Premature menopause is the permanent end of menstrual periods before age 40. It occurs because the ovaries no longer release eggs (ovulation) regularly and stop producing the usual premenopausal levels of reproductive hormones.
Some women have no symptoms except absence of menstrual periods, but others have infertility or the same symptoms as those of natural menopause (such as hot flashes or night sweats).
Blood tests can confirm the diagnosis, and other tests are done to identify the cause.
Various measures, including estrogen (typically taken until about age 51, when menopause occurs on average), can relieve or reduce symptoms.
To become pregnant, women with premature menopause may be given fertility treatments (such as using eggs from another woman implanted in their uterus).
Hormonally, premature menopause resembles natural menopause. The ovaries produce very little or no estrogen. Ovulation completely or almost completely stops. However, sometimes the ovaries start functioning again for a short time and can release an egg, making pregnancy possible. The ovaries still contain thousands of eggs. Premature menopause does not imply that a woman is aging prematurely. It means only that her ovaries are no longer functioning normally.
Causes of Premature Menopause
Premature menopause has many causes:
Genetic abnormalities: Chromosomes, including the sex chromosomes, may be abnormal. Sex chromosome abnormalities include Turner syndrome, disorders that result in having a Y chromosome (which normally occurs only in males), and Fragile X syndrome.
Autoimmune disorder: The body produces abnormal antibodies that attack the body’s tissues, including the ovaries.
Metabolic disorders such as enzyme deficiencies
Viral infections: Mumps is an example.
Chemotherapy or radiation therapy for cancer
Surgical removal of the ovaries: Surgery to remove both ovaries (bilateral oophorectomy) ends menstrual periods and causes menopause.
Surgical removal of the uterus: Surgery to remove the uterus (hysterectomy) ends menstrual periods but does not cause most of the other symptoms of menopause as long as the ovaries are functioning.
Toxins: Tobacco is an example.
If the cause is a disorder that confers a Y chromosome, the risk of cancer of the ovaries is increased.
Symptoms of Premature Menopause
Some women may have no symptoms, except that menstrual periods become lighter or irregular, or stop (amenorrhea). Other women have infertility or develop the same symptoms that are associated with normal menopause (which occurs at about age 51), such as hot flashes, night sweats, or mood swings.
Women may have symptoms of the disorder that caused premature menopause. For example, if Turner syndrome is the cause, they may have physical or cognitive abnormalities.
If premature menopause is caused by an autoimmune process, women may also have other autoimmune disorders. such as thyroiditis, vitiligo, myasthenia gravis, and Addison disease (adrenal insufficiency). Addison disease can be life threatening.
The lack of estrogen may lead to decreased bone density (osteoporosis) and thinning and drying of the lining of the vagina (vaginal atrophy). The risk of other conditions (such as depression, anxiety, Parkinson disease, dementia, and coronary artery disease), may be increased.
Diagnosis of Premature Menopause
A pregnancy test
Measurement of hormone levels
Additional tests to identify the cause
Sometimes genetic testing and chromosome analysis
Doctors suspect premature menopause when a woman younger than 40 has menopausal symptoms, or few or no periods, or cannot become pregnant.
A pregnancy test is done to make sure that pregnancy is not the reason for periods stopping. Then, levels of estrogen and follicle-stimulating hormone (which stimulates the ovaries to produce estrogen and progesterone) are measured. These measurements may need to be repeated weekly for several weeks to confirm the diagnosis of premature menopause.
Additional tests may be done to help doctors identify the cause of premature menopause or associated disorders and thus evaluate a woman’s health risks and recommend treatment. For example, if doctors suspect a woman also has thyroiditis (an autoimmune disorder), they measure thyroid hormone levels in the blood.
Genetic counseling and testing are done if women have cognitive disability, tremor, or loss of balance (ataxia) or have a close relative with premature menopause or if they are younger than 35.
A blood test for antimüllerian hormone (which is produced in the ovaries) can be done to evaluate how well the ovaries are functioning and to estimate the chances that a woman will be able to become pregnant after treatment with fertility medications.
Bone density may be measured to check for osteoporosis.
Treatment of Premature Menopause
Combination oral contraceptives (estrogen and a progestin) or menopausal hormone therapy
If pregnancy is desired, in vitro fertilization
If a woman with premature menopause does not wish to become pregnant, she is given one of the following:
Birth control pills or a patch that contains estrogen and a progestin (combination oral contraceptives)
Menopausal hormone therapy (also called hormone replacement therapy) that contains a estrogen and a progestin (a synthetic form of the female hormone progesterone
These treatments are typically taken until about age 51 (the average age for menopause). Then, doctors decide whether to continue the treatments based on a woman's individual circumstances.
Estrogen therapy helps relieve symptoms and helps prevent other effects of menopause (such as vaginal dryness, and mood swings). It also helps maintain bone density (to prevent osteoporosis). Because taking estrogenestrogen
If a woman with premature menopause wishes to become pregnant, doctors may recommend in vitro (test tube) fertilization using another woman’s eggs (donor eggs). These eggs are implanted in the uterus after they have been fertilized in the laboratory. This technique gives women with premature menopause about a 50% chance (sometimes even higher) of becoming pregnant. Otherwise the chance of becoming pregnant is about 5 to 10%.
