What are the causes and symptoms of premature ovarian failure (POF) or premature menopause?

From the Guidelines

Premature ovarian failure (POF) or premature menopause is a condition where ovarian function declines before age 40, leading to irregular or stopped periods and reduced fertility, and its causes include chemotherapy, endocrine therapies, and surgery-induced menopause, while symptoms include hot flushes, night sweats, and vaginal dryness, which can be managed with hormone replacement therapy (HRT), non-hormonal medications, and lifestyle modifications 1. The condition can result from various factors, including:

• Chemotherapy, which can lead to premature cessation of ovarian function 1
• Endocrine therapies, such as tamoxifen, which can cause hot flushes in up to 70% of women 1
• Surgery-induced menopause, which can lead to more severe vasomotor symptoms than natural menopause 1 Symptoms of POF or premature menopause can include:
• Hot flushes and night sweats, which can be severe and persistent 1
• Vaginal dryness and pain during intercourse, which can be managed with topical therapies and vaginal dilators 1
• Emotional distress and decreased quality of life, which can be addressed with psychological support and counseling 1 Management of POF or premature menopause typically involves:
• Hormone replacement therapy (HRT) until the natural age of menopause (around 51) to manage symptoms and prevent long-term health consequences, with a common regimen including estradiol (1-2mg daily) combined with progesterone (100-200mg daily) for those with a uterus 1
• Non-hormonal medications, such as selective serotonin reuptake inhibitors (SSRIs) and gabapentin, which can help reduce hot flushes and other symptoms 1
• Lifestyle modifications, including calcium and vitamin D supplements, weight-bearing exercise, and bone density monitoring to maintain bone health and prevent osteoporosis 1 It is essential to note that women with POF or premature menopause face increased risks of osteoporosis, cardiovascular disease, and cognitive issues if left untreated, and those seeking pregnancy should consult reproductive specialists, as egg donation may be necessary 1.

From the Research

Causes of Premature Ovarian Failure (POF) or Premature Menopause

• The exact causes of POF or premature menopause are not explicitly stated in the provided studies, but it is mentioned that premature ovarian insufficiency (POI) is characterized by the cessation of menses before the age of 40 years 2.
• The clinical manifestations of menopause result from the eventual exhaustion of oocytes within the ovaries, leading to a chronic hypo-estrogenic state 3.

Symptoms of Premature Ovarian Failure (POF) or Premature Menopause

• Vasomotor symptoms of menopause may include hot flashes and diaphoresis that vary in intensity and duration 4.
• Other symptoms of menopause can include vaginal atrophy and dryness, leading to dyspareunia and increased risk of infection 4.
• The long-term consequences of premature or early menopause include adverse effects on cognition, mood, cardiovascular, bone, and sexual health, as well as an increased risk of early mortality 5.
• Menopausal symptoms can be impactful on a woman's life, and hormone replacement therapy (HRT) has data to support its efficacy in managing these symptoms 4, 2, 3.

Hormone Replacement Therapy (HRT) for Premature Ovarian Failure (POF) or Premature Menopause

• HRT is indicated to restore sex hormones to normal premenopausal levels and prevent chronic diseases, such as osteoporosis and cardiovascular disease 2.
• The use of hormone therapy has been shown to lessen some of the risks associated with premature or early menopause, and multiple medical societies recommend providing hormone therapy at least until the natural age of menopause 5.
• Individualization is the key to management, aiming at maximizing efficacy and minimizing clinically relevant risks 2, 5.