Plan offers guidance for evaluating menopause-like condition in girls and young women

A comprehensive plan to help health care professionals diagnose and treat primary ovarian insufficiency—a menopause-like condition affecting girls and young women that may occur years before normal menopause is expected—has been developed by a scientist at the National Institutes of Health.

Lawrence Nelson, M.D., head of NIH's Integrative and Reproductive Medicine Unit, provided recommendations based on the research he has conducted at the NIH. His recommendations are published in the Clinical Practice feature of the February 5 New England Journal of Medicine.

In primary ovarian insufficiency, the ovaries stop releasing eggs and producing estrogen and other reproductive hormones. The sudden cessation of ovarian function results in a condition similar to that of normal menopause: loss of menstrual periods, infertility, hot flashes and night sweats, sleep loss, and increased risk for bone fracture and heart disease. The sudden and unexpected loss of fertility frequently results in feelings of grief, anxiety and depression.

Treatment consists of hormones to replace those no longer produced by the ovaries and counseling to help women cope with the grief, anxiety, and depression that may result from the diagnosis and the loss of fertility.

"The early indicators of primary ovarian insufficiency are subtle and the condition can be difficult to diagnose," said Duane Alexander, M.D., director of NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development, where Dr. Nelson conducts his research. "Dr. Nelson's report provides helpful information for health care professionals and patients on how to recognize the early symptoms of the condition so that women can benefit from prompt diagnosis and early treatment."

Because ovulation may sometimes occur in this group of women, primary ovarian insufficiency is more accurate than other terms that have been used to describe the condition, such as premature menopause or premature ovarian failure, Dr. Nelson wrote. Primary ovarian insufficiency occurs in women younger than age 40—the age at which menopause may begin.

A woman can be considered to have primary ovarian insufficiency if she has not experienced a menstrual cycle in 4 months or more, and if at least two tests taken more than 1 month apart show that she has abnormal levels of follicle stimulating hormone (FSH). FSH is produced by the pituitary and stimulates the ovaries to produce estrogen and prepare an egg for release.

Specifically, girls and young women with primary ovarian insufficiency have high FSH levels like those of women in menopause.

Dr. Nelson wrote that in rare instances, primary ovarian insufficiency may resolve spontaneously, and normal menstrual cycles and fertility will be restored. In 5 to 10 percent of cases, women become pregnant after having been diagnosed with primary ovarian insufficiency.