Merck Manual

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Premature Menopause

(Premature Ovarian Failure; Primary Ovarian Insufficiency)


JoAnn V. Pinkerton

, MD, University of Virginia Health System

Reviewed/Revised Feb 2023

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 Perimenopause symptoms Menopause is the permanent end of menstrual periods, ovulation, and fertility. For up to several years before and just after menopause, estrogen levels fluctuate widely, periods become irregular... read more Perimenopause symptoms . 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:

If the cause is a disorder that confers a Y chromosome, the risk of cancer of the ovaries is increased.

Symptoms of Premature Menopause

The lack of estrogen may lead to decreased bone density (osteoporosis Osteoporosis Osteoporosis is a condition in which a decrease in the density of bones weakens the bones, making breaks (fractures) likely. Aging, estrogen deficiency, low vitamin D or calcium intake, and... read more Osteoporosis ) and thinning and drying of the lining of the vagina (vaginal atrophy). The risk of other conditions (such as depression Depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more , anxiety Overview of Anxiety Disorders Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience. It is also present in a wide range of mental health conditions, including generalized anxiety disorder... read more , Parkinson disease Parkinson Disease (PD) Parkinson disease is a slowly progressive degenerative disorder of specific areas of the brain. It is characterized by tremor when muscles are at rest (resting tremor), increased muscle tone... read more , dementia Dementia Dementia is a slow, progressive decline in mental function including memory, thinking, judgment, and the ability to learn. Typically, symptoms include memory loss, problems using language and... read more , and coronary artery disease) Overview of Coronary Artery Disease (CAD) Coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked. The heart muscle needs a constant supply of oxygen-rich blood. The coronary... read more Overview of Coronary Artery Disease (CAD) , 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 Hashimoto Thyroiditis Hashimoto thyroiditis is chronic, autoimmune inflammation of the thyroid gland. Hashimoto thyroiditis results when antibodies in the body attack the cells of the thyroid gland—an autoimmune... read more (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:

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 estrogen alone increases the risk of cancer of the uterine lining (endometrial cancer), most women should also take a progestin or progesterone with the estrogen to help protect against this cancer. Women who have had a hysterectomy (removal of the uterus) do not need to take a progestin or progesterone.

If a woman with premature menopause wishes to become pregnant, doctors may recommend in vitro (test tube) fertilization Assisted Reproductive Technologies (ARTs) Assisted reproductive technologies (ARTs) involve working with sperm and eggs or embryos in a laboratory (in vitro) with the goal of producing a pregnancy. If infertility treatment with only... read more Assisted Reproductive Technologies (ARTs) 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%.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Crinone, Endometrin , First - Progesterone MC 10, First - Progesterone MC 5, Prochieve, PROMETRIUM
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