Premature menopause

Menopause occurring before the age of 40 years is considered to be premature. Premature ovarian failure (or premature menopause) affects about one woman in 10,000 before the age of 20, one woman in 1000 before 30, and one in 100 before 40 years.

This situation does not stop you becoming pregnant: it is estimated that spontaneous pregnancy can occur in 3 to 5% of patients with premature ovarian failure.

Apart from genetic problems, the reason remains unknown in more than 80% of cases. It is necessary to determine the patient's endocrine and genetic status in order to determine a possible cause.

In cancer cases, chemotherapy and radiotherapy may alter ovarian function. The risk depends on the patient's age, type of chemotherapy, dose and duration of treatment. Whole-body irradiation, before a bone marrow graft, for example, may reduce ovarian function significantly.

Premature ovarian failure is often combined with other autoimmune endocrine conditions such as Basedow's disease, type I diabetes, Hashimoto's thyroiditis, Addison's disease, disseminated lupus erythematosus, rheumatoid arthritis, myasthenia, or even Crohn's disease.

Premature menopause is defined by irregular periods or an absence of periods arising before the age of 40, accompanied by a high concentration of the hormone FSH in at least two samples taken several weeks apart. Psychological support should be given when the patient is given this difficult diagnosis. The problem of infertility also needs to be addressed.

The aim of treatment is to avoid cardiovascular and bone complications linked to a low level of oestrogens. This is done by hormone replacement therapy or use of a contraceptive pill.