Menopause marks the cessation of a woman’s reproductive ability. It is characterized by the discontiuation of ovulation and monthly periods and usually arises in the 50s although some women may enter menopause earlier or later in life. If menopause sets in earlier than the age of 40 years then it is referred to as premature menopause or early menopause. This is also known as premature ovarian failure because the ovaries do not produce sufficient estrogen and ovulation does not occur regularly if at all. In the true sense of the word, premature menopause would mean a complete cessation of ovulation and menstruation for the rest of a woman’s life. With premature ovarian failure, there may be the occasional period sometimes even after years and some woman may even fall pregnant. Nevertheless the terms ‘premature menopause’ and ‘premature ovarian failure’ are used interchangeably.
Under normal circumstances, the pituitary hormones FSH (follicle-stimulating hormone) and luteinizing hormone (LH) stimulate the ovaries to mature follicles. Although many follicles will mature simultaneously, normally one one will rupture to release an egg cell (ovum) into the fallopian tube. The ovaries produce estrogen and progesterone in preparation for pregnancy should the ovum be fertilized. If pregnancy does not occur, the estrogen and progesterone levels decrease, menstruation occurs and the entire menstrual cycle starts again.
The reason why the ovarian function ceases so early in life is not always clear. Women will experience a gradual decrease in ovarian function in the 30s which becomes prominent by the 40s. However, with premature ovarian failure there is a marked reduction in ovarian function before the age of 40. A hysterectomy is an obvious cause. Radiation therapy to the pelvis may cause damage to the ovaries that can lead to premature ovarian follicle. Other causes may not be as obvious. It is believed that a significant number of cases may be autoimmune in nature meaning that the body’s immune system is directed towards the ovaries as a result of antibodies formed against the ovarian tissue. There are several other risk factors that have also been identified and this includes :
The symptoms are similar to menopause although periods may return and pregnancy is possible.
Premature ovarian function can also be associated with an increased risk of hypertension and other cardiovascular diseases, osteoporosis and hypothyroidism. The clinical features of these conditions may also be present.
There is no specific treatment to restore ovarian functioning. By treating any underlying disorders the ovarian function may return. The aim of treatment is largely focused on preventing the complications associated with the low estrogen state. This can be achieved with estrogen-replacement therapy which may also involves the simultaneous administration of progesterone. Calcium and vitamin D supplements are essential to limit the reduction in bone density as osteoporosis is a major complication of premature ovarian failure. Infertility needs to be addressed separately but most conventional medication will not be effective and other options have to be considered.
