From the Research
For a 41-year-old woman with suspected early menopause, investigations should begin with measuring follicle-stimulating hormone (FSH) and estradiol levels on two occasions 4-6 weeks apart, as recommended by the most recent guidelines 1. If FSH is elevated (>25 IU/L) and estradiol is low (<50 pmol/L), this supports the diagnosis of premature ovarian insufficiency (POI). Additional testing should include:
- Thyroid function tests
- Prolactin
- Karyotyping to rule out chromosomal abnormalities
- Anti-Müllerian hormone (AMH) to assess ovarian reserve Management typically involves hormone replacement therapy (HRT) until the average age of natural menopause (around 51 years) to prevent long-term health consequences, with consideration of the right formulation, dose, and time for the right patient 1. A typical regimen includes estradiol 1-2mg daily (as patch, gel, or oral tablet) combined with cyclical progesterone (such as micronized progesterone 200mg for 12-14 days per month) for women with an intact uterus to prevent endometrial hyperplasia. Women should also receive lifestyle advice including:
- Weight-bearing exercise
- Adequate calcium intake (1000-1200mg daily)
- Vitamin D supplementation (800-1000 IU daily)
- Smoking cessation Psychological support is important as early menopause can impact fertility plans and emotional wellbeing. Regular monitoring should include:
- Annual blood pressure checks
- Breast examinations
- Bone density scans every 2-3 years to assess for osteoporosis risk. It is essential to consider the individualized approach to menopausal hormone therapy, taking into account the latest research and guidelines 1, to provide the best possible care for women with suspected early menopause.