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 . 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 Turner Syndrome Turner syndrome is a sex chromosome abnormality in which girls are born with one of their two X chromosomes partially or completely missing. Turner syndrome is caused by the deletion of part... read more , disorders that result in having a Y chromosome (which normally occurs only in males), and Fragile X syndrome Fragile X Syndrome Fragile X syndrome is a genetic abnormality on the X chromosome that leads to intellectual disability and behavior problems. Chromosomes are structures within cells that contain DNA and many... read more .
Autoimmune disorder Autoimmune Disorders An autoimmune disorder is a malfunction of the body's immune system that causes the body to attack its own tissues. What triggers an autoimmune disorder is not known. Symptoms vary depending... read more : The body produces abnormal antibodies that attack the body’s tissues, including the ovaries.
Metabolic disorders such as enzyme deficiencies
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 Absence of Menstrual Periods Having no menstrual periods is called amenorrhea. Amenorrhea is normal in the following circumstances: Before puberty During pregnancy While breastfeeding read more ). Other women have infertility Overview of Infertility Infertility is usually defined as the inability to achieve a pregnancy after 1 year of regular sexual intercourse without birth control. Frequent intercourse without birth control usually results... read more 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 Turner Syndrome Turner syndrome is a sex chromosome abnormality in which girls are born with one of their two X chromosomes partially or completely missing. Turner syndrome is caused by the deletion of part... read more 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 Hashimoto Thyroiditis Hashimoto thyroiditis is chronic, autoimmune inflammation of the thyroid gland. Hashimoto thyroiditis results when antibodies in the body attacks the cells of the thyroid gland—an autoimmune... read more , vitiligo Vitiligo Vitiligo is a loss of melanocytes that causes patches of skin to turn white. Patches of whitened skin are present on various parts of the body. Doctors usually base the diagnosis on the appearance... read more , myasthenia gravis Myasthenia Gravis Myasthenia gravis is an autoimmune disorder that impairs communication between nerves and muscles, resulting in episodes of muscle weakness. Myasthenia gravis results from malfunction of the... read more , and Addison disease (adrenal insufficiency Adrenal Insufficiency In adrenal insufficiency, the adrenal glands do not produce enough adrenal hormones. Adrenal insufficiency may be caused by a disorder of the adrenal glands, a disorder of the pituitary gland... read more ). Addison disease can be life threatening.
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 ) 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 , 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 attacks 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:
Birth control pills or a patch Skin patches Contraceptive hormones can be Taken by mouth (oral contraceptives) Inserted into the vagina (vaginal rings) Applied to the skin (patch) Implanted under the skin read more that contains estrogen and a progestin (combination oral contraceptives)
Menopausal hormone therapy Hormone Therapy for Menopause 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 (also called hormone replacement therapy) that contains a estrogen and a progestin (a synthetic form of the female hormone progesterone) or 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 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 Assisted reproductive technologies involve working with sperm and eggs or embryos in a laboratory (in vitro) with the goal of producing a pregnancy. (See also Overview of Infertility.) If treatment... read more 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
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|Crinone, Endometrin , First - Progesterone MC 10, First - Progesterone MC 5, Prochieve, PROMETRIUM|