FSH was done and it was raised on two separate occasions. What is the SINGLE most appropriate management?

A 39 year old woman has had no menstrual periods for the last 11 months. Prior to that she had regular menstrual cycles. She recently has hot flashes and night sweats. She is also experiencing feelings of anger and helplessness. FSH was done and it was raised on two separate occasions. What is the SINGLE most appropriate management?

A. Hormone replacement therapy (HRT) for 5 years
B. Hormone replacement therapy (HRT) until age 51
C. Tricyclic antidepressants
D. Levothyroxine
E. Progestogen-only pill (POP)

Premature ovarian failure

Premature ovarian failure (Premature ovarian insufficiency) is defined as the onset of menopausal symptoms and elevated gonadotropin levels before the age of 40 years. It occurs in around 1 in 100 women.

Causes • Idiopathic - the most common cause • Chemotherapy (this can be temporary, as recovery of ovarian function can occur, especially in younger women) • Radiation • Autoimmune disease • Bilateral oophorectomy or surgical menopause Presentation

  1. The most common presentation is amenorrhoea or oligomenorrhoea (which may not necessarily be accompanied by hot flushes) 2. Infertility 3. Other features are similar to those of the normal climacteric symptoms: • Hot flashes • Night sweats • Irritability • Poor concentration • Decreased sex drive • Dyspareunia • Vaginal dryness

Tests:

FSH levels: • FSH test should be undertaken in women aged under 40 years in whom menopause is suspected • Two raised levels (more than 40 IU/L) taken at least four weeks apart are diagnostic

Serum follicle-stimulating hormone (FSH) measurement alone can be used to diagnose the disease. The anterior pituitary secretes FSH and LH at high levels due to the dysfunction of the ovaries and consequent low estrogen levels.

Management: • hormone replacement therapy (HRT) until at least the average age of the menopause (51 years)

(The average age of the menopause in women in the UK is 51 years)

Important Notes: Do NOT use early menopause and premature ovarian failure interchangeably • The term early menopause is used for those women who go through their menopause between 40-45 years Do NOT use premature menopause and premature ovarian failure interchangeably • Premature ovarian failure is sometimes referred to as premature menopause, but the two conditions aren’t exactly the same. Women with premature ovarian failure may have irregular or occasional periods for years and may even become pregnant. Women with premature menopause stop having periods and can’t become pregnant.