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414 Current Topics in Menopause, 2013, 414-441
Premature Menopause
Amanda Vincent 1,2,* and Elizabeth Farrell 1
CHAPTER 14
1 Menopause Unit, Monash Medical Centre, Southern Health, Clayton, Victoria,
Australia and 2 Monash Applied Research Stream, School of Public Health and
Preventive Medicine, Monash University, Clayton, Victoria, Australia
Abstract: 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.
INTRODUCTION
Delayed diagnosis, menopausal symptoms, infertility, increased risk of
cardiovascular disease and osteoporosis are some of the issues confronting young
women with premature menopause (PM). Psychological distress including
depression, altered body image and “feeling old before their time” is also
commonly experienced. This review discusses epidemiology, pathophysiology,
*Address correspondence to Amanda Vincent: Monash Applied Research Stream, Monash University, 43-
51 Kanooka Grove, Clayton 3168, Victoria, Australia; Tel: +61 3 9594 7545; Fax: +61 3 9594 7550;
E-mail: amanda.vincent@monash.edu
Volodymyr Dvornyk (Ed)
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