Premature menopause (premature ovarian failure) is the permanent end of menstrual periods before age 40. It occurs because the ovaries no longer release eggs (ovulation) and become less able to produce hormones.

• Symptoms are the same as those of natural menopause.
• Blood tests can confirm the diagnosis, and other tests are done to identify the cause.
• Various measures, including estrogen (used only for a few years) and other drugs, can relieve or reduce symptoms.
• To become pregnant, women with premature menopause can have eggs from another woman implanted in their uterus.

Hormonally, premature menopause resembles natural menopause (see Menopause: Perimenopause). The ovaries produce very little estrogen. Ovulation stops.

Premature menopause has many causes:

• Genetic abnormalities: Chromosomes, including the sex chromosomes, may be abnormal. Sex chromosome abnormalities include Turner syndrome and disorders that confer a Y chromosome (which normally occurs only in males).
• Autoimmune disorders: The body produces abnormal antibodies that attack the body's tissues, including the ovaries. Examples are thyroiditis, vitiligo, and myasthenia gravis.
• Metabolic disorders: Addison disease and diabetes are examples.
• Viral infections: Mumps is an example.
• Chemotherapy for cancer
• Radiation therapy
• Surgical removal of the ovaries: Surgery to remove the uterus (hysterectomy)ends menstrual periods but does not cause menopause as long as the ovaries are functioning.
• Toxins: Tobacco is an example.

Some women may have no symptoms, but they cannot become pregnant. Other women develop the same symptoms that are associated with normal menopause (which occurs at about age 51), such as hot flashes and mood swings. Menstrual periods may become irregular or stop.

The lack of estrogen may lead to decreased bone density (osteoporosis) and thinning and drying of the lining of the vagina (atrophic vaginitis). If women with premature menopause do not take estrogen therapy, the risk of Parkinson's disease, dementia, and coronary artery disease is increased.

If the cause is a Y chromosome, the risk of cancer of the ovaries is increased. Women may have symptoms of the disorder causing premature menopause. For example, if Turner syndrome is the cause, they may be short and have a webbed neck and learning disabilities.

Diagnosis

Doctors suspect premature menopause when women younger than 40 have menopausal symptoms or cannot become pregnant. A pregnancy test is done, and levels of estrogen and follicle-stimulating hormone (which stimulates the ovaries to produce estrogen and progesterone) are measured weekly for several weeks to confirm the diagnosis.

Additional tests may be done to help doctors identify the cause of premature menopause and thus evaluate a woman's health risks and recommend treatment.

For women younger than 35, a chromosome analysis may be done. If a chromosomal abnormality is detected, additional procedures and treatment may be required.

Treatment

If women with premature menopause do not wish to become pregnant, they are given birth control pills that contain estrogen and a progestin (combination oral contraceptives), typically until the usual time of menopause. Estrogen helps relieve symptoms and helps maintain bone density, but taking estrogen alone increases the risk of cancer of the uterine lining (endometrial cancer). Taking a progestin with estrogen helps protect against this cancer. Women who no longer have a uterus may take estrogen alone.

If womenwith premature menopause wish to become pregnant, doctors recommend in vitro (test tube) fertilization (see Infertility: Assisted Reproductive Techniques). Another woman's eggs (donor eggs) are implanted in the uterus after they have been fertilized in the laboratory. Estrogen and a progestin are also given to enable the uterus to support the pregnancy. This technique gives women up to a 50% chance of becoming pregnant. Otherwise the chance of becoming pregnant is less than 10%.

Women who have a Y chromosome need to have their ovaries removed to decrease the risk of developing ovarian cancer.

Last full review/revision August 2012 by JoAnn V. Pinkerton, MD