Premature Menopause: Clinical Significance and therapeutic Options 61 PREMATURE MENOPAUSE: CLINICAL SIGNIFICANCE AND THERAPEUTIC OPTIONS

When we use the term “premature menopause” or climacterium praecox, we mean cessation of the normal cyclic ovarian function prior to the age of 40. Some authors have defined the limit at an even earlier age, namely 35 and in some cases even 30 [1]. Especially in young women, speaking of a prema­ ture menopause often causes problems for psychological reasons. The thought of being menopausal at such an early age produces worries and fears in many of the patients, especially if they still want children. Since a premature menopause may sometimes be tran­ sient, it is probably more acceptable to the younger patients if the term “hyper­ gonadotropic amenorrhea” is used. The occurrence of premature ovar­ ian failure was described as early as 1920 [2]. In 1950, Arias [3] published 20 cases and in 1957 Perlhoff and Schneeberg [4] published 27 cases of younger women with a premature cli­ macterium and increased gonadotro­ pin excretion. In 1965, Kinch et al. [5] reported on an afollicular and a follicular form of premature ovarian insufficiency. Aiman and Smentek [6] reported that 18% of 157 women with ovarian biopsies had intact oocytes. Other authors reported a similar rate [7]. In 1967, De Moraes-Ruehsen and Tones [8] published three possible causes of premature menopause: 1. Reduced number of germ cells at the time of birth 2. Acceleration of the normally con­ stant follicular atresia processes 3. Postnatal destruction of germ cells in the ovaries