What happens in the body
The supply of eggs is laid before birth and is only used up throughout life. With premature ovarian failure, this reserve is depleted ahead of schedule or the remaining follicles stop responding to signals from the pituitary gland. In response, the pituitary gland increases the production of FSH, and estradiol levels drop. That is why the characteristic combination is high FSH with low estradiol. Unlike natural menopause, the work of the ovaries here can be inconsistent: episodes of ovulation and even spontaneous pregnancy are possible.
- Depletion of follicle supply
- Insensitivity of follicles to pituitary hormones
- High FSH and low estradiol
- Decreased anti-Mullerian hormone
- Ovarian activity may be undulating
- Differs from natural menopause in age and course
Causes and risk factors
In about half of women, the cause cannot be determined. Of the known ones, the most common are genetic: changes in the X chromosome, premutation of the FMR1 gene, Turner syndrome, as well as familial cases of early menopause in the mother and sisters. A significant group consists of iatrogenic causes - chemotherapy, radiation therapy to the pelvic area, operations with removal or resection of ovarian tissue. Autoimmune mechanisms are combined with damage to the thyroid gland and adrenal glands. Smoking delays menopause by several years.
- Genetic changes and family predisposition
- Premutation of the FMR1 gene, Turner syndrome
- Chemotherapy and radiation therapy
- Surgeries on the ovaries, including for endometriosis
- Autoimmune diseases
- Past infections, rare
- Smoking
Symptoms
The first sign is usually a change in the cycle: it lengthens, menstruation comes irregularly, and then stops. Estrogen deficiency gives the same symptoms as in menopause, but in a young woman they are more difficult to tolerate: hot flashes, night sweats, sleep disturbances, irritability and depression, decreased concentration. Vaginal dryness and pain during intimacy appear, and libido decreases. Often it is unsuccessful attempts to get pregnant that lead a woman to the doctor.
- Irregular or absent periods
- Hot flashes and night sweats
- Sleep and mood disorders
- Vaginal dryness, pain during intercourse
- Decreased sex drive
- Difficulty getting pregnant
What examinations are needed
The diagnosis is confirmed by elevated FSH levels, determined twice with an interval of at least a month, in combination with low estradiol and absence of menstruation for four months or more in a woman under 40 years of age. Be sure to rule out pregnancy, thyroid disease and elevated prolactin, which give a similar picture. AMH and antral follicle count on ultrasound indicate ovarian reserve. If the diagnosis is confirmed, karyotype, analysis for FMR1 premutation and testing for autoimmune diseases are recommended, as well as densitometry to assess bone density.
- FSH twice at intervals
- Estradiol
- Anti-Mullerian hormone and pelvic ultrasound
- TSH and prolactin
- Pregnancy test
- Karyotype and analysis for FMR1 premutation
- Densitometry and autoimmune markers
Treatment and pregnancy planning
The basis of management is hormone replacement therapy, which is recommended to be continued until the age of natural menopause. It eliminates hot flashes and dryness, but most importantly, it protects bones from osteoporosis and blood vessels from early atherosclerosis. The doctor selects the regimen; if the uterus is preserved, estrogens must be combined with gestagens. Additionally, a sufficient supply of calcium and vitamin D, physical activity with stress on the bones, and smoking cessation are needed. When planning a pregnancy, assisted reproduction programs with donor eggs are discussed; Contraception is needed for those who are not planning a pregnancy.
- Hormone replacement therapy until mid-menopause
- Progestogens in combination with estrogens with a preserved uterus
- Local estrogens for vaginal dryness
- Calcium, vitamin D and strength training
- Quitting smoking
- Programs with donor oocytes if you want to have children
- Psychological support
