Premature Menopause

Premature ovarian failure

The word menopause refers to the last menstrual bleed. The term premature menopause (premature ovarian failure) is defined as the occurrence of menopause before the age 40. Menopause does not usually occur until a woman has reached her late fourties or early fifties. Premature ovarian failure can present at varying ages and in many forms. If premature menopause happens before puberty, the woman will present with lack of sexual developments and her periods will not started. If the condition presents after puberty, the woman will suffer from amenorrhoea and infertility. The diagnosis of premature menopause can be a shattering experience to the women and her family.

Since the woman's estrogen production is low, hormone replacement treatment is prescribed to put the brakes on the premature ageing effects of menopause. 

 

Incidence of premature menopause

About 1-3% of women will experience menopause before the age 40 years. Premature ovarian failure accounts for about 10% of amenorrhoea and 1% of all cases of infertility.

 

Causes of premature menopause

In the majority of cases no cause can be found. However, some of the known causes include:

• Congenital, if the ovaries failed to develop and are absent from birth.

• Chromosomal abnormalities, such as Turner's syndrome, where the ovaries contain only a few follicles.

• Genetic, as some women's ovaries run out of eggs long before their middle age. This is possibly due to an increased rate of disappearance of follicles. The incidence of familial premature ovarian failure (POF) varies from 4% to 30%. The risk of a female relative developing POF may be as high as 100% in familial POF and as low as 1% in sporadic cases. 

• Ovarian antibodies, where antibodies act against the ovaries.

• The ovaries are physically damaged by infections, such as the mumps, or by cancer treatment, such as radiotherapy or chemotherapy. This later group is increasing in number because of the longer survival of cancer patients due to advances in both diagnostic modalities and treatment available.

• The ovaries were surgically removed because of cancer or other causes.

 

 What fertility options are available for women with PMM?

• At present, the only realistic chance of a pregnancy for women with premature menopause lies through egg donation.

• Many fertility centers are now offering ovarian tissue freezing and storage for women with a positive family history of premature menopause. The aim is restoration of ovarian function through the transplantation of ovarian tissue. Although the technique of transplantation remains experimental, successful transplantations has been reported. Bedaiwy and colleagues (2008) reported that ovarian function was restored within 120 days. Furthermore, they reported six pregnancies. Anderson and colleagues (2008) described freezing of a whole ovary from six women (age 26-35 years) prior to cancer treatment.  After a storage period of between 17 and 32 months, ovarian transplantation was performed. In all cases, the transplanted tissue restored menstrual cycles within 20 weeks of the transplantation. Four of the six women conceived following assisted reproduction: two of the women delivered a single healthy child one woman miscarried.

• Egg freezing and storage is another option for women with a positive family history of premature menopause and has no partner. Many IVF centers are currently offering egg freezing

• IVF with donated eggs and nuclear transfer is another possible future treatment. Here the nucleus of a healthy donor egg is replaced with the nucleus taken from a skin cell that 'would be a mother'. The donor egg is then fertilised by the male partner’s sperm and the resulting embryo is subsequently transferred into the recipient.

• Embryo donation is another option if the male partner is also infertile.
 

Male Infertility

 

Female Infertility

 

Diagnosis Male

 

Diagnosis Female

   
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