The diagnosis of spontaneous early menopause (EM) or Premature Ovarian Insufficiency (POI) involves several tests over a period of time. Women will often visit health practitioners with symptoms such as changes to their menstrual cycle, hot flushes, and night sweats (see Symptoms of early menopause and Seeking help and diagnosis for spontaneous early menopause (women’s experiences)).
The health practitioners we interviewed explained that after taking a menstrual and medical history, they conduct a range of blood tests to determine, for example, levels of Anti-Mullerian hormone, and Follicle-stimulating hormone, and a pelvic ultrasound. Women will also commonly undergo tests for the cause of spontaneous EM, although most cases are ‘idiopathic’, meaning there is no known cause. Genetic factors that can cause spontaneous EM or POI include Fragile X syndrome or Turner Syndrome. Other factors associated with spontaneous EM or POI include a family history of spontaneous EM, autoimmune conditions (such as thyroid disease) and galactosaemia.
Tests to diagnose and determine the cause of spontaneous EM are usually followed by screening to assess bone (bone mineral density test or DXA) and cardiovascular health for long-term monitoring (see Long-term health effects of early menopause).
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Delays in diagnosis
Several health practitioners noted that the diagnosis of spontaneous EM can often be delayed. This can be due to the extensive tests required, or sometimes because of women ignoring the absence of menstrual periods, especially if they have completed their family. Using the example of women who visit her practice for a pap smear, general practitioner Dr Goeltom commented, ‘sometimes [women have asked me] “If I don’t have a period for so many years, do I still need a pap smear?” And then, [I ask] “Why aren’t you [having] a period for so long?”… [They] don’t see it as a problem … especially [women] who have finished trying to have children.’
In addition, some health practitioners noted that women may be dismissed by their health practitioners when they discuss their symptoms, causing further delays in the diagnosis of spontaneous EM.
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The frustration that women can experience due to delays in the diagnosis of spontaneous EM was acknowledged by health practitioners. Dr D, an endocrinologist, commented that specialists can be ‘very difficult to get into, [this] is another factor of delay, and some women have waited months to get in…’
Investigating the cause of EM
Some health practitioners observed that the range of symptoms and co-existing health conditions that women can experience sometimes leads to other conditions being investigated before spontaneous EM. General practitioner Dr Ee added: ‘for me the biggest barriers were getting the diagnosis right because sometimes you may not even think about it and you start investigating other things.’
In addition, health practitioners explained that depending on women’s medical and family histories, there can be several tests conducted to determine the cause of spontaneous EM. Dr K, a fertility specialist, explained: ‘having a positive family history is a big predictor of premature ovarian insufficiency [and] having serious auto-immune conditions, and women who have Fragile X pre-mutations often have early menopause. So, there’s a wide variety of conditions that lead to premature ovarian insufficiency.’
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For women who are undergoing fertility treatment in particular, health practitioners emphasised the importance of repeated tests over a period of time because, as endocrinologist Dr D explained, ‘ovarian function [in women diagnosed with spontaneous EM] may recover … there is a chance of fertility there…’
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Further Information
Talking Points (Health Practitioners)
- Delivery of diagnosis of early menopause and emotional impact
- Telling women that medical or cancer treatment may cause early menopause
- Symptoms of early menopause
- Personal and emotional impact of early menopause on women
Talking Points (Women)
Other resources
- Resources and Information page – health practitioners
- Early Menopause – Diagnosis and Evaluation Algorithm
- Early Menopause – Management Algorithm
- Webpage: Guideline on the management of POI (ESHRE)
- Webpage: Clinical practice guidelines for the care of girls and women with Turner Syndrome (ESHRE)
- Journal article: Baber R, Panay N & Fenton A the IMS Writing Group (2016) 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric, 19:2, 109-150, DOI: 10.3109/13697137.2015.1129166