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Diagnosis
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Premature menopause (PM) should be considered in any woman presenting with a history of secondary amenorrhoea (see Table: Causes of secondary amenorrhoea) or menstrual disturbance regardless of whether they have menopausal symptoms. Although the clinical presentation of premature menopause may be similar to that of a woman in the perimenopause at the usual age, the diagnosis is often not thought of and may be delayed because the woman is considered to be too young. The median time to diagnosis of premature ovarian failure (POF) was 2 years in one study; however, in 25% of women it took longer than 5 years to establish the diagnosis. 61% of women consulted 3 or more different clinicians prior to the diagnosis being made. The diagnosis of premature menopause following oophorectomy is obvious. A high index of suspicion should be maintained in women with a past history of hysterectomy, chemotherapy or irradiation.
Clinical assessment including history (see Table: History) and examination (see Table: Examination) provides information regarding aetiology, assessment of hormone deficiency and related complications. In the majority of cases, physical examination will be normal. Turner's syndrome is the most common cause of an abnormal phenotype. Other causes of secondary amenorrhoea (see Table: Causes of secondary amenorrhoea) should be excluded.
| Table: Examination |
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Assessment of secondary sex characteristics / pubertal development |
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General physical examination including
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| Examination of genitalia and vaginal examination where appropriate |
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Evidence of specific genetic disorders
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Content Updated November 21, 2007
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