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The absence of menstrual periods for a minimum of one year is the hallmark of menopause.  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 insufficiency”.

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 prove POF.

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 (www.POFsupport.org) or Rachel’s Well (www.rachelswell.com).  Additonally abundant general menopause information on our webiste.

Wishing you good health,

Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com