Periods in Young Women Could be Warning Sign for
menstrual periods in young women may be a warning
sign of a hormonal shortage that could lead to
osteoporosis, according to a preliminary study by
researchers at the National Institute of Child
Health and Human Development (NICHD). The study, of
women with a condition known as premature ovarian
failure, appears in the May issue of Obstetrics and
Premature ovarian failure occurs when the ovaries
stop producing eggs and reproductive hormones well
in advance of natural menopause. An estimated one
percent of American women develop the condition by
Most of the women who took part in the study
reported a history of amenorrhea-absence of a
menstrual period for three months or more-before
they were later diagnosed with premature ovarian
failure. Moreover, the majority of these young women
had not considered amenorrhea as a significant
"These findings suggest that women and their
physicians may want to err on the side of caution
and evaluate menstrual irregularities early," said
Duane Alexander, M.D., Director of the NICHD.
The NICHD researchers surveyed 48 women with
premature ovarian failure, to try to gain an
understanding of the early signs of the disorder,
according to the study's first author, Nahrain H.
The 48 women surveyed visited the National
Institutes of Health Clinical Center between
September 2000 and June 2001. Most of the women
interviewed did not view a change in menstrual
pattern as an important health issue and this factor
may have contributed to a delay in their receiving a
diagnosis of premature ovarian failure.
"Because missed periods are common symptoms in young
women, it's understandable that more than half of
our patients weren't concerned at first," said the
study's senior author, Lawrence Nelson, M.D., of
NICHD's Unit on Gynecologic Endocrinology "But the
delay in evaluating and treating ovarian
insufficiency may place young women at increased
risk of developing osteoporosis in later years."
The diagnosis of premature ovarian failure can be
problematic, Dr. Nelson said. Although 3 percent of
young women will experience amenorrhea in a given
year, most of them do not go on to develop premature
ovarian failure. Yet by the time they receive a
diagnosis, many women with premature ovarian failure
experience bone loss serious enough to possibly
place them at risk for later bone fractures.
In an earlier study of 89 women with premature
ovarian failure, Dr. Nelson and his colleagues had
found that 67 percent of the women had already
developed osteopenia-the low bone density that
precedes osteoporosis. Dr. Nelson said he suspects
that the high rate of bone loss in women with
premature ovarian failure might be due to a delay in
diagnosing and treating the hormonal shortfall that
accompanies the disorder.
Osteoporosis results from a loss of bone density,
which, in turn, leads to weaker bones that are more
likely to break. Estrogen and other reproductive
hormones produced by the ovary help to maintain bone
density. Although osteoporosis is more common after
menopause, younger women who are lacking sufficient
ovarian hormone production-particularly those with
premature ovarian failure-may also develop the
In the current study, the researchers found that 92
percent of the women with POF reported a change in
menstrual cycle as the first symptom they
experienced. Moreover, more than half of the women
with amenorrhea reported seeing three or more
different providers before they received their
diagnosis. One fourth of the women did not receive a
diagnosis for five or more years after the beginning
of menstrual irregularity.
In almost all cases, at least some laboratory
testing will need to be performed to determine the
cause of the irregular periods, Dr. Nelson said.
Typically, tests to detect premature ovarian failure
measure the amount of a reproductive hormone in the
blood known as follicle stimulating hormone (FSH for
short). Treatment for premature ovarian failure
usually consists of replacing the missing
reproductive hormones estrogen and progesterone.
"It's relatively easy to measure a blood FSH level
to detect ovarian failure early," Dr. Nelson said.
"When dealing with osteoporosis an ounce of
prevention is worth a pound of cure."
The NICHD is part of the National Institutes of
Health, the biomedical research arm of the federal
government. The Institute sponsors research on
development, before and after birth; maternal,
child, and family health; reproductive biology and
population issues; and medical rehabilitation.
publications, as well as information about the
Institute, are available from the NICHD Web site,
the NICHD Information Resource Center,