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Premature menopause (PMM)
Premature ovarian failure
The word menopause refers to the last menstrual bleed.
The term premature menopause (premature ovarian failure) is defined
as the occurrence of menopause before the age 40. Menopause does not
usually occur until a woman has reached her late forties or early fifties.
Premature ovarian failure can present at varying ages and in many forms.
If premature menopause happens before puberty, the woman will present
with lack of sexual developments and her periods will not started. If
the condition presents after puberty, the woman will suffer from amenorrhoea
and infertility. The diagnosis of premature menopause can be a shattering
experience to the women and her family.
At present, the only chance of a pregnancy for women
wih premature menopause lies through
egg donation. It may be possible in the future to restore ovarian
function in some women with a positive family history of premature menopause
through the transplantation of their ovarian
tissue, which had been frozen years before thus allowing natural conception.
IVF with donated eggs and nuclear transfer
is another possible future treatment. Here the nucleus of a healthy donor
egg is replaced with the nucleus taken from a cell that 'woud be a mother'.
The donor egg is then fertilised by the male partners sperm and the resulting
embryo is subsequently transferred into the recipient.
Embryo donation is another option if the male partner is also infertile.
Since the woman's estrogen production is low, hormone
replacement treatment is prescribed to put the brakes on the premature
ageing effects of menopause.
Incidence of premature menopause
About 1-3% of women will experience menopause before
the age 40 years. Premature ovarian failure accounts for about 10% of
amenorrhoea and 1% of all cases
of infertility.
Causes of premature menopause
In the majority of cases no cause can be found. However,
some of the known causes include:
- Congenital, if the ovaries failed to develop and are absent from
birth.
- Chromosomal abnormalities, such as Turner's syndrome, where the
ovaries contain only a few follicles.
- Genetic, as some women's ovaries run out of eggs long before their
middle age. This is possibly due to an increased rate of disappearance
of follicles. The incidence of familial premature ovarian failure
(POF) varies from 4% to 30%. The risk of a female relative developing
POF may be as high as 100% in familial POF and as low as 1% in sporadic
cases.
- Ovarian antibodies, where antibodies act against the ovaries.
- The ovaries are physically damaged by infections, such as the mumps,
or by cancer treatment, such as radiotherapy or chemotherapy.
This later group is increasing in number because of the longer survival
of cancer patients due to advances in both diagnostic modalities and
treatment available.
- The ovaries were surgically removed because of cancer or other
causes.
User Contributed Notes
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Dr Samuel Marcus
10-Jan-2005 9:30 |
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A woman received chemotherapy and radiotherapy for Ewing's sarcoma (bone cancer) of the pelvis when she was 14 years old, after which her periods ceased and hormonal tests confirmed ovarian failure; she was given HRT to prevent menopausal symptoms. 6 years later she conceived without medical assistance and has since given birth to a healthy baby boy.
This is the first documented case of a woman conceiving naturally despite being labeled infertile after intensive cancer treatment.
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samuel marcus
25-Jun-2006 11:02 |
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| Professor Silber and colleagues from United States presented the outcome of ovarian transplantation in a series of nine pairs of identical twins discordant for premature ovarian failure.(one of the twin sisters had undergone premature ovarian failure and the other was still fertile). Following transplantation, menstruation and ovulation resumed in the sisters with premature menopause. Spontaneous pregnancy has occurred in three women without additional treatment so far (ESHRE 2006.) |
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