The clinical presentation of premature menopause (PM) is variable (see Table: Clinical Presentation of PM). Menstrual disturbance is the most common reported presenting symptom; however, there is no particular menstrual pattern which could indicate PM. Following oophorectomy there is a rapid onset of severe vasomotor symptoms; oestrogen and testosterone levels falling by 50% in the first 24 hours postoperatively. Vasomotor symptoms are present in 50% of women and may accompany menstrual disturbance or be associated with regular menses. A common scenario is the onset of amenorrhoea and/or vasomotor symptoms after cessation of the oral contraceptive pill (OCP). Premature ovarian failure (POF) may present with infertility or poor response to assisted reproduction. Chemotherapy or radiation induced PM may develop acutely or insidiously.

Table: Clinical Presentation of PM

Menstrual disturbance Amenorrhoea Increased / decreased menstrual blood loss Irregular menses Oligomenorrhoea Polymenorrhoea

Infertility including poor response to assisted reproduction

Vasomotor symptoms

Other menopausal symptoms

Other symptoms associated with menopause can be experienced (see Table: Menopausal symptoms) and may be more severe than those experienced by typical age menopausal women.

Table: Menopausal symptoms

Hot flushes and night sweats Vaginal dryness Aches and pains Crawling or itching sensation under the skin Headaches Reduced sex drive / painful sexual intercourse Urinary frequency / incontinence Tiredness Insomnia Hair and skin changes including alopecia and dry skin Palpitations Psychological symptoms - irritability, depression, mood changes Memory and concentration difficulties