Published: 18 Jun 2025

ICD9: 256.31      ICD10: E28.31      ICD11: GA30.6

Premature menopause, also known as primary ovarian insufficiency (POI), is when a woman's periods stop before the age of 40.
It's essentially menopause that happens much earlier than the typical age range (around 45-55).

Here's a breakdown:

Menopause: Defined as the cessation of menstruation for 12 consecutive months, signaling the end of a woman's reproductive years. This occurs due to the ovaries no longer producing enough estrogen and other hormones.
Premature: The key here is the age. Menopause before 40 is considered premature.

Key characteristics:

Irregular or absent periods: This is usually the first sign. Periods may become less frequent, lighter, or stop altogether.
Menopausal symptoms: These are similar to those experienced during normal menopause and can include:
Hot flashes
Night sweats
Vaginal dryness
Sleep disturbances
Mood swings, irritability, or depression
Difficulty concentrating
Decreased libido
Dry skin and eyes
Hair thinning
Elevated FSH (follicle-stimulating hormone) levels: A blood test to measure FSH is often used to diagnose premature menopause. High levels indicate that the ovaries are not functioning properly.
Low estrogen levels: Another hormonal change that can be detected through blood tests.

Causes:

In many cases, the exact cause of premature menopause is unknown (idiopathic). However, some potential causes include:

Genetic factors: Family history of early menopause can increase the risk. Certain genetic conditions, such as Turner syndrome and Fragile X syndrome, are also associated with POI.
Autoimmune disorders: Conditions like thyroid disease, lupus, and rheumatoid arthritis can sometimes trigger the body to attack the ovaries.
Medical treatments:
Chemotherapy and radiation therapy: These treatments can damage the ovaries.
Surgery: Removal of both ovaries (oophorectomy) will immediately induce menopause.
Infections: In rare cases, viral infections can damage the ovaries.
Environmental factors: Exposure to certain toxins or pollutants is being researched as a potential factor.

Diagnosis:

Diagnosis usually involves:

Medical history and physical exam: To review symptoms and potential risk factors.
Blood tests: To measure hormone levels, particularly FSH and estrogen.
Other tests: Depending on the suspected cause, additional tests may be performed to rule out other conditions.

Treatment:

While premature menopause cannot be reversed, treatments are available to manage symptoms and reduce the long-term health risks associated with estrogen deficiency. Treatment options may include:

Hormone therapy (HT): This is the most common treatment. It replaces the estrogen that the ovaries are no longer producing, which can alleviate symptoms like hot flashes and vaginal dryness, and protect against bone loss (osteoporosis) and cardiovascular disease.
Non-hormonal therapies: These can help manage specific symptoms like hot flashes, mood swings, and sleep problems. Examples include certain antidepressants, gabapentin, and lifestyle changes.
Calcium and vitamin D supplements: Important for bone health.
Vaginal lubricants: To treat vaginal dryness.
Lifestyle modifications: Regular exercise, a healthy diet, stress management, and avoiding smoking can improve overall health.
Fertility options: If a woman desires to have children, she may explore options like egg donation and in vitro fertilization (IVF).

Important Considerations:

Premature menopause can have significant emotional and psychological effects. Support groups, counseling, and therapy can be helpful.
Women with premature menopause are at a higher risk of certain health problems, including osteoporosis, heart disease, cognitive decline, and depression. Regular medical checkups and screenings are essential.
It's important to discuss all treatment options with a healthcare provider to determine the most appropriate plan based on individual needs and risks.

If you suspect you may be experiencing premature menopause, it is crucial to consult with a doctor for proper diagnosis and management.