated otherwise. Most POI, with premature menopause and early menopause previously defined as 40 years and under. Studies focused on women with either POI ( n  = 7) or both POI and EM ( n  = 5). Most studies included both spontaneous and medically induced ( n  = 7) or solely spontaneous ( n  = 4), while one study included just medically induced menopause. For studies focusing on POI, age of menopause or diagnosis ranged from 19 to 39 years, and the average time since diagnosis was 6.4 years ( n  = 4). The mean age of diagnosis was 30 years ( n  = 3) for studies that included both POI and EM. Due to changes in terminology and/or definition of POI and EM over time, some studies appeared to focus on those with POI yet include individuals aged 40; therefore while such studies include those with POI and EM, the predominant sample was POI. Self‐concept was variably reported and most prominently inferred to via associated constructs. The most frequently reported construct across studies was body image, followed by self‐identity/identity, self‐confidence, self‐esteem, sense of self, self‐image, self‐worth, self‐concept, self‐view and social identity. Some constructs which were less frequently addressed were often inferred, such as self‐concept and social identity. Sexual identity was only inferred in studies ( n  = 4) rather than explicitly discussed. The qualitative and mixed methods studies explored a wider range of self‐concept related constructs, while the quantitative focus was narrower, most commonly investigating impacts of POI and/or EM on body image and self‐esteem. Table  3 broadly summarizes the impacts of POI and EM on self‐concept and associated constructs reported in each study. Impacts of POI and EM on self‐concept and associated constructs. All studies highlighted the potentially disruptive nature of POI and/or EM on the women's lives, many detailing the sense of uncertainty and the questioning of the self often associated with diagnosis (Boughton & Halliday,  2008 , p. 569 ‘The uncertainty of symptoms and not being given an explanation or diagnosis led some women to a point of feeling everything might have been in their heads or that they were “going insane”’). Impacts to physical, social and emotional self‐concept were explored across studies, with review of such impacts, via content analysis, indicating eight distinct categories. Some categories could fit into more than one domain of self‐concept, reflecting the interconnected nature of aspects of self‐concept, however, each were assigned to the area of ‘best‐fit’ to aid presentation of results. Figure  2 provides a graphical representation of the percentage of studies which described each category. Percentage of studies identifying each self‐concept category. Impacts to physical self‐concept were most frequently reported on across the reviewed studies, making up 38% of all category references (see Figure  2 ). Distorted body‐image and self‐perception were described by 67% of studies ( n  = 8), representing the most prevalent impact of POI and EM on self‐concept reported. This category reflected the women's shifted perception of their physical appearance and abilities due to menopause, often relating to fears that they were ageing prematurely and were less physically attractive and youthful compared to others their age. Such fears often aligned with negative stereotypes relating to menopause. The image associated with POI or EM often led the women to perceive themselves as less physically or sexually attractive and rather prematurely aged and withered. Increased self‐surveillance of the body often followed as an attempt to regain control over the perceived rapid changes. The experience of the women in Boughton's ( 2002 ) study was like that of other studies: ‘The women in this study lost their sense of their outward body appearance because they had been exposed to the socially contrived view of the menopausal woman, always an older woman, “the grandmotherly type”’ (Boughton,  2002 , p. 427) . ‘The women in this study lost their sense of their outward body appearance because they had been exposed to the socially contrived view of the menopausal woman, always an older woman, “the grandmotherly type”’ (Boughton,  2002 , p. 427) . Half of the studies ( n  = 6) described body out of synchrony as an impact of POI and EM on self‐concept. Body out of synchrony reflected some women's experience of feeling as though their physical body was out of synchrony from their age and usual abilities. Many women acknowledged knowing they were young in relation to their age, yet their body felt old, with a sense of being caught between two polarities (Singer & Hunter,  1999 , p. 73: ‘ being young (“me”) and menopausal (“not me”) ’; Boughton,  2002 , p. 427: ‘ menopause meant that biologically their body was ahead of their embodied self – it was out of synchrony ’). This experience reflected a self‐body disruption and often fostered a sense of disconnect from their body because of POI or EM. Distrust in body was described by one third of studies (33%, n  = 4), encompassing the experience of uncertainty and ambiguity around the women's bodily experiences (Boughton & Halliday,  2008 , p. 568): ‘ the vagueness led to women feeling they could not interpret symptoms with certainty ’. As women experienced menopause earlier than the average or expected age, many viewed their body as problematic, feeling as though it was malfunctioning or at odds with itself. This was perpetuated by responses from HCPs, family and friends, adding to a pervasive sense of uncertainty and doubt. Since the image of the menopausal woman did not align with the women diagnosed, they were often led to feel that their bodies couldn't be trusted and rather were ‘ a site of sickness needing treatment ’ (Singer & Hunter,  1999 ). Boughton and Halliday ( 2008 ) captured this theme in their findings: ‘With many women being told they were just too young for menopause, they were left with a sense that they were “going insane”, that it must have been “all in their heads”…The uncertainty of what was happening to them was a significant factor in their feelings of insanity.’ (p. 570–571) . ‘With many women being told they were just too young for menopause, they were left with a sense that they were “going insane”, that it must have been “all in their heads”…The uncertainty of what was happening to them was a significant factor in their feelings of insanity.’ (p. 570–571) . Impacts to social self‐concept made up just under one third of all category references ( n  = 32%). Discordance from peers was described in 42% of studies ( n  = 5). This category described a perceived separation from people their age, with the women feeling that they could not relate to their peers, nor entirely identify with those experiencing natural menopause. This often led to feelings of isolation, with a sense of confusion around where they belong, with some women feeling a sense of inferiority to their peers. The following words were often used by women to describe themselves and their perceived otherness: ‘ abnormal ’, ‘ not natural ’, ‘ deficient ’, ‘ useless ’, ‘ different ’, ‘ outsider ’ and ‘ freak ’ (Golezar et al.,  2020 ; Singer,  2012 ; Singer & Hunter,  1999 ). The women in Singer and Hunter's study (Singer & Hunter,  1999 ) recognized the negative impact of such isolation and spoke to the buffering effect of connection with those whose experiences closely match their own; however, this was often difficult to find. Threatened female identity/femininity was recognized by 42% of studies ( n  = 5). The physical and psychological changes experienced in menopause, alongside the stereotypes of the menopausal woman, threatened the women's identity associated with femininity, womanhood and/or motherhood. The experience of menopause was seen as not aligning with the societal ideals around womanhood and femininity (i.e., young, attractive, fertile), underscoring the fragility of such ideals (Singer & Hunter,  1999 ). Amenorrhea and infertility were experienced as substantial losses for those with or without children. For many women, fertility was strongly connected with womanhood and femininity, with such changes leading them to not feel like a ‘ proper ’ or ‘ real ’ woman (Singer,  2012 ; Singer & Hunter,  1999 ). Singer and Hunter ( 1999 , p. 70) reported on the experience of this in their study, ‘ More generally it was felt, although to differing degrees, that a “complete” woman is one who is at least potentially fertile .’ For some women loss of fertility challenged identities associated with motherhood. Despite not specifically planning to have children, projected identity of motherhood was impacted by the lack of choice and/or no longer being fertile. One woman in Boughton's ( 2002 , p. 429) study spoke to the shift in the way she experienced her identity in terms of motherhood: ‘The sad thing is that I can't have children any more…It's all that sort of image of you as the earth mother, you know, bearing fruit and all those images that we're supposed to symbolize—that's no longer there. So, you need to find another sort of identity—not being a mother and that's something I find difficult to deal with.’ ‘The sad thing is that I can't have children any more…It's all that sort of image of you as the earth mother, you know, bearing fruit and all those images that we're supposed to symbolize—that's no longer there. So, you need to find another sort of identity—not being a mother and that's something I find difficult to deal with.’ Challenged sexual identity was reported on in 42% of studies ( n  = 5). Sexual identity often felt challenged due to shifts in sexual relationships due to physical and emotional changes, social norms pertaining to sex and/or the perceptions of the ‘menopausal women’. Experiences of menopause such as hot flushes, vaginal dryness and decreased libido, often felt misaligned with sex and intimacy, making it difficult to think of themselves as a ‘ sexual being ’ (Johnston‐Ataata et al.,  2020 ). Generally, responses from themselves and partners influenced this experience (Johnston‐Ataata et al.,  2020 ; Golezar et al., 2020 ). Acceptance often aided transition to a reimagined sexual identity (Johnston‐Ataata et al.,  2020 ), whereas more traditional views around sexuality and relationships, and negative judgements from partner's often led individuals to dishonour their bodies and feel disconnected from their sexual identity. Social constructions of the menopausal individual as less feminine, less desirable and asexual or less sexual felt threatening to some of the women's sexuality. Internalization of such stereotypes impacted how the women experienced or expressed their sexuality, often leading to feelings of embarrassment and shame around their sexual identities (Singer & Hunter,  1999 ). Impacts to emotional self‐concept made up 30% of all category references. Disrupted life trajectory or plans were described by 58% of studies ( n  = 7), indicating how the experiences of POI and EM were often perceived to interfere with imagined life trajectories and plans. Disruptions varied in terms of scale. For some, their daily life was immediately impacted, with symptoms making things they usually were able to do, such as going to work, parenting and managing the house, unmanageable (Boughton,  2002 ). Often the disruptions were associated with long‐term ongoing losses, associated with considerable grief—grieving the person they “should” have been (Golezar et al.,  2020 , p. 6 ‘women experienced grief for quote a long time after being diagnosed with the disease… they were concerned about the complications of the disease… and couldn't easily talk about it’). Such experience is described by one of the younger participants in Singer's ( 2012 , p. 104) study, ‘It's hard to know how I would have been without the menopause. I've grown up…feeling life is over before it started’. With this, some of the women experience a lack of control over their lives, with choice around certain decisions being taken away (Singer,  2012 ; Singer & Hunter,  1999 ). The disruption to family plans and having children was especially impactful, as expressed by a woman in Singer & Hunter ( 1999 , p. 70), ‘It's a bit of a bereavement feeling. I realised I hadn't dealt with the feeling of loss. I dealt with the practical side of things, but emotionally I was crippling myself’. Such bereavement was associated with the realization that something can never or no longer be. In response to such disruptions, especially as time went on, women attempted to reimage their future roles or plans (Johnston‐Ataata et al.,  2020 ; Singer & Hunter,  1999 ). Seven studies (58%) reported on erosion of self‐esteem and self‐confidence, detailing the negative impact of the changes and losses experienced with POI and EM. Self‐esteem was shown to be more negatively impacted for those with POI and EM than those experiencing normal menopause (Ryu et al.,  2022 ), or relatively low compared to age‐related norms (Singer,  2012 ). Impacts to self‐esteem and self‐confidence were often associated with the feeling of being abnormal or lacking something compared to others (Golezar et al.,  2020 ; Johnston‐Ataata et al.,  2020 ; Singer,  2012 ; Singer & Hunter,  1999 ). Often women would blame themselves or question whether such experiences reflected personal failures (Singer,  2012 ; Singer & Hunter,  1999 ). For some women, the sense of failure lessened over time (Singer,  2012 ). As identified in Table  2 , the studies, to varying degrees, suggest that the extent of impact to self‐concept and related constructs is influenced by various interconnected factors relating to the women's context, both societally and individually, such as identification with societal norms, stereotypes, stigma, age, cause, symptoms, children, relationships, psychological support and time since diagnosis. Traditional norms around reproduction, femininity and/or age, and identification with such norms, were often associated with a greater sense of loss and impact to self‐concept and related constructs such as self‐confidence, body‐image, self‐ and social‐identity (Golezar et al.,  2020 ; Johnston‐Ataata et al.,  2020 ; Singer & Hunter,  1999 ). The attachment to such norms from family, partners and friends also played a role. The sample in Johnston‐Ataata et al.'s ( 2020 ) study showed variation in experiences. Those whose feminine identity was not strongly tied to social norms or who questioned such norms experienced a smoother transition to their menopause self, while those more rigidly attached to norms often experienced such changes in terms of loss. Golezar et al. ( 2020 ) indicated that impacts for Iranian women were predominantly negative as a key part of the Iranian women's cultural identity was tied to having children and filling a maternal role. Many studies reported on the impact of the negative stereotypes and stigma associated with menopause, often influencing a sense of isolation from peers and the self (Boughton, 2002 ; Boughton & Halliday,  2008 ; Golezar et al.,  2020 ; Johnston‐Ataata et al.,  2020 ; Singer,  2012 ; Singer & Hunter,  1999 ). Boughton and Halliday ( 2008 ) described how stigma and stereotypes around age and image of the menopausal woman contributed to participants' altered self‐perceptions, with feelings of abnormality and distance from peers. Johnston‐Ataata et al. ( 2020 ) reported that for some women in their study, sharing their experiences helped them to challenge stereotypes and accept their menopausal selves. Several studies indicated that age has an impact on women's experiences, with menopause at a younger age often being experienced as a greater disruption to life‐stage or trajectory, fostering increased feelings of separation from peers and themselves (Boughton,  2002 ; Boughton & Halliday, 2008 ; Johnston‐Ataata et al.,  2020 ; Liao et al., 2000 ; Ryu et al.,  2022 ; Singer,  2012 ). Symptoms which were more severe or difficult to manage were associated with increased negative impacts on body‐image and self‐confidence (Johnston‐Ataata et al.,  2020 ). Experiences of menopausal symptoms, for some, served as indicators of the potential damage occurring to the body and/or reinforced a sense of confusion or disconnect towards their body (Boughton,  2002 ; Boughton & Halliday, 2008 ). Women across many studies described the impact of not being able to have children, or additional children (Boughton,  2002 ; Boughton & Halliday, 2008 ; Golezar et al.,  2020 ; Johnston‐Ataata et al.,  2020 ; Liao et al.,  2000 ; Singer,  2012 ; Singer & Hunter,  1999 ). Boughton ( 2002 ) suggested that the female identity was threatened for those with or without children, whereas identity connected to motherhood was primarily impacted for those without children.

The current scoping review identified impacts across core areas of self‐concept (i.e., physical, social, emotional). The specific impacts were grouped into eight categories (e.g., body out of synchrony, disrupted life trajectory or plans, threatened female identity/femininity), with categories relevant to more than one aspect of self‐concept, reflecting the interconnected nature of the individual domains of self‐concept and the experiences of POI and EM (Hunter & Edozien,  2017 ; Mercer,  2012 ; Shavelson et al.,  1976 ). Implications for physical self‐concept were most frequently described across the reviewed studies, suggesting that POI and EM significantly shape individuals embodied experience of these conditions. This aligns with the significant physical changes associated with POI and EM (Faubion et al.,  2015 ; Hammond & Marczak,  2025 ; Li et al.,  2020 ), which are often experienced as disruptive and distressing (Hammond & Marczak,  2025 ; Singer,  2019 ). Existing findings have noted a link between menopause and negative perceptions of both the body and self, with such perceptions often associated with menopausal symptoms themselves and the cultural and societal meanings attached to menopause (Vincent et al.,  2023 ; Walter,  2000 ). The prevailing stereotype of menopause or the ‘menopausal woman’ is often internalized by those with POI, EM and naturally occurring menopause, as efforts to make sense of their experiences are shaped by negative imagery of ageing centred around loss of youth, fertility, physical attractiveness and sexual desire (De Boer & Halsema,  2024 ; Vincent et al.,  2025 ; Walter,  2000 ). Studies suggest that the impact of such reckoning on body image and self‐perception is often substantial due to the sociocultural expectations placed on women, and those assumed female at birth, to conform to an ‘ideal’ image (Vincent et al.,  2025 ; Walter,  2000 ). Notably, other experiences relating to reproduction such as puberty, pregnancy, postpartum and naturally occurring menopause reflect periods of vulnerability to body image concerns (Spinoni et al.,  2023 ; Vincent et al.,  2025 ). However, POI and EM encompass unique experiences such as age of onset and timing of diagnosis, which also influence body image, self‐perception and the broader domain of physical self‐concept (Boughton,  2002 ; Singer,  2012 ; Singer & Hunter,  1999 ). The participants in the reviewed studies often indicated that their physical body was out of synchrony with their age and/or was problematic and not to be trusted. While naturally occurring menopause is associated with negative depictions of ageing, such fears appear to be exacerbated for those with POI and EM due to the lack of comparability with their same age peers (Hoga et al.,  2015 ; Walter,  2000 ). Specifically, an increased sense of premature ageing was influenced by the polarity between a young adult identity and the perception of a rapidly changing and ageing body due to POI and EM. This experience is comparable to findings focused on individuals with chronic illness where they describe a sense of feeling older than their chronological age, with the associated physical experiences contributing to the embodiment of premature ageing (Giddings et al.,  2007 ; Weeks et al.,  2003 ). Similarly, the sense of distrust towards the body reflected in the current review is also consistent with distrust towards the body found in individuals living with chronic illness (Giddings et al.,  2007 ; Hajdarevic et al.,  2025 ). Such similarities between the experiences of POI and EM and chronic illness may reflect the differing perception of POI and EM versus naturally occurring menopause. While historically the medicalization of menopause has framed menopause around the breakdown of the reproductive system alongside terms such as ‘failure’ and ‘deficiency’ such conceptualization is gradually shifting (Pasquali,  1999 ; Wood et al.,  2025 ). Increasingly, menopause is recognized as a normal part of life, with a slow but growing understanding and acknowledgement that those with menopausal symptoms should not be left to struggle, but rather have access to medical intervention, such as HRT, to support such transition (Davis et al.,  2023 ; Wood et al.,  2025 ). However, despite this gradual shift, POI and EM continue to be framed as abnormal and centre around loss and risk (Hammond & Marczak,  2025 ; Lawlor et al.,  2002 ; Pasquali,  1999 ; Singer,  2012 ). For instance, in the 12 reviewed studies, those with POI and EM report viewing their bodies as sites of sickness due to their experiences not fitting the expected timeline of natural menopause (Boughton & Halliday,  2008 ; Singer & Hunter,  1999 ). The 12 reviewed studies also indicated broad ranging impacts to the social domain of self‐concept, often noting a sense of ‘otherness’ or ‘lacking’. Predominantly this was a result of the experiences of POI and EM not aligning with cultural and societal ideals around age, femininity, womanhood and sexuality. Such experiences, as recognized by Johnston‐Ataata et al. ( 2020 ), align with the notion of biographical disruption, which was first described by Bury ( 1982 ) in relation to the experience of chronic illness. Biographical disruption describes how illness can cause significant disruption in everyday life as well as the imagined or projected life trajectories through which the individual understands themselves and their life through (Bury,  1982 ). Accordingly, many of the participants in the reviewed studies experienced a significant rupture in their imagined biographies, influencing how they view and understand themselves in relation to others. Certainly, within other diagnoses such as breast or gynaecological cancers and endometriosis, women's experiences are shaped by embedded societal norms equating femininity with reproductive capacity, bodily control and expected life trajectories (Sun et al.,  2018 ). When illness disrupts areas such as fertility, sexual function or expectations of motherhood, these culturally prescribed ideals may be internalized, leading to feelings of shame, inadequacy and ‘failure’ (Brania et al.,  2026 ). The sense of being different extended beyond the physical body itself for the women in the reviewed studies, with a sense of inferiority to their peers felt due to the emotional and physical changes of POI and EM. Such interpretations were often influenced by norms around age or time of life and perpetuated by confusion and a sense of not necessarily ‘belonging’ to their age‐matched social groupings (Boughton,  2002 ; Boughton & Halliday,  2008 ; Golezar et al.,  2020 ; Johnston‐Ataata et al.,  2020 ; Singer,  2012 ). Fertility‐based literature citing concerns noted by women experiencing infertility is like that of the current review finding, whereby seeing their peers' forming families or talking about their future with children maintained a sense of inferiority, being different or not belonging (Assaysh‐Öberg et al.,  2023 ; Lindsey & Driskill,  2013 ). Notably, when women were able to connect with others experiencing POI or EM, and see shared experiences, it often acted as a buffer to feelings of otherness (Johnston‐Ataata et al.,  2020 ; Singer & Hunter,  1999 ). Some participants spoke to internalizing sexual desire stereotypes and others reported that the fertility loss or insecurity impacted their identity as fertility is often tied to sense of womanhood and motherhood. Such identity disruption or alteration in projected life trajectories is well documented across experiences of infertility (Alamin et al.,  2020 ; Greil et al.,  2010 ). Impacts to the emotional domain of self‐concept were noted across the 12 reviewed studies, with alterations within this domain including the emotional consequences of POI and EM. Bury's ( 1982 ) biographical disruption provides context to the reported outcomes, whereby disruption to the projected life trajectory leads to significant shifts in how one perceives their emotional self – leading to emotional experiences of grief and loss – negatively impacting self‐esteem and broader self‐concept. As indicated previously in relation to the physical and social consequences of POI and EM and shared similarities with those with chronic illness, the personal and emotional impacts also share similarities in the experiences of unexpected losses or disruptions and sense of distance from peers. Loss and grief associated with the view of who they ‘could have’ or ‘should have been’ was a common experience (Culley et al.,  2013 ; Wilkins,  2001 ; Young et al.,  2015 ). This was especially mirrored in studies around endometriosis, where plans around having children can be similarly disrupted (Culley et al.,  2013 ; Young et al.,  2015 ). Existing findings relating to both menopause and chronic illness reference the emotions that individuals report as they attempt to understand and make meaning of menopause or illness‐related experiences, often recounting high distress in the initial phase and moving towards a greater level of acceptance as time goes on (de Salis et al.,  2017 ; Morrison et al.,  2013 ; Wilkins,  2001 ; Yang et al.,  2016 ). While the reviewed studies suggested that impacts to self‐esteem and self‐confidence were experienced to a greater degree for women with POI and EM compared to naturally occurring menopause (Ryu et al.,  2022 ), shifts from emotional distress towards greater acceptance were noted. During the initial stages, some women reportedly blamed themselves or felt that their diagnosis reflected a personal failure but indicated that negative views towards the self gradually decreased with time (Singer,  2012 ; Singer & Hunter,  1999 ). The shift from distress and a negative view of self towards one of acceptance aligns with the process of biographical repair, which has been recognized in the literature as a process following biographical disruption where there is an attempt to reconstruct or reimage identity and/or the self along with physical changes (Bury,  1982 ; Locock et al.,  2009 ). Evident in the reviewed studies was the importance of considering the role that other individual or contextual factors have on the impact on self‐concept in POI and EM, alongside the cause. All studies, to varying degrees, indicated that the extent to which areas of self‐concept are influenced by POI and EM is associated with various interconnected factors relating to social and personal context. Among the reviewed studies, Johnston‐Ataata et al. ( 2020 ) emphasized the need to account for individual or contextual factors, with their findings suggesting that the cause of POI and EM was not a stand‐alone influence but rather intertwined with various factors. Such findings emphasize the importance of considering potential alterations to self‐concept associated with POI and EM through a biopsychosocial lens (Hunter & Edozien,  2017 ).

In summary, this scoping review highlights the significant impacts that POI and EM can have on multiple domains of self‐concept—physical, social and emotional. Individuals with POI and EM often experience similar difficulties, which reflect the significant disruption that these diagnoses may have on projected life trajectories. However, the severity of self‐concept impacts appears to depend on various contextual factors including the cause of menopause, symptoms and identification with societal norms. While changes in terminology and research approaches potentially limit the current findings to cisgender heteronormative individuals, there is further need for research that includes greater sample diversity. Further investigation of the availability of person‐centred health care, both physical and psychological and the patient‐health care practitioner relationship is recommended to address the identified self‐concept implications of POI and EM.

The current scoping review was limited by a few factors. Firstly, while the review aimed to provide data on the impacts to self‐concept experienced in POI and EM, much of the data focused predominantly on POI. As such, this limits the ability to differentiate between the experiences of each diagnosis separately, with less support for conclusions drawn about EM compared to POI. This may be due to various factors, one being that POI includes a bigger age range than EM, potentially making it easier to source participants. Another reason is connected to a second limitation. Due to variation in menopause terminology over time and contexts, it was often difficult to determine whether included participants met POI and EM diagnoses. For instance, some authors referred to ‘premature menopause’ to describe medically induced menopause, reflecting menopause that was not naturally occurring, whereas other authors directly referred to POI. Furthermore, while some studies included participants who may have met criteria for POI and EM, results were not differentiated between other participants who experienced menopause at 50 years or older. In addition to the lack of diagnostic differentiation reported in study samples, some studies reported limited inclusion or exclusion criteria or reported on participant age at the time of study but not the age at menopause or diagnosis. More detailed inclusion and exclusion criteria, consistent terminology and definitions, and diagnostic differentiation within study samples may help in mitigating these limitations in future research. Lastly, the current scoping review was limited by the lack of sample diversity in the included studies, especially in terms of ethnicity and cultural background and sexuality, with most studies including participants who were from white western backgrounds, heterosexual and cisgender. This limits the ability to generalize the conclusions found in the current review beyond cisgender heteronormative populations. However, the current authors note that there was some variation in the cultural experiences reflected in the reviewed studies, underscoring the importance of such diversity, with such contextual factors having an impact on experiences of POI and EM and self‐concept.

Premature ovarian insufficiency (POI) and early menopause (EM) are life‐changing diagnoses, yet those diagnosed repeatedly report feeling ignored and misunderstood (Singer,  2019 ). Experiences from natural menopause have been generalized to POI and EM, although such generalizations undermine the unique experiences of POI and EM (Loxton et al.,  2021 ; Singer,  2019 ). Natural menopause, a normative age‐related biological transition typically occurs midlife (age 45–54 years), whereas POI and EM involve the premature loss of ovarian function. POI occurs before 40 years of age, and EM occurs between 40 and 45 years of age, can be spontaneous or medically induced/iatrogenic, and are defined by loss of ovarian activity, low estradiol levels, and elevated gonadotropins (Hamoda & Sharma,  2024 ; Webber et al.,  2016 ). In EM, these symptoms denote a permanent cessation of ovarian function, yet while reproduction is unpredictable with POI, it is not impossible (Hamoda & Sharma,  2024 ; Singer,  2019 ). These distinctions have only recently been acknowledged within the literature, with much of the research conflating the two diagnoses (Singer,  2019 ). With consideration to aetiology, POI or EM should not be understood through age and fertility changes alone, but rather as multifactorial diagnoses, with life‐altering physical and psychological impacts (Faubion et al.,  2015 ; Singer,  2019 ). The physical menopausal symptoms associated with POI and EM include hot flushes/flashes, mood changes, vaginal dryness, night sweats, sleep disturbance, low libido and dyspareunia (painful sexual intercourse), as well as more long‐term health problems in relation to bone health, cardiovascular health and sexual health (Hammond & Marczak,  2025 ; Li et al.,  2020 ). While these impacts are experienced in natural menopause, they are often more severe in POI and EM (Hammond & Marczak,  2025 ). The deficiency of oestrogen and other associated hormones and hormonal mechanisms prior to the median age of menopause increases risk of early morbidity and mortality, with oestrogen treatment mitigating only some consequences (Ossewaarde et al.,  2005 ; Shuster et al.,  2010 ). The psychological impacts of POI and EM are influenced by physiological changes, the diagnostic journey and the social and cultural environment in which the diagnoses are experienced (McDonald et al.,  2022 ; Pal & Santoro,  2002 ). The rapid decline in hormones such as oestrogen and subsequent physical symptoms and changes influence mood disturbances and cognitive changes (Li et al.,  2020 ; Singer,  2019 ). Ongoing psychological distress persists with symptoms of depression, anxiety and somatization, as well as reduced life satisfaction and self‐esteem (Guerrieri et al.,  2014 ; Liao et al.,  2000 ; Schmidt et al.,  2006 ). Feelings of uncertainty, shock, grief, sadness and anger often fluctuate as individuals try to understand and manage their diagnosis (McDonald et al.,  2022 ). These experiences are interwoven with the personal meaning gathered from diagnosis, which is influenced by the social and cultural context (Singer,  2019 ). With this, interpersonal relationships are not only impacted by a POI or EM diagnosis but also have a role in shaping how one conceptualizes and experiences the diagnosis (Johnston‐Ataata et al.,  2020 ). Notably, changes in fertility and/or sexual intimacy may differentially impact romantic relationships depending on factors such as, stage of relationship, identification with gender and age norms and individual and shared goals (Johnston‐Ataata et al.,  2020 ). For instance, a lack of ovarian activity may lead to feelings of isolation from the self and peers, especially if an individual perceives this as an important part of their femininity and/or sense of womanhood (Johnston‐Ataata et al.,  2020 ; Singer & Hunter,  1999 ; Singer 2019 ). Accordingly, for many with POI or EM, aspects of self‐concept may be fractured and reimagined (Hammond & Marczak,  2025 ). Self‐concept may be viewed through a multidimensional hierarchical model in which the individual domains of self‐concept (i.e., physical, emotional, social) interconnect to form a global self‐concept (Mercer,  2012 ; Shavelson et al.,  1976 ). Physical self‐concept encompasses how one perceives their body in terms of appearance, functionality and health. Emotional self‐concept reflects one's perception of their internal emotional world, their own competencies and/or abilities relating to emotional experiences (i.e., emotional stability). Social self‐concept indicates how one perceives themselves in social contexts in relation to others including perceived roles, shared values and belonging to certain groups (Mercer,  2012 ). Constructs such as self‐esteem, self‐confidence, self‐image, body image and identity are closely related to self‐concept, but serve different psychological functions (Bailey, 2003 ; Mercer,  2012 ). Self‐esteem and self‐confidence are linked to the evaluative aspects of self‐concept, with self‐esteem reflecting an individual's overall understanding of their worth or value, and self‐confidence referring to an individual's belief about their capabilities and skills (Harter, 1999 ). Body image encompasses the evaluations made in relation to our physical self, predominantly linking into the physical dimension of self‐concept (Bailey, 2003 ). Identity, while very interrelated with self‐concept, focuses on an individual's sense of self derived from a specific social context and/or community, rather than a broader domain (i.e., emotional self‐concept; Mercer,  2012 ). Common experiences across the lifespan (i.e., increased independence, relationship formation, children, career), as well as disruptions to such experiences (i.e., chronic illness) can impact self‐concept, shifting the content and nature of self‐descriptions (Charmaz,  2002 ; Mazalin et al.,  2024 ; Mercer,  2012 ). Accordingly, research suggests that disruptions experienced with POI and EM impact physical, emotional and social self‐concept (Hammond & Marczak,  2025 ; Singer,  2019 ). Many individuals with POI or EM identify a significant shift in how they conceptualize their health, perceiving a shift from being healthy individuals to an ill person who is damaged or broken (Singer,  2019 ). For some, their young adult identity may be challenged due to a perceived incongruence between their chronological and biological age (Boughton,  2002 ; Moukhah et al.,  2021 ). Yet others feel that their diagnosis threatens their femininity, with changes in their body's function and appearance influencing feelings of alienation from their past selves (Golezar et al.,  2020 ; Orshan et al.,  2001 ; Singer,  2019 ). Research on self‐concept in POI and EM shows considerable variability in how the construct is defined and measured. While some studies explicitly examine self‐concept, others focus on related constructs such as self‐esteem, body image and identity without directly naming self‐concept (Hammond & Marczak,  2025 ; Johnston‐Ataata et al.,  2020 ; Moukhah et al.,  2021 ). This inconsistency is further compounded by the predominance of qualitative research, where these terms are often used interchangeably, limiting comparability across studies. Although existing systematic reviews have examined broader psychosocial outcomes and quality of life in POI (Li et al.,  2020 ; McDonald et al.,  2022 ), they have not specifically addressed self‐concept, its associated constructs or included EM populations. Consequently, a gap remains in understanding how these diagnoses uniquely affect self‐concept. Addressing this gap is important for informing targeted psychosocial interventions that move beyond generalizations from natural menopause and instead respond to condition‐specific changes in self‐concept (Hammond & Marczak,  2025 ; Singer,  2019 ). Therefore, this study aims to conduct a scoping review of self‐concept and related constructs in adults presumed female at birth diagnosed with POI or EM.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.