Premature menopause (before the age of 40) and early menopause (before the age of 45), whether spontaneous or induced, are associated with long-term health risks which may include premature death, cardiovascular disease (ishaemic heart disease and stroke), osteoporosis, neurologic disease (cognitive impairment, Pakrinson’s disease), psychosexual dysfunction and mood disorder. The age of the onset of oestrogen deficiency appears to be an important determinant of long-term health. Therefore, the younger a woman is at the time of the diagnosis of premature menopause (premature ovarian failure - POF) the greater the risk of all disorders mentioned above. Oestrogen can mitigate some of these consequences.
HRT is strongly advised for women with premature menopause for long-term use until the normal age of menopause (50 to 51 years). There is some evidence that restoring low oestroegn levels will reduce later development of cardiovascular disease, steoporosis and possibly dementia. It is presumed that long-term use of HRT in this population of women does not increase the risk of breast cancer.
It is well known that women with POF and early menopause have decreased risk of breast cancer. Therefore well balanced standard HRT dose, whish contains relatively small amounts of oestrogen and progesterone is not expected to increase the risk of breast cancer at least up to the age of 50 years. If their ovaries continued to function all these women would have been exposed to much higher levels of oestrogen and porogesteron than those present in their HRT. The fact is, however, that we lack long-term outcome data in this population of women. This is why caution is recommended and it is advisable that HRT dose should be decreased with time.