The absence of menstrual periods for a minimum of one year is the hallmark
Premature ovarian failure (POF) is the term usually used to describe women entering menopause before
the age of 40. Surprisingly, about 25% of these women may ovulate and
some even conceive after the diagnosis is made, so some specialists suggest
that it may be more appropriate to refer to this as “primary ovarian
Semantics aside, 5–10% of women who complain of absent or irregular
periods, or infertility have POF. Many display intermittent or persistent
symptoms of estrogen deficiency (hot flushes, night sweats, emotional
lability, and painful sex due to vaginal dryness).
In general, evaluation is warranted for any young woman with fewer than
nine menstrual periods per year or missing three or more consecutive menstrual
cycles. Once excluding pregnancy, measurements of hormones FSH TSH and
prolactin levels are indicated. If the FSH is significantly elevated above
30 it should be repeated with an estrogen level (decreased below 50) to
Since autoimmune disease is the most frequent cause of POF, screening for
other types like thyroid abnormalities and diabetes should also be performed.
Periodic bone density testing will assess for early bone loss that these
women are at risk of developing.
Hormone therapy addresses symptoms such as hot flushes, night sweats, vaginal
dryness, and also slows bone loss (The findings of the Women’s Health
Initiative study do not apply to women with POF). It is important to remember
that young women with diminished ovarian function typically require more
estrogen than do postmenopausal women to alleviate similar symptoms. Although
combination oral contraceptives (OCs) provide higher levels of estrogens
then are required, OCs may be more emotionally acceptable and simplify
compliance. Additionally, 1,200 to 1,500 mg of calcium each day, preferably
with added vitamin D, is recommended for bone health.
Finally these women often need emotional support and resources such as the
International Premature Ovarian Failure Association or
Rachel’s Well. Additionally abundant general
menopause information on our webiste.