Absent and Infrequent Periods: Premature Ovarian Failure

Premature ovarian failure is defined as cessation of menstruation together with elevated gonadotrophin levels before the age of 40 years. It is generally estimated that 1% of women will have premature ovarian failure. Clearly if the ovaries are removed at surgery, or if they are subjected to radiotherapy or chemotherapy, ovarian failure may result. About a quarter of women presenting with secondary amenorrhoea in their late thirties will prove to have premature ovarian failure. The most frequent abnormality to be found when investigating premature ovarian failure is autoantibodies (Q6.16)Chromosome abnormalities can be found in about 3% of women with premature ovarian failure.

If a hormone test suggests a diagnosis of premature ovarian failure, it is advisable to repeat the test. The diagnosis of premature ovarian failure can be devastating to a woman particularly if her family has not been completed so careful and sympathetic counselling is essential. The possibility of the resistant ovary syndrome should also be explained (Q6.15).  The long-term health risks of oestrogen deficiency (Chapter 26) are increased for those with premature menopause and the virtues of hormone replacement should be emphasised.

A fifteen year old girl was referred to me as her periods had stopped. Her menarche (first period) occurred when she was ten and when she was fourteen she was investigated under the care of one of my colleagues who diagnosed a large ovarian cyst. A 10cm cyst was removed from her left ovary and some ovarian tissue was conserved. The right ovary and both tubes were healthy. The tumour was innocent and not hormone producing. Following surgery her periods did not resume. Hormone tests on several occasions have demonstrated high FSH and low oestradiol levels consistent with a premature menopause. She has been happy with a cyclical HRT preparation.

A lady of twenty-two stopped seeing her periods. All appropriate hormone tests were consistent with the menopause on several occasions. She took cyclical HRT for eight years and had regular withdrawal bleeds. On one occasion, in 1997, she failed to see a withdrawal bleed and her pregnancy test proved to be positive. We monitored her pregnancy carefully and, much to everyone's delight, she went on to deliver a healthy son. A few months after delivery her hormone picture was again consistent with the menopause.

A thirty-one year old lady presented with amenorrhoea and infertility. Her hormone tests on two occasions demonstrated high FSH and low oestradiol levels indicating a premature menopause. We recommended HRT and discussed IVF with donated eggs.

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