Early menopause: diagnosis and management

Abstract It is clear that reproductive aging plays a critical role in overall population health and longevity. The effects of ovarian aging on overall health are largely due to the progressive, irreversible loss of follicles and oocytes, which results in declining feedback from the somatic cells of the aging ovary, changes in endocrine hormones, and ultimately, menopause. Menopause, the culmination of the ovarian aging process, represents a major hormonal, psychological, and physiological event and confers increased risk for comorbidities and overall mortality unrelated to fertility. Primary ovarian insufficiency (POI) is a process characterized by a catastrophic acceleration of ovarian follicle loss. The resultant early menopause and infertility is devastating for women. Women who experience earlier onset of natural menopause due to POI, or surgical menopause (e.g., following oophorectomy) live shorter lives, with a higher incidence of diabetes, ischemic heart disease, cardiovascular disease mortality, bone fracture, and earlier cognitive decline than women who experience normal or late menopause. An understanding of the pathophysiology and treatment of early menopause and POI is critical in order to identify and treat women suffering from this condition, thus improving the long-term health of over half of the population.