The average age of menopause in the U.S. is age 51 yrs. If a woman enters menopause before age 40 yrs, she is considered to have premature ovarian failure (POF) which essentially means that the ovaries have stopped functioning earlier than would be expected. The signs and symptoms would include seldom or absent periods as well as hot flashes, which are a frequent complaint. There are certain genetic conditions that are associated with premature failure of the ovaries, such as fragile X syndrome. It is now recommended by the American College of Obstetricians and Gynecologists (ACOG) that women with premature ovarian failure be offered testing for Fragile X syndrome. This syndrome is the most common cause of inherited mental impairment and is caused by an abnormality in the gene FMR1 located on the X-chromosome. Mostly males are more severely affected and females are usually carriers of the mutation. This mutation is important to test for because it can propagate in severity over generations.

 Other things that can cause premature ovarian failure are autoimmune conditions, Turner’s syndrome, prior multiple ovarian surgeries, lifestyle factors like heavy smoking, and a lot of times the cause is idiopathic, which essentially means that the cause is unidentifiable with current tests and knowledge. The important thing to remember is that in young women with POF, it is important to get started on hormone replacement therapy (HRT) for protection against osteoporosis and cardiovascular disease, at least until natural age of menopause is reached, after which the indications for HRT can be reassessed. For the purposes of fertility, women with POF typically have to use donor eggs.  Although, in some women with POF, occasional spontaneous ovulation and pregnancy can occur, this is exceedingly rare. Donor egg remains the best option. Diagnosis of premature ovarian failure is made by clinical history of absent periods and significantly elevated levels of the hormone FSH in the serum.