Early menopause

Disease Description (Causes and Symptoms)

• Definition: A condition in which ovarian function is lost before the age of 40, resulting in decreased estrogen secretion and menstruation stopping or becoming irregular (primary ovarian insufficiency or premature menopause).
• Causes (major): Ovarian damage (surgery, chemotherapy or radiation therapy, infection), autoimmune diseases (rheumatoid arthritis, lupus, thyroid disease, etc.), chromosomal abnormalities or genetic causes, stress or severe weight loss, etc. The cause is unknown in many cases.
• Pathophysiology: Depletion or dysfunction of ovarian follicles causes follicle-stimulating hormone (FSH) levels to rise and estrogen levels to decrease → irregular menstruation, menopausal symptoms, and, over the long term, increased risks of bone loss and cardiovascular disease.
• Main symptoms: Hot flashes and sweating (vasomotor symptoms), insomnia, fatigue, depression, anxiety, decreased libido, vaginal dryness, urinary frequency, urinary incontinence, musculoskeletal pain, and increased risk of osteoporosis-related fractures. Symptoms may appear gradually or suddenly.

Treatment Methods

• Standard treatment
  • Hormone replacement therapy (HRT): Estrogen-centered treatment (with progesterone if the uterus is present). It relieves symptoms and helps maintain bone density, with benefits for cardiovascular and bone health. Continuous use is generally considered until the average age of natural menopause (approximately 50 years).
  • Local estrogen: Local treatment such as vaginal creams or suppositories for severe vaginal dryness or painful intercourse.
  • Osteoporosis management: Calcium and vitamin D supplements, regular weight-bearing exercise, bone density testing (DEXA), and, when necessary, osteoporosis medications (such as bisphosphonates).
  • Infertility treatment: If pregnancy is desired, consultation with a reproductive endocrinology or infertility specialist is recommended. Natural pregnancy is possible in some cases but is unlikely. If preservation is not possible, options such as egg or embryo preservation or in vitro fertilization (IVF) with donor eggs may be considered.
  • Psychosocial support: Psychotherapy or counseling is recommended for symptoms of depression or anxiety.
• Procedures/Surgery: Surgical treatment may be necessary depending on the cause (such as an ovarian tumor).
• Lifestyle management and precautions
  • When taking HRT, regular follow-up as directed by a doctor (including breast examinations, blood pressure checks, blood tests, etc.) is necessary. Stopping treatment on your own may worsen symptoms.
  • Smoking cessation, regular exercise, limiting caffeine and alcohol, and maintaining a balanced diet are recommended.
  • If an infectious or autoimmune cause is suspected, treatment of the underlying condition should be provided concurrently.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items/records to prepare
  • List of medications and supplements currently being taken
  • Menstrual history (date of the last menstrual period and changes in the menstrual cycle)
  • Medical history: surgeries (related to the ovaries or uterus) and whether chemotherapy or radiation therapy was received
  • Family history: history of premature menopause or genetic disorders
  • Copies of previous test results (hormone tests, ultrasound, bone density tests, etc.)
  • Timing of symptom onset and a symptom diary (frequency of hot flashes, number of episodes of urinary incontinence, etc.)
• Tests expected at the outpatient visit: Pregnancy test, blood FSH/estradiol/AMH, thyroid and prolactin tests, autoimmune markers (if necessary), bone density test, bone metabolism tests, pelvic ultrasound, and chromosomal testing (if necessary).
• Example questions (for preparation before scheduling an appointment)
  • When the symptoms began and their pattern (e.g., When did menstrual irregularity begin?)
  • Whether you have previously received chemotherapy or pelvic surgery and whether there is a family history

Examples of General Questions to Ask the Doctor

• What are the expected benefits and side effects of this medication (hormone treatment)?
• How long should I use HRT, and in what form (oral, patch, or local)?
• When should I start having bone density tests, and how often should I have them?
• If I want to become pregnant, what options are available (the possibility of natural pregnancy, preservation, and treatment methods)?
• What additional tests are needed regarding cardiovascular and cancer risks?

Examples of Disease-Specific Questions

• If pregnancy is desired: "Given my current condition, how likely is pregnancy, and which option would be appropriate: egg preservation or treatment with donor eggs?"
• If you want to identify the cause: "Are chromosomal, genetic, or autoimmune testing necessary? Which tests do you recommend first?"