title: Long-term health consequences of premature or early menopause and considerations for management.
abstract: OBJECTIVE
  To review the current evidence concerning the long-term harmful effects of premature or early menopause, and to discuss some of the clinical implications.
  
  
  METHODS
  Narrative review of the literature.
  
  
  RESULTS
  Women undergoing premature or early menopause, either following bilateral salpingo-oophorectomy or because of primary ovarian insufficiency, experience the early loss of estrogen and other ovarian hormones. The long-term consequences of premature or early menopause include adverse effects on cognition, mood, cardiovascular, bone, and sexual health, as well as an increased risk of early mortality. The use of hormone therapy has been shown to lessen some, although not all of these risks. Therefore, multiple medical societies recommend providing hormone therapy at least until the natural age of menopause. It is important to individualize hormone therapy for women with early estrogen deficiency, and higher dosages may be needed to approximate physiological concentrations found in premenopausal women. It is also important to address the psychological impact of early menopause and to review the options for fertility and the potential need for contraception, if the ovaries are intact.
  
  
  CONCLUSIONS
  Women who undergo premature or early menopause should receive individualized hormone therapy and counseling.
authors.affiliation: Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic , Rochester, MN.
authors.forename: S S
authors.initials: SS
authors.lastname: Faubion
authors.forename: C L
authors.initials: CL
authors.lastname: Kuhle
authors.forename: L T
authors.initials: LT
authors.lastname: Shuster
authors.forename: W A
authors.initials: WA
authors.lastname: Rocca
mesh_terms: D000328:Adult; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods; D004967:Estrogens / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008594:Menopause, Premature / Q000187:drug effects / Q000502:physiology / Q000523:psychology; D008603:Mental Health; D010052:Ovariectomy; D011183:Postoperative Complications / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D016649:Primary Ovarian Insufficiency / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D058994:Salpingectomy
chemical_list: D004967:Estrogens
keywords: EARLY MENOPAUSE; ESTROGEN; HORMONE THERAPY; OOPHORECTOMY; PREMATURE MENOPAUSE
references.citation: Menopause. 2014 Sep;21(9):952-61
references.pmid: 24473536
references.citation: Osteoporos Int. 2014 Oct;25(10):2359-81
references.pmid: 25182228
references.citation: J Obstet Gynecol Neonatal Nurs. 2001 Mar-Apr;30(2):202-8
references.pmid: 11308110
references.citation: Maturitas. 2003 Apr 25;44(4):279-86
references.pmid: 12697368
references.citation: Menopause. 2011 Jul;18(7):786-93
references.pmid: 21407138
references.citation: Osteoporos Int. 2003 Jul;14(6):525-30
references.pmid: 12730751
references.citation: Climacteric. 2011 Aug;14(4):445-52
references.pmid: 21545272
references.citation: Menopause Int. 2008 Sep;14(3):111-6
references.pmid: 18714076
references.citation: Brain Res. 2011 Mar 16;1379:188-98
references.pmid: 20965156
references.citation: Neurology. 2007 Jan 2;68(1):33-8
references.pmid: 17200489
references.citation: Fertil Steril. 2009 Aug;92(2):688-93
references.pmid: 18829005
references.citation: Climacteric. 2009 Oct;12(5):404-9
references.pmid: 19479488
references.citation: Am J Obstet Gynecol. 2006 Mar;194(3):711-7
references.pmid: 16522402
references.citation: Menopause. 2010 May-Jun;17(3):506-10
references.pmid: 20042893
references.citation: Obstet Gynecol. 2012 May;119(5):935-41
references.pmid: 22525904
references.citation: Obstet Gynecol. 2004 Nov;104(5 Pt 1):1042-50
references.pmid: 15516400
references.citation: Menopause. 2012 Mar;19(3):257-71
references.pmid: 22367731
references.citation: Dement Geriatr Cogn Disord. 2010;30(1):43-50
references.pmid: 20689282
references.citation: Menopause. 2008 Nov-Dec;15(6):1050-9
references.pmid: 18724263
references.citation: Hum Reprod. 2003 Jan;18(1):199-206
references.pmid: 12525467
references.citation: Fertil Steril. 2005 Jun;83(6):1734-41
references.pmid: 15950644
references.citation: Menopause. 2009 Jan-Feb;16(1):15-23
references.pmid: 19034050
references.citation: Maturitas. 2013 Oct;76(2):109-10
references.pmid: 23849176
references.citation: Menopause. 2005 May-Jun;12(3):281-90
references.pmid: 15879917
references.citation: Int J Womens Health. 2014 Feb 20;6:235-43
references.pmid: 24591848
references.citation: Neurology. 2012 Oct 30;79(18):1846-52
references.pmid: 23100399
references.citation: Eur J Prev Cardiol. 2016 Jan;23(2):178-86
references.pmid: 25331207
references.citation: Menopause. 2008 Jan-Feb;15(1):23-31
references.pmid: 18257141
references.citation: J Psychosom Obstet Gynaecol. 1993 Dec;14(4):283-93
references.pmid: 8142982
references.citation: Maturitas. 2008 Apr 20;59(4):323-8
references.pmid: 18495388
references.citation: Ann N Y Acad Sci. 2010 Sep;1205:254-61
references.pmid: 20840281
references.citation: Cancer Treat Rev. 2008;34 Suppl 1:S3-18
references.pmid: 18515009
references.citation: Obstet Gynecol. 2010 Nov;116(5):1088-95
references.pmid: 20966693
references.citation: Menopause. 2014 Apr;21(4):391-8
references.pmid: 24061049
references.citation: JAMA. 2004 Jun 23;291(24):2947-58
references.pmid: 15213206
references.citation: J Bone Miner Res. 2004 Jul;19(7):1172-80
references.pmid: 15177001
references.citation: Menopause. 2004 Nov-Dec;11(6 Pt 2):766-77
references.pmid: 15543028
references.citation: Menopause. 2012 Aug;19(8):942-7
references.pmid: 22415565
references.citation: JAMA. 2006 Mar 22;295(12):1374-6
references.pmid: 16551707
references.citation: J Clin Oncol. 2006 Aug 1;24(22):3576-82
references.pmid: 16877724
references.citation: Stroke. 2009 Apr;40(4):1044-9
references.pmid: 19233935
references.citation: Obstet Gynecol. 2005 May;105(5 Pt 1):944-52
references.pmid: 15863529
references.citation: Obstet Gynecol Clin North Am. 2012 Dec;39(4):567-86
references.pmid: 23182561
references.citation: Womens Health (Lond Engl). 2009 Jan;5(1):39-48
references.pmid: 19102639
references.citation: Menopause. 2015 Jan;22(1):12-6
references.pmid: 24824644
references.citation: Menopause. 2015 Jan;22(1):1-3
references.pmid: 25490113
references.citation: Menopause. 2014 Jun;21(6):592-601
references.pmid: 24253486
references.citation: Menopause. 2014 Jun;21(6):585-91
references.pmid: 24423934
references.citation: Lancet Oncol. 2006 Oct;7(10):821-8
references.pmid: 17012044
references.citation: J Neurosci. 2006 Oct 11;26(41):10332-48
references.pmid: 17035515
references.citation: J Clin Endocrinol Metab. 2014 Oct;99(10):3489-510
references.pmid: 25279570
references.citation: Menopause Int. 2007 Mar;13(1):44-5
references.pmid: 17448268
references.citation: J Neurol Neurosurg Psychiatry. 2005 Jan;76(1):103-5
references.pmid: 15608005
references.citation: N Engl J Med. 2007 Jun 21;356(25):2639-41
references.pmid: 17582075
references.citation: J Bone Miner Res. 2000 Oct;15(10):1965-73
references.pmid: 11028449
references.citation: Maturitas. 1994 Aug;19(2):117-24
references.pmid: 7968644
references.citation: J Clin Endocrinol Metab. 2013 Jul;98(7):2716-24
references.pmid: 23678038
references.citation: Menopause. 2012 Mar;19(3):272-7
references.pmid: 21993082
references.citation: Obstet Gynecol. 2009 May;113(5):1027-37
references.pmid: 19384117
references.citation: J Clin Endocrinol Metab. 2011 Jan;96(1):53-8
references.pmid: 21118827
references.citation: Maturitas. 2012 Jan;71(1):1-2
references.pmid: 22079872
references.citation: Calcif Tissue Int. 1991 Aug;49(2):90-4
references.pmid: 1913299
references.citation: Neurology. 2008 Jan 15;70(3):200-9
references.pmid: 17761549
references.citation: Mol Cell Endocrinol. 2014 May 25;389(1-2):7-12
references.pmid: 24508665
references.citation: J Clin Endocrinol Metab. 2004 Aug;89(8):3907-13
references.pmid: 15292326
references.citation: Menopause. 2010 Sep-Oct;17(5):938-45
references.pmid: 20651619
references.citation: Menopause. 2007 May-Jun;14(3 Pt 2):567-71
references.pmid: 17476146
references.citation: J Clin Epidemiol. 1996 Oct;49(10):1111-5
references.pmid: 8826990
references.citation: Menopause. 2012 Jun;19(6):616-21
references.pmid: 22648302
references.citation: Neurology. 2014 Jan 21;82(3):222-9
references.pmid: 24336141
references.citation: Obstet Gynecol. 2013 Apr;121(4):709-16
references.pmid: 23635669
references.citation: BMJ. 1995 Jun 17;310(6994):1570-1
references.pmid: 7787646
references.citation: Arch Intern Med. 2011 Apr 25;171(8):760-8
references.pmid: 21518944
references.citation: Menopause. 2012 May;19(5):510-6
references.pmid: 22547252
references.citation: N Engl J Med. 2000 Sep 7;343(10):682-8
references.pmid: 10974131
references.citation: Obstet Gynecol. 2000 Mar;95(3):319-26
references.pmid: 10711536
references.citation: Climacteric. 2012 Oct;15(5):481-9
references.pmid: 22335389
references.citation: J Clin Endocrinol Metab. 2011 Nov;96(11):3502-10
references.pmid: 21880799
references.citation: Menopause. 2012 Oct;19(10):1081-7
references.pmid: 22692332
references.citation: Neurology. 2014 Jan 21;82(3):196-7
references.pmid: 24336139
references.citation: Menopause Int. 2013 Jun;19(2):59-68
references.pmid: 23761319
references.citation: Maturitas. 2010 Feb;65(2):161-6
references.pmid: 19733988
references.citation: Eur Heart J. 2011 Mar;32(6):745-50
references.pmid: 21186237
references.citation: Menopause. 2013 Sep;20(9):888-902; quiz 903-4
references.pmid: 23985562
references.citation: Ann Neurol. 2011 Jan;69(1):163-9
references.pmid: 21280086
references.citation: Ann Intern Med. 1976 Oct;85(4):447-52
references.pmid: 970770
references.citation: N Engl J Med. 2009 Feb 5;360(6):606-14
references.pmid: 19196677
references.citation: J Clin Endocrinol Metab. 2011 Feb;96(2):E278-87
references.pmid: 21047929
references.citation: Maturitas. 1992 Jan;14(2):103-15
references.pmid: 1565019
references.citation: Maturitas. 2013 Apr;74(4):391-2
references.pmid: 23497918
references.citation: Neurology. 2007 Sep 11;69(11):1074-83
references.pmid: 17761551
references.citation: Menopause. 2006 Mar-Apr;13(2):265-79
references.pmid: 16645540
references.citation: JAMA. 2004 Jan 7;291(1):47-53
references.pmid: 14709575
references.citation: J Steroid Biochem Mol Biol. 2014 Jul;142:107-14
references.pmid: 23727129
references.citation: Presse Med. 1996 Feb 24;25(7):277-80
references.pmid: 8685165
references.citation: Menopause. 2014 Apr;21(4):355-60
references.pmid: 23942250
references.citation: Menopause. 2014 Jun;21(6):558-60
references.pmid: 24755898
references.citation: Br J Cancer. 2011 Jun 28;105(1):22-7
references.pmid: 21654687