Materiały źródłowe

• #1 Premature & Early Menopause: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21138-premature-and-early-menopause

  Premature menopause happens before age 40 and early menopause happens before age 45. […] Premature menopause and early menopause are conditions where a woman goes through menopause at an earlier age than is typically expected. […] Early menopause is when menopause happens before age 45. […] Premature menopause is when menopause happens before age 40. […] Many of the causes of premature menopause can also be causes of early menopause. […] If you begin to have symptoms of menopause before age 45, your healthcare provider may perform several tests and ask questions to help diagnose premature or early menopause. […] Diagnosing early or premature menopause can include asking about the regularity of your menstrual periods, discussing any family history of menopause at an early age, a physical exam, a blood test to look at your hormone levels, and looking for other medical conditions that may be contributing to your symptoms such as a thyroid condition.

• #1 Premature & Early Menopause: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21138-premature-and-early-menopause

  Treatment for early or premature menopause may vary depending on why menopause started earlier than normal. […] Providers recommend hormone replacement therapy (HRT), unless there’s a reason hormone therapy is unsafe. […] If you have infertility as a result of early or premature menopause, discuss your options with a fertility specialist, who can help you achieve your goal of becoming a parent. […] Talk to your healthcare provider if you’re under 45 and have signs of menopause like irregular periods, spotting between periods, hot flashes or vaginal dryness. Your provider can order blood work and discuss your health history to help diagnose these conditions.

• #2 Early and premature menopause | NHS inform

  https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/early-and-premature-menopause

  Menopause before the age of 45 is called early menopause. Menopause before the age of 40 is called premature menopause. […] Premature menopause, or premature ovarian insufficiency (POI), is defined as being menopause that happens before the age of 40. […] Your GP can carry out a blood test to measure your hormone levels. It can take a long time for a diagnosis of premature menopause to be made as symptoms could be due to other conditions. Your blood test can rule out diabetes and thyroid problems.

• #3 Diagnosis and Tests for Menopause

  https://www.healthline.com/health/menopause/tests-diagnosis

  If youre having menopausal symptoms, your doctor may order tests to rule out other conditions, such as ovarian failure or a thyroid condition. […] Your doctor may order a blood test to check your levels of follicle-stimulating hormone (FSH) and estrogen. During menopause, your FSH levels increase and your estrogen levels decrease. […] A recently approved diagnostic test called the PicoAMH Elisa test measures the amount of anti-Mullerian hormone (AMH) in the blood. It can help your doctor determine when you will enter menopause if you havent already. […] Early menopause is menopause that begins between the ages of 40 and 45. Premature menopause starts even earlier, before age 40. If you start noticing symptoms of menopause before you turn 40, you may be experiencing premature menopause.

• #4 Premature Menopause

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3634232/

  Premature menopause affects 1% of women under the age of 40 years. […] The diagnosis should always be considered in any woman presenting with a history of primary or secondary amenorrhea or oligomenorrhoea, vasomotor disturbances or other signs of oestrogen deficiency and may be confirmed by the detection of an elevated serum level of follicle stimulating hormone. […] The diagnosis is based on a triad of amenorrhea, elevated gonadotrophin levels and signs and symptoms of oestrogen deficiency. […] Women with FSH levels above 40 mIU/ml may not have viable ovarian follicles on biopsy and such women may be regarded as having undergone permanent ovarian failure. […] The most important approach in management of premature menopause is to identify the cause and institute treatment based on the cause.

• #4 Premature Menopause

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3634232/

  It is now possible to restore follicular maturation, ovulation and menstruation with treatment of identified cause of premature menopause. […] With ovulation induction or oocyte donation in IVF programmes, it is possible to achieve pregnancy. […] Women with hypo oestrogenaemia may require hormone replacement therapy (HRT) to avoid osteoporosis. […] Premature menopause is associated with long term health risks such as premature death, cardiovascular disease, neurologic disease, osteoporosis, and psychosexual dysfunction and mood disorders. […] Women with premature menopause are at risk for low bone density, earlier onset osteoporosis and fractures, earlier onset of coronary heart disease and increased cardiovascular mortality.

• #5 Early or premature menopause – NHS

  https://www.nhs.uk/conditions/early-menopause/

  Early menopause is when you stop having regular periods before the age of 45. Premature menopause is if this happens before the age of 40. […] The main symptom of early or premature menopause is not having your period regularly or your periods stopping completely before the age of 45. […] If you’re under 45 and having menopause symptoms, a GP may sometimes do blood tests. […] Early or premature menopause can also be caused by treatment for other conditions. […] The main treatments for early or premature menopause are medicines such as the combined contraceptive pill or hormone replacement therapy (HRT) to replace the hormones that are at low levels. […] It’s important to replace missing hormones if you’ve started menopause before the age of 45 because there’s a higher chance of getting problems with your bones and heart. […] Early or premature menopause can affect both your physical and mental health. […] You’ll have a higher chance of developing conditions such as osteoporosis and cardiovascular disease. […] Early or premature menopause means you may find it harder to get pregnant.

• #6 Premature and early menopause | Jean Hailes

  https://www.jeanhailes.org.au/health-a-z/menopause/premature-early-menopause

  Premature menopause is when your final period happens before the age of 40. […] Early menopause is when your final period happens between the ages of 40 and 45. […] Premature ovarian insufficiency (POI) can cause premature and early menopause. […] Cancer treatment and surgery can also cause premature and early menopause. […] If you are younger than 45 and you haven’t had your period for more than 3 months, talk to your doctor. […] Your doctor may refer you to a specialist to do some tests. […] After POI is diagnosed, your doctor may ask you to do more tests to check for possible causes and other conditions. […] Some studies suggest women who have premature or early menopause may have a higher risk of developing heart disease and osteoporosis compared with women who reach menopause at the expected age.

• #6 Premature and early menopause | Jean Hailes

  https://www.jeanhailes.org.au/health-a-z/menopause/premature-early-menopause

  Women who experience premature or early menopause can start to lose bone density at an earlier age than women who experience menopause in their 50s. […] Menopause can happen because of cancer treatment, such as chemotherapy or radiotherapy, that causes your ovaries to stop working. […] Some surgeries can cause menopause. This is known as surgical menopause. […] If you have menopause due to surgery, your levels of oestrogen and testosterone hormones will suddenly drop, causing symptoms to be more severe than normal. […] Talk to your doctor about how to manage menopausal symptoms and reduce the risk of other health problems.

• #7 Premature Menopause: Causes, Symptoms, and Treatments

  https://www.webmd.com/menopause/premature-menopause-symptoms

  In the U.S., the average age of onset for „natural” menopause is 51. However, because of genetics, illness, or medical procedures, some women go through menopause before the age of 40. Menopause that occurs before this age, whether natural or induced, is known as „premature” menopause or premature ovarian insufficiency. […] To diagnose premature ovarian insufficiency, your doctor will most likely perform a physical exam and draw blood to rule out other conditions, such as pregnancy and thyroid disease. They may also order a test to measure your estradiol levels. Low levels of estradiol, a form of estrogen, can indicate that your ovaries are starting to fail. When estradiol levels are below 30, it may signal that you are in menopause. […] However, the most important test used to diagnose premature menopause is a blood test that measures follicle stimulating hormone (FSH). FSH causes your ovaries to produce estrogen. When your ovaries slow down their production of estrogen, your levels of FSH increase. When your FSH levels rise above 40 mIU/mL, it usually indicates that you are in menopause.

• #8 Premature Menopause – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/menstrual-disorders-and-abnormal-vaginal-bleeding/premature-menopause

  Premature menopause is the permanent end of menstrual periods before age 40. It occurs because the ovaries no longer release eggs (ovulation) regularly and stop producing the usual premenopausal levels of reproductive hormones. […] Blood tests can confirm the diagnosis, and other tests are done to identify the cause. […] Doctors suspect premature menopause when a woman younger than 40 has menopausal symptoms, or few or no periods, or cannot become pregnant. […] A pregnancy test is done to make sure that pregnancy is not the reason for periods stopping. Then, levels of estrogen and follicle-stimulating hormone (which stimulates the ovaries to produce estrogen and progesterone) are measured. These measurements may need to be repeated weekly for several weeks to confirm the diagnosis of premature menopause.

• #8 Premature Menopause – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/menstrual-disorders-and-abnormal-vaginal-bleeding/premature-menopause

  Additional tests may be done to help doctors identify the cause of premature menopause or associated disorders and thus evaluate a woman’s health risks and recommend treatment. […] Genetic counseling and testing are done if women have cognitive disability, tremor, or loss of balance (ataxia) or have a close relative with premature menopause or if they are younger than 35. […] A blood test for antimullerian hormone (which is produced in the ovaries) can be done to evaluate how well the ovaries are functioning and to estimate the chances that a woman will be able to become pregnant after treatment with fertility medications.

• #9 Diagnosing Menopause – Australasian Menopause Society

  https://www.menopause.org.au/hp/gp-hp-resources/diagnosing-menopause

  Menopause is diagnosed 12 months after the final menstrual period. […] Early menopause is defined as menopause occurring between 40-45 years and premature ovarian insufficiency (POI) prior to age 40. […] Measurement of FSH is indicated in women under 40 and 40-45 with menopausal symptoms. Premature menopause is diagnosed by elevated FSH levels on two occasions, 4-6 weeks apart. […] Premature menopause is considered to have occurred if a woman is younger than 40 when she becomes menopausal. […] About 1% of women experience a spontaneous premature menopause (POI or premature ovarian insufficiency) and around another 6% have premature menopause due to surgery, chemotherapy or radiation. […] This is the one time that measuring and finding a high FSH and a low oestradiol is helpful to differentiate between menopause and other causes of secondary amenorrhoea. […] The measurement of FSH and oestradiol should be repeated at least once.

• #10 Clinical manifestations and diagnosis of primary ovarian insufficiency (premature ovarian failure) – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-primary-ovarian-insufficiency-premature-ovarian-failure

  Clinical manifestations and diagnosis of primary ovarian insufficiency (premature ovarian failure) […] DIAGNOSIS […] Importance of early diagnosis […] Primary ovarian insufficiency (POI) is defined as the development of hypergonadotropic hypogonadism before the age of 40 years. […] Menopause before age 40 years is considered to be abnormal and is referred to as primary ovarian insufficiency (POI). […] An alternative term, „premature ovarian insufficiency,” is used by some experts. […] The terms „premature menopause” and „premature ovarian failure” were used in the past for POI, but both are inaccurate because many patients with POI intermittently produce estrogen and ovulate, a few experience intermittent return of regular menses, and, in 5 to 10 percent of cases, women conceive and have a normal pregnancy. […] Overt POI refers to the presence of irregular menses, elevated serum gonadotropins, and reduced fertility.

• #11 Early or premature menopause | Office on Women’s Health

  https://womenshealth.gov/menopause/early-or-premature-menopause

  Early or premature menopause can happen on their own for no clear reason, or they can happen because of certain surgeries, medicines, or health conditions. […] Reasons for early or premature menopause can include: Family history. Women with a family history of early or premature menopause are more likely to have early or premature menopause. […] Women who smoke may reach menopause as many as two years before nonsmokers. […] A bilateral oophorectomy may cause menopausal symptoms right away. Your periods will stop after this surgery, and your hormone levels will drop quickly. […] Women with HIV whose infection is not well controlled with medicine may experience early menopause. […] Women with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have extreme tiredness, weakness, muscle and joint pain, memory loss, headache, unrefreshing sleep, and other symptoms. Research has found that women with ME/CFS are more likely to have early or premature menopause.

• #12 Primary ovarian insufficiency – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/diagnosis-treatment/drc-20354688

  Most women have few signs of primary ovarian insufficiency, but your health care provider may suspect the condition if you have irregular periods or are having trouble conceiving. Diagnosis usually involves a physical exam, including a pelvic exam. Your provider might ask questions about your menstrual cycle, exposure to toxins, such as chemotherapy or radiation therapy, and previous ovarian surgery. […] Your provider might recommend one or more tests to check for: […] Hormone levels. Your provider may check the levels of a number of hormones in your blood, including follicle-stimulating hormone (FSH), a type of estrogen called estradiol, and the hormone that stimulates breast milk production (prolactin). […] For primary ovarian insufficiency, some questions to ask your health care professional include: […] What tests do I need? […] What treatments are available? What side effects can I expect? […] Your health care professional is likely to ask questions, such as: […] Do you have hot flashes, vaginal dryness or other symptoms like those of menopause? For how long?

• #13 Premature ovarian failure – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1004

  Cessation of menses for more than 1 year before 40 years of age secondary to loss of ovarian function. […] Differential diagnosis includes genetic/chromosomal abnormalities, autoimmune disorders, infections, and toxic and idiopathic causes. […] Screening for underlying medical conditions is recommended (as is karyotyping), especially in women younger than 30 years of age. […] Key diagnostic factors include age 40 years, family history of primary ovarian failure, menstrual irregularities, and toxic exposures. […] Other diagnostic factors include hot flashes, sleep disturbance, irritability, vaginal dryness, infertility, vaginal atrophy, small uterus with nonpalpable ovaries, cognitive abnormalities, signs of thyroid dysfunction, signs of adrenal dysfunction, signs of hyperprolactinemia, and signs of genetic syndromes.

• #13 Premature ovarian failure – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1004

  1st tests to order include pregnancy test, serum follicle-stimulating hormone (FSH) level, serum luteinizing hormone (LH) level, serum estradiol level, anti-Mullerian hormone (AMH) level, thyroid function tests, serum prolactin level, and transvaginal ultrasound. […] Tests to consider include thyroid peroxidase antibody, serum fasting glucose level, electrolytes, BUN, creatinine, karyotype, fragile X premutation, adrenocorticotropic hormone (ACTH) stimulation test, serum adrenal antibodies, and baseline dual-energy x-ray absorptiometry scan.

• #14 Tests and challenges in the diagnosis of spontaneous early menopause – Healthtalk Australia

  https://www.healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/overview-health-professionals/tests-and-challenges-in-the-diagnosis-of-spontaneous-early-menopause/

  The first thing is confirm it, because there are other conditions that can mimic menopause, and some other conditions can shut the ovaries off temporarily. […] So for example I test thyroid, I test a hormone called prolactin, and you want to confirm that it is menopause, so you need to do an oestrogen level, which is estradiol, and an FSH which is a pituitary hormone that regulates the ovarian production of oestrogen, and then you want to confirm that later. […] The other issue is that peri-menopause can be tricky as well, so typically in the 40s those levels can be high, but then you might check them again and they might be normal. […] So the diagnosis is the first thing, and I will usually do a gynaecological ultrasound as well to have a look at the ovaries, and that will really be looking at follicles or eggs.

• #14 Tests and challenges in the diagnosis of spontaneous early menopause – Healthtalk Australia

  https://www.healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/overview-health-professionals/tests-and-challenges-in-the-diagnosis-of-spontaneous-early-menopause/

  A delay in diagnosis is the commonest problem, for sure, and thats what we really have to address. […] Some health practitioners observed that the range of symptoms and co-existing health conditions that women can experience sometimes leads to other conditions being investigated before spontaneous EM. […] In addition, health practitioners explained that depending on womens medical and family histories, there can be several tests conducted to determine the cause of spontaneous EM. […] The tree that you could draw of all the conditions that could cause early ovarian failure is huge, medically, so thats where the puzzle is quite complicated. […] The women who are had periods for a long time, then become amenorrhoeic or have no periods anymore, again, you sort of almost have to go through a little bit the same process.

• #14 Tests and challenges in the diagnosis of spontaneous early menopause – Healthtalk Australia

  https://www.healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/overview-health-professionals/tests-and-challenges-in-the-diagnosis-of-spontaneous-early-menopause/

  So your first test is the history of menstruation, FSH twice, and then after that, prolactin levels, pregnancy tests, Anti-Mullerian hormone levels, which will tell you how many follicles are in fact there. […] Dr Goeltom, a general practitioner, explained that spontaneous EM is often diagnosed once other possibilities have been excluded. […] Several health practitioners noted that the diagnosis of spontaneous EM can often be delayed. […] In addition, some health practitioners noted that women may be dismissed by their health practitioners when they discuss their symptoms, causing further delays in the diagnosis of spontaneous EM. […] It takes quite a while to get diagnosed often. […] I think there’s probably a lack of appreciation of how relatively common it is and how you diagnose it, what the possible symptoms are.

• #15 Early Menopause Test (Blood & Hormone) | Quest®

  https://www.questhealth.com/product/early-menopause-assessment-test-panel-12570M.html?srsltid=AfmBOooViZlKwzwOqeF2G1QftbqKGlBvfDv7Qb8jUaWu_mIZdC6-YzY9

  The Early Menopause Panel measures hormones including follicle-stimulating hormone (FSH), estradiol, luteinizing hormone (LH), thyroid stimulating hormone (TSH), and prolactin, to help give you insights about your hormone levels. […] This panel may be helpful for women who have a history of irregular menstrual periods and a negative pregnancy test to help you and your doctor decide next steps for handling any symptoms you may be experiencing. […] The Early Menopause Panel measures follicle-stimulating hormone (FSH), estradiol, luteinizing hormone (LH), thyroid stimulating hormone (TSH), and prolactin levels in the blood to help determine when you’re entering or in the menopause transition phase. […] High levels can indicate that you have begun the menopause transition. […] A low level of estradiol may indicate the start of the menopause transition.

• #16 Ovarian Insufficiency Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/271046-workup

  Three groups of tests should be performed when ovarian failure is suspected or has been diagnosed. They include tests that establish the diagnosis of POI/POF, tests that help clarify the etiology, and screening tests for other diseases known to have higher prevalence among women with POI/POF. […] A pregnancy test (urine or beta human chorionic gonadotropin [bhCG] in the blood) should be the first study performed in every woman of reproductive age who presents with amenorrhea. […] Measuring serum FSH level is the core study to establish the diagnosis of POI/POF after pregnancy has been ruled out. By convention, 2 FSH levels in the menopausal range for the specific assay (40 IU/mL by radioimmunoassay), measured at least 1 month apart, are diagnostic of POI/POF. […] A parallel test of serum estradiol is necessary. As a rule, serum estradiol is low in women with POI/POF and is similar to or less than the early follicular phase estradiol of women who cycle normally. The combination of low estradiol and high gonadotropins defines POI/POF.

• #16 Ovarian Insufficiency Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/271046-workup

  Occasionally, women with POI/POF may have spontaneous follicular activity, and, if hormonal tests are performed during such episodes, levels of FSH, LH, and estradiol could be in the normal range or FSH and LH could be elevated only minimally (below the menopausal range). This may lead to an erroneous rejection of the diagnosis of POI/POF. In these cases, persistent amenorrhea or oligomenorrhea accompanied by menopausal symptoms necessitates a repeat of the above tests in 1-2 months. […] A karyotype should be performed as a part of the routine evaluation after the diagnosis of POI/POF is established. […] The presence of a second autoimmune endocrine or nonendocrine disease is traditionally used as an argument that the ovarian failure of a particular patient is of autoimmune etiology. In most cases, this is not true, the only exception being the combination of Addison disease and POI/POF.

• #17 Menopause – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552590/

  Consider using the persons serum FSH level to confirm menopause only: in people aged 40 to 45 with menopause-associated symptoms, including a change in their menstrual cycle; in people under 40 in whom menopause is suspected (see also diagnosing and managing premature ovarian insufficiency). […] Take into account the persons clinical history (for example, previous medical or surgical treatment) and family history when diagnosing premature ovarian insufficiency. […] Diagnose premature ovarian insufficiency in women, trans men and non-binary people registered female at birth who are under 40 based on: menopause-associated symptoms, including no or infrequent periods (taking into account whether the person has had a hysterectomy) and elevated follicle stimulating hormone (FSH) levels on 2 blood samples taken 4 to 6 weeks apart.

• #17 Menopause – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK552590/

  Do not diagnose premature ovarian insufficiency on the basis of a single blood test. […] Do not routinely use anti-Mullerian hormone testing to diagnose premature ovarian insufficiency. […] Offer sex steroid replacement with a choice of hormone replacement therapy (HRT) or a combined hormonal contraceptive to people with premature ovarian insufficiency, unless contraindicated (for example, in people with hormone-sensitive cancer). […] Explain to people with premature ovarian insufficiency: the importance of starting hormonal treatment either with HRT or a combined hormonal contraceptive and continuing treatment until at least the age of natural menopause (unless contraindicated).

• #18 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  HCPs should diagnose POI based on the presence of spontaneous amenorrhea or irregular menstrual cycles and biochemical confirmation. […] The guideline group recommends the following diagnostic criteria: disordered menstrual cycles (spontaneous amenorrhea or irregular menstrual cycles) for at least 4 months, and an elevated follicle stimulating hormone (FSH) concentration25 IU/l. […] The guideline group recommends that HCPs consider these points when diagnosing POI: Pregnancy should be excluded in women presenting with amenorrhea. […] The guideline group does not recommend diagnosing POI based on serum estradiol concentrations. […] Anti-Mullerian hormone (AMH) should not be used as the primary diagnostic test for POI. […] The guideline group recommends that HCPs inform women with POI of the different causes of POI, the limitations of current knowledge and testing for causes of POI, and that an exact cause may not be identified.

• #18 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends that HCPs discuss the risk of POI as part of the consent process before a medical or surgical intervention that may cause POI. […] The guideline group recommends that HCPs convey the diagnosis of POI in a compassionate and sensitive manner, provide personalised evidence-based information about the condition, and ensure time for the women to ask questions. […] The guideline group recommends shared decision making and support for continuity of care in managing POI. […] The guideline group recommends that women with POI should be informed that POI without HT is associated with reduced life expectancy, largely due to cardiovascular disease. […] HT is recommended for women with POI until the usual age of menopause for primary prevention to reduce the risk of morbidity and mortality, whether there are estrogen deficiency symptoms or not.

• #18 Evidence-based guideline: Premature Ovarian Insufficiency (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/evidence-based-guideline-premature-ovarian-insufficiency–2024/

  The guideline group recommends that women with POI should be encouraged to adopt a healthy lifestyle (including avoiding smoking, having a healthy diet and regular physical activity, and maintaining a healthy weight range) to reduce cardiovascular risk. […] Women with POI should be informed that POI substantially reduces the chances of natural conception. […] Women with POI should be informed that there are no interventions that have been reliably shown to increase ovarian activity and natural conception rates. […] Women with POI should be informed that oocyte donation is an established option to achieve pregnancy after a diagnosis of POI. […] Women with POI should be informed that there is limited evidence on the effectiveness of acupuncture for menopausal symptoms in POI and the evidence does not suggest a benefit from adding acupuncture to HT.

• #19 Premature ovarian insufficiency in general practice: Meeting the needs of women

  https://www.racgp.org.au/afp/2017/june/premature-ovarian-insufficiency-in-general-practic

  Diagnosis of POI requires follicle-stimulating hormone (FSH) levels in the menopausal range on two occasions, at least four to six weeks apart in a woman aged […] Diagnosis of POI requires FSH levels in the menopausal range on two occasions at least four to six weeks apart in a woman aged 40 years after more than four months of amenorrhea or menstrual irregularity, and after secondary causes of amenorrhea have been excluded. […] Diagnosis of POI can be difficult because of the variable and fluctuating presentation, reflecting fluctuating ovarian activity. […] Diagnosis of POI requires FSH levels in the menopausal range on two occasions at least four to six weeks apart in a woman aged 40 years after more than four months of amenorrhea or menstrual irregularity, and after secondary causes of amenorrhea have been excluded. […] The routine use of anti-Mllerian hormone levels in the diagnosis of POI is not currently recommended as its accuracy is not validated in this setting.

• #20

• #21 Menopause – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/menopause/

  Premature menopause is the permanent cessation of ovarian function and menses before the age of 40 years. […] If the cause is unknown, diagnostic studies for menopause are recommended. […] Clinical features of menopause may be more pronounced because of the rapid drop in hormone levels. […] Hormonal therapy is recommended to reduce symptoms of menopause and risks of early menopause, e.g., increased risk of heart disease, dementia, and increased risk of overall mortality. […] The occurrence of physiological menopause between 40 and 45 years of age with no other identified cause affects 5% of women. […] Clinical features and diagnostics are the same as for older patients. […] In individuals 40 years of age, perimenopause and menopause are diagnosed clinically. […] Diagnostic testing is reserved for premature menopause. […] If FSH levels are needed to verify menopause in individuals using oral contraceptives, discontinue oral contraceptives at least 2 weeks prior to testing. […] If the underlying cause is known (e.g., induced menopause), diagnostic studies may not be required.

• #22 Early menopause – under 45 (Remedy BNSSG ICB)

  https://remedy.bnssg.icb.nhs.uk/adults/menopause/early-menopause-under-45/

  Early menopause is defined as menopause under the age of 45 years and is relatively common, predicted to occur in 8-12% of women. Diagnosis of early menopause is often delayed and can cause emotional distress, particularly in individuals hoping to become pregnant. […] Women diagnosed with menopause under the age of 40 should be managed as POI. […] Under age 45 at time of diagnosis. […] Oligo/amenorrhoea for 4 months duration. […] Elevated (25 iu/L) FSH on at least two occasions, measured at least 4-6 weeks apart (do not measure FSH whilst a patient is using combined hormonal contraception, estradiol or injectable contraceptives). […] In women under 45y, with possible menopausal symptoms and two normal FSH results, other causes for her symptoms should be explored. If no other cause is found, offer a 6-month trial of HRT (there is a high placebo rate in the first 3 months) and if good symptom control is achieved, provide a diagnosis of early perimenopause, instigate investigations for a cause and continue treatment with HRT. […] FSH measurement is not required in women over 45y old with menopausal symptoms.

• #23 Seeking help and diagnosis for spontaneous early menopause – Healthtalk Australia

  https://www.healthtalkaustralia.org/early-menopause-experiences-and-perspectives-of-women-and-health-professionals/overview-womens-experiences/spontaneous-early-menopause-experiences-of-seeking-help-and-diagnosis/

  Although some women were diagnosed with spontaneous EM by their regular GPs, most were diagnosed by doctors they had seen for a second opinion or for other problems other GPs, doctors at specialist womens health clinics, fertility specialists, or gynaecologists. Women were usually diagnosed after blood tests checking levels of FSH or other hormones (e.g. oestrogen, dihydroepandrosterone (DHEA), testosterone). […] Being diagnosed with spontaneous early menopause at 25 was a shock for Lorena, and really, really hard. […] However, not all women found being diagnosed with spontaneous EM difficult.

• #24 Premature Ovarian Failure (POF) Diagnosis & Treatment | CCRM

  https://www.ccrmivf.com/blog/premature-ovarian-failure-pof/

  Premature Ovarian Failure (POF) is defined as the cessation of ovarian function prior to the age of 40. It is diagnosed in women under age 40 when ovarian function ceases, menstruation stops, the onset of menopausal symptoms, estrogen levels falling to a menopausal range (less than 20 pg/ml) and resulting infertility. […] The diagnosis of Premature Ovarian Failure (POF) is made with a thorough medical history and physical examination along with a simple blood test measuring FSH level, or follicle stimulating hormone, any time in the cycle. When the value is over 40 mIU/ml on two separate occasions, the diagnosis can be made. […] The diagnosis of Premature Ovarian Failure (POF) can be emotionally devastating to patients, especially for women looking forward to their childbearing years. […] Since the diagnosis can have such long-reaching physical and emotional circumstances, CCRM Fertility of Arizona believes strongly, it is important that elevated FSH levels are confirmed by repeat testing and the patient should never be told over the phone or by anyone other than her physician; who will have the time to answer all her questions and give her reassurances that having children, now or in the future, is possible.

• #25 Premature Menopause | The Menopause Society

  https://menopause.org/patient-education/menopause-topics/premature-menopause

  Premature Menopause occurs in about 3 in 100 women. […] The normal age range of menopause is between 46 and 55 years However, about three in 100 women will go through menopause before age 40. This is known as premature menopause. […] When it does occur, examination by a healthcare professional is recommended. […] Women aged younger than 40 years who have missed three or more menstrual periods are advised to see a healthcare professional to determine whether this is caused by POI or whether another reason for absent or irregular menstruation is at play. […] For women with induced menopause, especially when it results from treatment for a serious illness, a number of other fears and concerns may compound the challenges of premature menopause. […] Women with POI do sometimes ovulate, and pregnancy can occur naturally, which is why contraception is still recommended for those who do not desire pregnancy. […] A referral to a fertility specialist or a reproductive endocrinologist may be beneficial.

• #26 Menopause: What It Is, Age, Stages, Signs & Side Effects

  https://my.clevelandclinic.org/health/diseases/21841-menopause

  When discussing treatment for menopause with your healthcare provider, it’s about treating the symptoms of menopause that disrupt your life. There are many different types of treatments for managing menopause symptoms. The main types are: Hormone therapy (HT). A term used for hormones offered to those going through menopause at natural ages (after age 45). Hormone replacement therapy (HRT). The word replacement is added when using hormones to treat menopause which occurs at a young age, especially before age 40. […] People experiencing menopause before age 40 should be offered hormone replacement therapy, except in rare circumstances (such as a personal history of breast cancer at a young age).

• #27 Premature and early menopause | healthdirect

  https://www.healthdirect.gov.au/early-menopause

  Premature or early menopause can also be caused by surgery that removes your ovaries. […] If you are affected by early menopause, it’s important to get medical support. […] Hormone therapy may be recommended. […] Hormone therapy can help lower your risk of osteoporosis and early onset cardiovascular disease. […] Early menopause can’t be prevented. […] Females who go through premature or early menopause may have a higher risk of developing cardiovascular disease and osteoporosis. […] A diagnosis of menopause is made on the basis of new onset vasomotor symptoms and a change in the pattern of menstrual bleeding.

• #28 Premature and early menopause | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/premature-and-early-menopause

  Premature menopause is when menopause happens before the age of 40. […] Early menopause is when menopause happens between the ages of 40 and 45. […] It’s recommended that people who have premature or early menopause take menopausal hormone therapy (MHT) to reduce the risk of health conditions such as osteoporosis and heart disease. […] Premature and early menopause may be caused by primary ovarian insufficiency (POI), cancer treatment or surgery. […] Menopausal hormone therapy (MHT) or the oral contraceptive pill can help to reduce these risks. These treatments should be taken until the expected age of menopause. […] If you cannot take hormone therapy (e.g. you have a history of breast cancer), your doctor will discuss your situation and recommend other treatments.

• #29

  https://bpac.org.nz/2019/ovarian.aspx

  Primary ovarian insufficiency can be diagnosed in women aged 40 years with four to six months of amenorrhoea (after excluding other causes) and two FSH tests 40 IU/L, at least four weeks apart. […] A diagnosis of primary ovarian insufficiency can be made on the basis of four to six months of amenorrhoea in women aged 40 years after excluding other causes of secondary amenorrhoea, and two FSH tests 40 IU/L, conducted four to six weeks apart. […] Hormone treatment until at least the age of natural menopause is recommended. […] Hormone treatment, either with MHT or a COC, is recommended for women with primary ovarian insufficiency (unless there are contraindications) to alleviate symptoms, improve their quality of life, and reduce the long-term risks of oestrogen deficiency. […] Treatment should be continued until at least the age of natural menopause (approximately age 50 years). […] Women with primary ovarian insufficiency should be reviewed at least annually, including an assessment of symptom control, adherence to treatment and cardiovascular risk.

• #30 New guidelines for early menopause diagnosis and management – School of Public Health – University of Queensland

  https://public-health.uq.edu.au/article/2024/03/new-guidelines-early-menopause-diagnosis-and-management

  New guidelines for early menopause diagnosis and management […] University of Queensland research has led to the development of a practical framework to help medical professionals around the world diagnose and manage early menopause. […] The diagnosis of early menopause is often not straightforward unless a clear medical cause, like surgery or cancer treatment, is identified. […] The study recommends that instead of applying distinct age thresholds, early menopause should be seen on a spectrum between premature ovarian insufficiency (menopause before 40) and menopause at the average age of 50 51 years. […] We recommend a more holistic and individualised care approach to managing early menopause, Professor Mishra said. […] The study also highlighted the need for more research in the areas of early menopause and premature ovarian insufficiency.

• #30 New guidelines for early menopause diagnosis and management – School of Public Health – University of Queensland

  https://public-health.uq.edu.au/article/2024/03/new-guidelines-early-menopause-diagnosis-and-management

  There are important evidence gaps, particularly in middle- and low-income countries, around the causes, the associated health risks, and optimal management of early menopause, Professor Mishra said. […] Senior-author Professor Martha Hickey from The University of Melbourne said more information was urgently needed about the unmet needs of people going through early menopause. […] It would be valuable to know whether they experience more severe symptoms and for a longer duration, than those who go through menopause at the average age, Professor Hickey said.

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