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Early Menopause

Medically reviewed by Norbert Gleicher, MD, FACOG, FACS - Written by CHR Staff - Updated on Oct 08, 2018

Diagnosis

AMH-FSH-AGE-Normal graph

Early menopause is the last stage of usually a lengthy process of premature ovarian aging (POA). If caught early, women with POA can still receive successful treatments and have healthy babies. Here, it is very important to be accurate in terminology: Diagnosis of POA needs to be clearly differentiated from diagnosis of POF .

POA is usually completely asymptomatic, though some women may report changes in menstrual pattern, especially shortening of their menstrual cycles. In contrast, there are a number of symptoms associated with POF/early menopause, many of which mirror those experienced by women who are entering natural menopause. Those include irregular or missed periods, hot flashes, vaginal dryness, bladder irritability, incontinence, dry skin, dry eyes, dry mouth, problems with sleep, decreased sexual desire, and emotional shifts such as irritability, feelings of depression, or mood swings.

Women who are experiencing symptoms of early menopause, or who have had fewer than nine periods in a year or missed more than three consecutive periods, should talk with their doctor about early menopause. A blood test will likely be ordered to rule out other possibilities, such as pregnancy. Your doctor may also test your levels of estrogen, with abnormally lower levels often being a potent indicator of POF.

The decisive test for early menopause, including POF, is the level of follicle stimulating hormone (FSH) . When FSH levels are above 40 mIU/mL), it indicates early menopause.

POA, in contrast, is characterized by elevated FSH levels but below 40 mIU/mL. Researchers at CHR have identified age-specific FSH level thresholds and have been successful in detecting POA in timely manner, for a number of years now. The bottom portion of the figure above shows the curve of age-specific normal FSH level. (The top portion demonstrates normal age-specific AMH (anti-Müllerian hormone) levels .) Women at abnormally high FSH and/or abnormally low AMH levels for their age by definition suffer from POA, and at a higher risk of entering early menopause. With age-specific levels, we are able to diagnose even the earliest stages of the path toward early menopause. This is crucial in providing the best possible fertility treatments to women with risk towards early menopause.

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Norbert Gleicher, MD, FACOG, FACS

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.

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