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Missed Periods - Premature Menopause?
As a reader of this blog you probably know that missed periods, very late, and erratic periods usually can be attributed to missed ovulations. Yet when hot flashes or night sweats are also present many younger women wonder "Could I have premature menopause?" After reading this post you should have the information needed to work with your GYN to get a definitive answer.
Is there a difference between early menopause, premature menopause, and premature ovarian failure?
Overall, menopause means the failure of ovaries to produce estrogen. Estrogen builds up the lining of the uterus so that there is something to shed as a period. Technically, if your uterus is removed with a hysterectomy you will have no more periods. Yet if the ovaries are still in place and working, a woman is not yet in menopause. If ovaries are taken out that is considered "surgical menopause."
According to the North American Menopause Society, early menopause is when the last, natural menstrual period occurs before age 45, while premature menopause indicates a woman aged 40 or less. Premature ovarian failure (POF), like premature menopause, also is linked to being age 40 or younger. Among researchers who study POF, a term used first by the French "Ovarian Insufficiency" may become the new standard term for POF. I'll explain why that is the most appropriate term in a moment.
How common is POF?
Overall the incidence in the USA is reported to be 1-4% of women. While POF can be triggered by medical interventions such as chemotherapy, radiation, or surgery, the greatest number of women will not have an observable cause. The majority of woman with POF will have had prior menstrual periods.
The exceptions to these generalizations are in teenagers, who have not yet had a first period. In this specific group there is a 50% incidence of an abnormal, genetic karyotype. If this is suspected specialized testing is done, along with genetic counseling.
Is it true that POF can reverse back to normal?
The answer here is both "yes" and "no". About half of younger women (age less than 40) with a clear diagnosis of POF will experience normal function of the ovary that can come and go. That's why the term "Ovarian Insufficiency" may end up as the new standard name for POF. Insufficiency suggests the status quo might return - it is not permanent as implied by the idea of "menopause."
Does that mean I COULD get pregnant after a diagnosis of POF?
The data suggests that 5-10% of POF women will conceive unexpectedly. That is good news if women are trying to conceive. But the majority of women with POF will usually have a family via donor eggs, or adoption. There have been numerous studies of ovulation induction treatments (eg. Clomid, estrogens, GnRH, FSH, etc.) for women with POF. Alas, the best designed studies have failed to show ovulation rates any better than in untreated POF women (Sinha, 2007).
What if I don't want to get pregnant?
Among women who become menopausal at around age 50, we suggest some type of birth control should be used for one year after the last period. For women with POF, contraception should be used for a minimum of two years. Because of the intermittent, and unpredictable, ovulations in some women there are reports of POF women conceiving 8-15 years after there diagnosis of POF! For birth control, barrier methods (eg condoms/spermicide, diaphragm) or birth control pills (BCPs) can be used. BCPs have the additional benefit of adding needed estrogen if a woman's ovaries are not producing their own estrogen. One study (Buckler, 1993) found that BCP use did not enhance the return of normal ovary function.
What should I ask of my GYN if I want them to check for POF?
There is no completely standardized evaluation for POF. Generally, the following four elements need to be present to make a diagnosis of POF:
Probably the most important part of the work up for POF is for the GYN to consider it as a possibility. One study of 48 women with POF found age 25 to be the average age of symptom onset, but it took two years to get the correct diagnosis. Almost two thirds of the women had to see three or more MDs before getting the correct diagnosis (Alzubaidi, 2002).
Where can I learn more?
Of all the internet sites I reviewed, I believe that these two have some of the best information.
Related Topics:
Is there a difference between early menopause, premature menopause, and premature ovarian failure?
Overall, menopause means the failure of ovaries to produce estrogen. Estrogen builds up the lining of the uterus so that there is something to shed as a period. Technically, if your uterus is removed with a hysterectomy you will have no more periods. Yet if the ovaries are still in place and working, a woman is not yet in menopause. If ovaries are taken out that is considered "surgical menopause."
According to the North American Menopause Society, early menopause is when the last, natural menstrual period occurs before age 45, while premature menopause indicates a woman aged 40 or less. Premature ovarian failure (POF), like premature menopause, also is linked to being age 40 or younger. Among researchers who study POF, a term used first by the French "Ovarian Insufficiency" may become the new standard term for POF. I'll explain why that is the most appropriate term in a moment.
How common is POF?
Overall the incidence in the USA is reported to be 1-4% of women. While POF can be triggered by medical interventions such as chemotherapy, radiation, or surgery, the greatest number of women will not have an observable cause. The majority of woman with POF will have had prior menstrual periods.
The exceptions to these generalizations are in teenagers, who have not yet had a first period. In this specific group there is a 50% incidence of an abnormal, genetic karyotype. If this is suspected specialized testing is done, along with genetic counseling.
Is it true that POF can reverse back to normal?
The answer here is both "yes" and "no". About half of younger women (age less than 40) with a clear diagnosis of POF will experience normal function of the ovary that can come and go. That's why the term "Ovarian Insufficiency" may end up as the new standard name for POF. Insufficiency suggests the status quo might return - it is not permanent as implied by the idea of "menopause."
Does that mean I COULD get pregnant after a diagnosis of POF?
The data suggests that 5-10% of POF women will conceive unexpectedly. That is good news if women are trying to conceive. But the majority of women with POF will usually have a family via donor eggs, or adoption. There have been numerous studies of ovulation induction treatments (eg. Clomid, estrogens, GnRH, FSH, etc.) for women with POF. Alas, the best designed studies have failed to show ovulation rates any better than in untreated POF women (Sinha, 2007).
What if I don't want to get pregnant?
Among women who become menopausal at around age 50, we suggest some type of birth control should be used for one year after the last period. For women with POF, contraception should be used for a minimum of two years. Because of the intermittent, and unpredictable, ovulations in some women there are reports of POF women conceiving 8-15 years after there diagnosis of POF! For birth control, barrier methods (eg condoms/spermicide, diaphragm) or birth control pills (BCPs) can be used. BCPs have the additional benefit of adding needed estrogen if a woman's ovaries are not producing their own estrogen. One study (Buckler, 1993) found that BCP use did not enhance the return of normal ovary function.
What should I ask of my GYN if I want them to check for POF?
There is no completely standardized evaluation for POF. Generally, the following four elements need to be present to make a diagnosis of POF:
- Absent periods for 4, or more, months
- Age 40 or less
- Evidence of low estrogen (eg vaginal dryness, hot flashes, etc)
- FSH blood test results of more than 40mIU on two tests taken a little over a month apart
Probably the most important part of the work up for POF is for the GYN to consider it as a possibility. One study of 48 women with POF found age 25 to be the average age of symptom onset, but it took two years to get the correct diagnosis. Almost two thirds of the women had to see three or more MDs before getting the correct diagnosis (Alzubaidi, 2002).
Where can I learn more?
Of all the internet sites I reviewed, I believe that these two have some of the best information.
Related Topics:
- Too Young for Menopause
- Menopause Health Center
- Get the Women's Health newsletter in your inbox weekly
Labels: menopause, missed periods, womens health
16 Comments:
this is my first time on this website so i'm not quiet sure how this works? i really just have a question about passing large bloodclots during my period.i'm 48yrs old and pretty sure i'm entering the menopause stage. i've been passing clots for yrs. usually about the size of a half dollor.they seem to be betting much larger. my last clot was the size of about 3 fingers on a womans hand,in width and lengh. is this something normal to other weman? would like to hear from you. mariamf
hi,nice website.
Im a 58 yrs old the last time I had a period was 2 years ago I thought after a full year of no period youre in menapause. I got a period and this is my 3 day.Ive never had cramps> Now I do/ Is this normal? @ yrs aho I woild bleed sometimes for two weeks very very heavy. Im bleeding regular now. Thanks in advance for any help.
I recently had surgery for diverticulitis. I am now not having a bowel movement except for once every three to four days. Should I be concerned about this?
I too suffer from nasty clots passing durring my period. I have suffered my whole life with God awful debilitating cramps, HEAVY bleeding, and clots the size of a half dollar and larger. I have passed out and have had to cut short trips because I was in so much pain. I am glad that I have boys! It would kill me to think that my daughter would have to suffer like I do. If anyone knows of a Dr. that is worth a damn please let me know. I AM DESPERATE!!
I am not a doctor, but between myself, family and friends I have heard and experienced many female related issues. Blood clots are not good, and should not be ignored. If you have them with most periods you should ask your doctor about endometriosis. My sister went through this for over a year before finally getting answers and medication to help. If it is not your norm to pass clots and you start to do so, especially if you recently missed a period you may have an ectopic pregnancy. I went through this and it was not caught in time. It ruptured and I was very sick. I had to have ER surgery and recovery was very hard. Don't take clots lightly. If you have them and your current OBGYN is not getting you answers seek a second opinion. Clots can be very serious.
well this is my first time on here but iam 17 years old i just wanted to know because on july i started my period for only 1 day then at the begging of august like on the 4th istarted my period for only 3 days then it stopped then it started 1 more time then stopped then at the end of august on the 28th it started again what does that mean.? it scares me because somee people tell me that it can mean prenancy but how is that?
Novasure Endometrial Ablation
My sister had this procedue 3 weeks ago due to having her period for several months straight. She, to this day 3 weeks later is still bleeding. She has notified her doctor but he tells her that it is common. Is that true. Please, she is so scared!
i had my last period when I was 34 years old. 5 and a half years later, out of the blue, i'm menstruating again at 39. Can anyone explain this.
Hi, 3 years ago I started taking the depo provera shot, its been a year since my last shot because my physician said i couldnt exceed its use over 2 years, i still havent had a period, making it more than 2 years that i havent had a cycle, im only 21. my doctor tried me on the provera challenge 10mg 1 pill every day for 10 days and it was suppose to make me have a period its been 2 weeks since the 10th pill and still no period, im really scared, what should i ask my doctor? whats happening to me? help! i also have an enlarged thyroid but it functions normally. can anyone help me?
Hi. I too have had Novasure. The bleeding can continue for about a month. Also, her next period may be kind heavy. After that she'll feel much better.
As to the Depo shot, that is nasty stuff. Can cause all kinds of issues they are just now finding out about. It took my best friend about 18 months to start her cycle again. But it did start. So have hope.
WILL I STILL HAVE MENSTRUAL PERIODS AFTER A HYSTERECTOMY?
i am 50 years old and did not have my period for 25 years now and then yesterday i started to bleed. i not sure this is normal or what if someone can tell me what up thanks.
This is a great place to post comments. However, if you have a specific question for Jane, please post it on her message board. While I cannot promise you an answer (she can't answer everyone) you have a better chance of getting a response.
I'm not sure what to think, I have not had a period for 4 months and before that I skipped 2 months had one and now nothing for 4 months. I am not pregnant. I'm 27 so I don't think I'm going in to menopause, but I am a little nervous about it. I don't ovulate, I have had 2 miscarriages and no kids. I have skipped a month before but not 4 months in a row. I feel like I'm going to start but then nothing happens. Has this happened to anyone else?
As far as the Depo-Provera, I had the same issue - no period even when it was supposed to wear off. After about a year, I went to the doctor and he prescribed the normal birth control pill. My period started right away with that (during the "off" week). Stopped after 3 months and conceived about 2 months later (that was the goal, though a bit earlier than expected).
And ... if you have one of those crazy insurance companies who still won't pay for the pill, make sure the doctor codes it as ammenora (sp?) - lack of periods, which is a medical issue rather than contraceptive issue.
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