Approximately 1 in every 1000 women between the ages of 15-29 and 1 in every 100 women between the ages of 30-39 are affected by premature ovarian failure (POF) also called premature menopause. A woman can be affected by POF at any age or time in her life. It can happen before or after she has had children or while she is still planning her family. No matter what season of life, it is overwhelming and many times there are questions that are left unanswered. The following are some of the most frequently asked questions about POF.
What is Premature Ovarian Failure (POF)?
Premature ovarian failure is the loss of ovarian function in women under the age of 40. Women with POF do not ovulate (release an egg) each month. This loss of function can be due to a less than normal amount of follicles or a dysfunction in the ovaries.
How does ovulation work?
Before we begin to understand ovarian failure we need to understand ovulation. In brief, a female is born with about 2 million ovarian follicles. As she gets older and reaches puberty she will only have about 300,000-400,000 left. The body does not make anymore. These follicles are very important because they mature to be eggs that will be released during ovulation. Now 300,000 may sound like a lot, but not every follicle becomes a mature egg.
When your menstrual cycle begins, your estradiol (estrogen) levels are low. Your hypothalamus (which is in charge of maintaining your hormone levels) sends out a message to your pituitary gland which then sends out a follicle stimulating hormone (FSH). This FSH triggers a few of your follicles to develop into mature eggs. Remember only one follicle will be the lucky one to become a mature egg. As the follicles mature they send out another hormone, estrogen. Estrogen sends a message to the hypothalamus to stop producing FSH. If the follicles do not mature and produce estrogen to stop the production of FSH, FSH will continue to produce and rise to high levels. This is why women with POF are checked for high levels of FSH. Once the levels of estrogen are high enough, the hypothalamus and pituitary gland know that there is a mature egg. A lutenizing hormone (LH) is then released; this is referred to as your LH surge. Within 24-36 hours of the LH surge the mature egg is released and ready for fertilization. During this period, progesterone has been thickening and preparing your uterine lining for implantation. If fertilization does not occur, then the egg dissolves and a few days later your hormone levels will decrease and your uterine lining will begin to shed. This is called menstruation (menstrual period) and brings us back to day 1 of your cycle. The journey then begins all over again.
Is there a difference between Premature Ovarian Failure (POF) and Menopause?
Menopause usually occurs on average around age 51. Premature ovarian failure can occur at any age before 40, usually on average around age 27. When a woman experiences menopause, she no longer has follicles to produce into eggs and therefore no longer gets her menstrual period.
A woman with premature ovarian failure, or premature menopause, may still have follicles, but there may be a depletion or dysfunction of these. Therefore, she can still get her period; however, most of the time her period is irregular. Irregular periods are one of the signs for POF. Keep in mind that there may be other explanations for an irregular period. Always discuss any irregularity in your menstrual cycle with your healthcare provider.
What are the Symptoms for Premature Ovarian Failure (POF)?
• Irregular periods (different length of bleeding or change in flow) • Hot flashes • Night sweats • Decrease in sexual drive • Irritability • Painful sex • Thinning and drying of vagina
Some women may continue to have normal periods and show no symptoms. Diagnosis may only be discovered when the FSH levels are measured and come back with elevated levels. Discuss any menstrual changes or symptoms with your healthcare provider before coming to any conclusion about POF.
What are my options if I have Premature Ovarian Failure (POF)?
Options for women who have POF and are seeking to have children include: using donor eggs, fertility treatments or seeking to adopt a child. Doctors may also try a variety of fertility treatments such as:
- Gonadotropin-releasing hormone (GnRH)
- Estradiol and corticosteroids (such as prednisone)
- Clomid (Clomiphene citrate)
- Human menopausal gondotropins (hMG)
None of these treatments have been proven to be effective in restoring fertility, but they are often still used. However, 8% of women with POF who have conceived were using Hormone Replacement Therapy (HRT). Even though there is no absolute treatment, HRT has been one aid in helping women achieve pregnancy.
What causes Premature Ovarian Failure (POF)?
Unfortunately, for most women the cause is unknown. There are, however, some causes that may be identified which include:
• Autoimmune disorder • Genetics • The end of a treatment for cancer with radiation or chemotherapy
• Hysterectomy with both ovaries removed • Thyroid dysfunction • Turner syndrome • Viral infection • Inadequate gondaotropin secretion or action • Eating Disorders
Where can I get more help?
If you have been diagnosised with premature ovarian failure and wish to get more information and support, you can visit the International Premature Ovarian Failure Association at ww.pofsupport.org
If you suspect that you may have symptoms of POF, contact your healthcare provider.
Compiled using information from the following sources:
Danforth’s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 41.
The International Premature Ovarian Failure Association, www.pofsupport.org