When climacteric symptoms occur in women, they usually appear between the ages of 40 and 50. They are occasionally seen in women past 60, are quite uncommon before 30 and rare before 20. In almost all cases climacteric symptoms are antedated by relatively normal menstrual periods.
Climacteric symptoms appearing before the menarche are very rare. Albright1 has used the term premenarchal menopause praecox in referring to cases of primary amenorrhea with little or no breast development and persistently positive tests for urinary gonadotrophins. However, similar cases which we have encountered and patients with primary amenorrhea in general do not have menopausal symptoms. In the case reported here climacteric symptoms appeared before the onset of the menses and at an age when puberal changes are not ordinarily complete. In addition to the primary amenorrhea there were typical signs of moderately severe prepuberal primary ovarian deficiency.
An unmarried white woman, aged 21, was seen on October 29, 1942 with the complaint of frontal headache of fifteen years' duration. The headaches occurred almost every day over periods of two to three weeks. They were never bilateral but were associated with nausea. Mild diplopia was present but was associated with close work only.
The patient had never menstruated. Since the age of 15 she had experienced hot flashes typical of ovarian deficiency, which spread upward over the neck and head and lasted a few minutes several times daily. They were always more pronounced when she was under nervous tension or had a. . .