My wife, age 33, is in excellent physical health, but has been under a great deal of stress for 15 months or so. Nine months ago she was diagnosed with premature menopause. However, although she has high levels of FSH, she also continues to have high levels of estrogen. The doctors have said that this appears to present a contradiction. She has been experiencing hot flashes, cessation of periods, etc. Do high levels of estrogen conflict with the diagnosis of premature menopause? A psychologist we consulted says she believes the hormonal trouble is psychogenic and emotional-based, and so might be reversible with therapy. Could her condition be psychological and treatable with psychotherapy?

E.A.

High levels of FSH and cessation of menses most likely indicates premature ovarian failure. Careful review of the medical history will often reveal clues to help understand what led to this condition. For instance, has she been exposed to radiation or chemotherapy? A chromosomal analysis can often pinpoint a genetic basis for premature menopause. Newer studies have indicated a certain type of abnormality of the X chromosome that is similar to Fragile X syndrome (a condition that leads to mental retardation in males), so we advise including the test for Fragile X along with the routine chromosomal analysis. www.repromedix.com Testing for anti-ovarian antibodies may indicate an immune basis for ovarian failure. Unfortunately, most of the time we can't come up with a reason.

However, I too am concerned about high FSH levels in the presence of normal estrogen levels. Where does this estrogen come from? Is she taking any medications that may contain estrogen? If she is overweight, it's possible that normal levels of male hormone produced by the ovaries and adrenal glands is being converted into estrogen. Still, if her estrogen levels are normal, she should not be having menopausal symptoms such as hot flashes, and the uterine lining should be stimulated to grow and shed, causing some sort of vaginal bleeding.

An ultrasound examination of the ovary may provide clues to this confusing conflict. If the uterine lining is thin, and the ovaries are quiet (no follicular activity), then I would doubt that estrogen production and levels are really normal. If however, the uterine lining is thickened, and there is follicular activity, she may have inappropriate secretion of FSH by the pituitary gland. In fact, if both the FSH and estrogen level are high, an MRI of the hypothalamus and pituitary gland should be done to be certain she does not have the very rare condition of a FSH-secreting pituitary tumor.

In any case, this condition is not stress-related or of psychogenic origin. While psychological counseling is often helpful for people whose fertility dreams are interrupted, I am concerned by the misinformation that your counselor has provided regarding a potential psychogenic cause of this condition. I think she would do well to see a fellowship-trained reproductive endocrinologist who can not only accurately diagnose her condition, but can also provide you with information about the potential of egg donation.