In the United States, the average age of onset for "natural" menopause is 51. However, because of genetics, autoimmune disorders, or medical procedures, some women go through menopause before the age of 40. Menopause that occurs before this age, whether natural or induced, is known as "premature" menopause.

In addition to dealing with hot flashes, mood swings, and other symptoms that accompany menopause, many women undergoing premature menopause have to cope with additional physical and emotional concerns. For example, since menopause signals the end of a woman's fertile years, a woman who wishes to get pregnant is likely to have trouble.

What are the symptoms of premature menopause?
Symptoms of premature menopause are often the same as those experienced by women undergoing natural menopause and may include:

• Irregular or missed periods
• Periods that are heavier or lighter than usual
• Hot flashes (a sudden feeling of warmth that spreads over the upper body)

These symptoms are a sign that the ovaries are producing less estrogen.

Along with the above symptoms, some women may experience:

• Vaginal dryness (the vagina may also become thinner and less flexible)
• Bladder irritability and worsening of loss of bladder control (incontinence)
• Emotional changes (irritability, mood swings, mild depression)
• Dry skin, eyes, or mouth
• Sleeplessness
• Decreased sex drive

In addition to the symptoms listed above, if you are under the age of 40 and experience any of the following conditions, you should see your doctor to determine whether you are undergoing premature menopause:

• You have undergone chemotherapy or radiation
• You or a family member has an autoimmune disorder such as hypothyroidism, Graves' disease, or lupus
• You have unsuccessfully tried to become pregnant for more than a year
• Your mother or sister experienced premature menopause

How is premature menopause diagnosed?
First, your doctor will most likely perform a physical exam and draw blood to rule out other conditions, such as pregnancy and thyroid disease. He or she may also order a test to measure your estradiol levels. Low levels of estradiol, a form of estrogen, can indicate that your ovaries are starting to fail. When estradiol levels are below 20 to 40, it may signal that you are in menopause.

However, the most important test used to diagnose premature menopause is a blood test that measures follicle stimulating hormone (FSH). FSH causes your ovaries to produce estrogen. When your ovaries slow down their production of estrogen, your levels of FSH increase. When your FSH levels rise above 30 or 40 mIU/mL, it usually indicates that you have premature ovarian insufficiency (POI).

What types of health issues affect women undergoing premature menopause?
Like all menopausal women, women in premature menopause experience lowered estrogen levels as the ovaries stop most of their production of this hormone. Low levels of estrogen can lead to changes in a woman's overall health and may increase her risk for osteoporosis and heart disease. Other health risks associated with the loss of estrogen include increased risk for colon, periodontal (gum) disease and tooth loss, and cataract formation.

However, compared with women who go through natural menopause, women undergoing premature menopause spend a greater portion of their lives without the protective benefits of their own estrogen. This puts them at an even greater risk for the above-mentioned menopause-related health problems.

How is premature menopause/POI treated?
The symptoms and health risks of premature menopause, as well as the emotional issues that may result from it, can be managed with the methods similar to those used for natural menopause. Women dealing with infertility that is brought on by premature menopause may want to discuss their options with their doctor or with a reproductive specialist.

Can premature menopause be reversed?
Usually not, although women with POI do occasionally ovulate.

For more information, see Dr. Holly L. Thacker’s book, "Women’s Health: Your Body, Your Hormones, Your Choices" (© 2007 Cleveland Clinic), available for free download at www.wowio.com. Dr. Thacker is director of the Women's Health Center at Cleveland Clinic.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/.

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