Early Menopause: Primary Ovarian Insufficiency and Surgical Menopause

Early menopause, whether a consequence of primary ovarian insufficiency or resulting from surgical removal of gonads in a premenopausal woman, offers unique health-related challenges. Premature deprivation of sex steroids sets into motion a cascade of events that preferentially target urogenital, skeletal, cardiovascular, and neurocognitive systems, and culminate in global health deterioration in a chronologically younger population of women compared with those undergoing age-appropriate, natural menopause. Overtly, menopausal symptoms may be shared between those experiencing early menopause versus those undergoing a natural attrition of their reproductive physiology. Extrapolation of concerns emanating from recent randomized trials of menopausal hormone therapy may not be applicable to young women experiencing early menopause, however, and estrogen replacement remains a mainstay in the clinical management of this population.