Premature Ovarian Failure

Premature ovarian failure is a condition that causes loss of function of ovaries before the age of menopause or 40 years of age.

This causes the loss of normal flow of hormones from the ovaries and infertility. Though often compared and labelled as premature menopause, the two conditions are not the same.

Menopause cause total cessation of the function of ovaries and they will not produce hormones or eggs.

The ovaries affected with premature ovarian failure may still produce eggs from time to time and it is possible for the woman to have menses or get pregnant.

Most signs and symptoms of premature ovarian failure are somewhat similar to menopause because both conditions are caused by halted production of hormones by the ovaries:

• Cessation or irregular menses, which may go for years or after pregnancy or soon after stopping use of birth control pills
• Hot flashes, sweating and unexplained sensation of heat
• Profuse sweating at night or during sleeping hours (night sweats)
• Unusual dryness of the vagina
• Inability to focus or concentrate
• Loss of interest in sexual activities

You need to see a doctor if you skipped menses for three months or more. Changes in menses can happen due to things like intense exercise, stress, diet changes, and pregnancy.

Changes in the schedule of menses, or cessation of monthly periods, must be evaluated by a doctor at all times to prevent undesirable problems like bone loss and infertility.

In some cases, the cause of premature ovarian failure is unknown.

The hormones produced by the pituitary gland govern the activity of the ovaries. The pituitary gland produces hormones in a carefully timed manner so the only small number of follicles (immature egg cells) in the ovaries will mature at a time.

Normally, only a single follicle will mature into egg cell during each month. This regular activity of the ovaries is responsible for regular menses, and if an egg cell becomes fertilized by the sperm cell, pregnancy.

Premature ovarian failure occurs if the follicles in the ovaries are depleted or functions abnormally. The follicles can develop abnormally due to genetic defects like Turner’s syndrome and Fragile X syndrome.

Certain toxins from things like chemotherapy and radiation therapy can also harm the follicles and cause premature ovarian failure. Some cases of premature ovarian failure are caused by abnormal immune system functioning, causing it to react and harm follicles instead.

Conditions like lupus and thyroid disorders are caused by immune system problems and associated with premature ovarian failure.

You probably will first consult a primary care physician or gynecologist to receive a diagnosis of premature ovarian failure. If you have fertility issues, you will be referred to a specialist doctor (reproductive endocrinologist) that helps couples conceive.

Preparing is a key to better diagnosis and treatment.

You can get ready by doing the following:

• Make a list. List of your symptoms and when did they start. Also, make a list of your medications (including vitamins and supplements) and questions you might want to ask your doctor.
• Track your menses firsthand. Note the dates when menses started or stopped, and the days in between.
• If possible, bring a close friend or family member (or spouse) along. This will help you remember all the information your doctor tells you.

Here are ideas on questions you might want to ask your doctor:

• What could have caused my menses to stop or become irregular?
• What are the tests I should have to find out the problem?
• What are the treatments and the side effects? What are the alternatives? What would be the best for my case?
• Will the treatments cause problems during sex such as low desire, lack of lubrication or pain?
• What would be the best for my problem if I have other health conditions?
• Are any restrictions I have to follow?
• Would I be referred to another specialist? Is that covered by my insurance?
• Are there any printed or online materials to help me better understand my condition?

Your doctor might ask you some questions about the following:

• Usual menstrual schedule missed menses or no periods at all
• Symptoms of hot flashes, dryness of the vagina and depressed mood, and how long did you have them
• History of surgery (especially on the ovaries) and getting treatment for cancers
• Family history of premature ovarian failure, thyroid problems and lupus
• Difficulties with previous pregnancies
• Recent or unexplained weight gain
• Any medications or supplements were taken

Treatment of premature ovarian failure depends on your goals. There is no treatment that completely restores normal function of the ovaries, but there are procedures to make pregnancy possible or, at least, reduce undesirable effects of the condition.

Premature ovarian failure causes profound estrogen deficiency, which results in problems such as osteoporosis and symptoms like hot flashes and vaginal dryness.

The doctor may recommend hormone therapy, which involves regular injections of the hormones progesterone and estrogen to compensate for the lack of hormone production in the ovaries. This procedure does not restore the ovaries, but can help prevent osteoporosis, reduce hot flashes and other effects of estrogen deficiency.

Hormone therapy itself is associated with problems like heart disease and certain cancers. The doctor will recommend hormone therapy based on risks and benefits. If everything went well, hormone therapy is continued until you reach around 50 years of age, the age of menopause.

You may also have to take calcium and vitamin D supplements to address osteoporosis. Depending on your needs, you be prescribed with calcium 1,200 mg 600 IU/ day and vitamin D 600 IU/day. Estrogen deficiency in premature ovarian failure tends to weaken the bones, especially if you do not get enough calcium in the diet. Weak bones can increase your risk of falls. The doctor may suggest a bone density test to measure the health of your bones.

Premature ovarian failure causes irreversible infertility. Some couples may try to have in-vitro fertilization to be able to conceive. In this case, it requires using donor’s eggs that will be fertilized using the male partner’s sperm in a laboratory. Then the fertilized egg is planted in your uterus, and you will take medications necessary to support pregnancy. The medications are stopped once pregnancy progresses well.

In general, premature ovarian failure (POF) can be neither predicted nor prevented.

Having premature ovarian failure can be a source of severe emotional distress, especially if the woman wants to have children.

For couples wanting to conceive, you may discuss having in-vitro fertilization to your doctor. You may also consider adoption as well. Inversely, you may want to consider using reliable birth control because it is still possible for you to get pregnant.

Your bone health is an important issue if you have premature ovarian failure or menopause. Make sure to take calcium and vitamin D supplements regularly and eat plenty of dark green vegetables. Weight bearing and strengthening exercises and avoid tobacco smoke to improve the health of your bones.

Aside from being in ages 35 to 40 years, your risk of having premature ovarian failure is increased if you have someone in the family with the same condition.