Long-term health consequences of premature or early menopause and considerations for management

Abstract

Aim To review the current evidence concerning the long-term harmful effects of premature or early menopause, and to discuss some of the clinical implications.

Material and methods Narrative review of the literature.

Results Women undergoing premature or early menopause, either following bilateral salpingo-oophorectomy or because of primary ovarian insufficiency, experience the early loss of estrogen and other ovarian hormones. The long-term consequences of premature or early menopause include adverse effects on cognition, mood, cardiovascular, bone, and sexual health, as well as an increased risk of early mortality. The use of hormone therapy has been shown to lessen some, although not all of these risks. Therefore, multiple medical societies recommend providing hormone therapy at least until the natural age of menopause. It is important to individualize hormone therapy for women with early estrogen deficiency, and higher dosages may be needed to approximate physiological concentrations found in premenopausal women. It is also important to address the psychological impact of early menopause and to review the options for fertility and the potential need for contraception, if the ovaries are intact.

Conclusions Women who undergo premature or early menopause should receive individualized hormone therapy and counseling.

Key words::

• PREMATURE MENOPAUSE
• EARLY MENOPAUSE
• ESTROGEN
• OOPHORECTOMY
• HORMONE THERAPY

ACKNOWLEDGEMENT

We thank Ms Carol Greenlee for secretarial support with formatting the manuscript.

Conflict of interest The authors report no conflict of interest. The authors alone are responsible for the content and writing of this paper.

Source of funding Dr. Rocca is funded by the US National Institutes of Health (AG 034676, AG 006786; AG 044170; and HD 065987).