Premature Menopause

Premature Menopause (PM) is defined as menopause occurring prior to the age of 40 years. It may occur spontaneously or as a result of medical intervention including pelvic surgery, chemotherapy or radiotherapy. Spontaneous PM affects approximately 1% of women with a potentially higher incidence of induced PM with increasing rates of cancer survival. In the majority of women, the cause of spontaneous PM is unknown. PM results in both significant short term (menopausal symptoms, psychological distress, sexual dysfunction) and long term sequelae (infertility, an increased risk of osteoporosis, cardiovascular disease, cognitive dysfunction, dementia and overall mortality). Diagnosis can be difficult and is often delayed. Unless contraindicated, hormone replacement therapy is indicated until at least age 51 years for symptom relief and prevention of long term complications. Management should also be directed at lifestyle measures for symptom control and minimizing long term risks, treating sexual dysfunction, infertility treatment where desired, psychological support and education. Multi-disciplinary care is required to manage the complex needs of these patients.

Keywords: Premature menopause, premature ovarian failure, premature ovarian insufficiency, hormone replacement therapy, infertility, surgical menopause, chemotherapy, osteoporosis, non-hormonal therapies, diagnosis, estrogen.