Premature Ovarian Failure

Sometimes, women in their 20s, 30s or early 40s may start having irregular periods or miss them altogether for a few months. This may be a symptom of premature ovarian failure, a term used to describe the dysfunction of the ovaries or the depletion of follicles in a woman’s body before the age of 40. In medical terms, it is also known as Primary Ovarian Insufficiency and affects between 1% and 4% of women. Though a taxing issue, POF is not the permanent loss of ovarian activity, unlike menopause, and in some cases is also reversible.

The Woman’s Body

To gain a better understanding of POF, it is first important to know what happens inside a woman’s body. From birth, every woman has millions of ovarian follicles in her body, which shrink down to around 300,000 to 400,000 by the time she reaches puberty. During your monthly cycle, one ovarian follicle matures to an egg and is released during ovulation. This process continues from puberty till the age of about 50, after which the supply of eggs in the ovary is basically depleted and you are said to have reached your menopausal years.

But in some cases, the supply of eggs to the ovaries is somehow stopped earlier than the normal menopause age. It is not a natural phenomenon and may even occur to someone in her teens. This loss of ovarian function is called Premature Ovarian Failure or POF.

Causes of POF

Unfortunately, in most woman, the cause of this sudden ovarian dysfunction is not known, though research is going on to analyse this issue. Some probable causes may be:

• The presence of a fragile or complete absence of an X chromosome. The female body normally has two X chromosomes, which are also responsible for the normal growth of the body and its parts. If a segment of such an X chromosome is missing, the body may not create enough follicles or uses them very early on in life.
• Other genetic conditions like Turner syndrome, Swyer syndrome or an androgen insensitivity syndrome.
• Enzyme defects, like galactosemia, thalassemia and hemochromatosis.
• Viral infection.
• Exposure to radiations, such as chemotherapy.
• Ovaries surgically removed.
• Inadequate secretion of FSH or LH

Menopause and POF

POF should not be confused with menopause or early menopause because the symptoms are different. Menopause refers to the condition when the woman does not have any follicles left that can mature into eggs and thus the menstrual periods totally cease to occur. It usually happens naturally in women in their late 40s to early 50s. On the other hand, someone with POF is typically less than 40 years and may still have a number of ovarian follicles left but is incapable of having regular periods because of depletion or ovarian dysfunction.

Age is the key factor to consider when classifying the condition as premature ovarian failure. Studies have revealed that 1 in100 women under the age of 40, 1 in 1000 women under the age of 30 and 1 in 10,000 women under the age of 20 suffer from this condition. In the UK, approximately 110,000 women from teens to the age of 40 have been known to have POF.

Symptoms of POF

A woman’s monthly cycle is an important way to know about her overall health and having irregular or missed periods for a considerable time is one major symptom of POF. Other symptoms attributed to this disorder include:

• Irritability
• Sleeping disorders
• Night sweats
• Vaginal dryness
• Decreased sexual interest
• Bladder control problems
• Painful sex
• Mood swings

POF is also not just a gynaecological problem. This is because, in females, the follicular stimulating hormone (or FSH) signals to the ovaries to make estrogen. Normally, the FSH level is around 10 to 15 mlU/ml in the blood. However, if the ovaries are not functioning, as is the case with POF, no estrogen is made and the FSH level may increase to as high as 40 mlU/ml. Therefore, it also becomes an endocrinal problem. Testing the FSH level in the blood is consequently a good way of knowing whether someone is suffering from POF or not.

Affect on Overall Health

With low levels of estrogen, which is also responsible for the conservation of calcium and other minerals in the bones, POF may lead to osteoporosis or the weakening of the bones. Doctors suggest regular calcium and vitamin intake along with weight bearing and muscle bearing physical activity to help prevent this bone condition.

Hypothyroidism or low level of thyroids, which can lead to sluggishness and low energy, is also something to be cautious about. The thyroid is a gland that releases hormones necessary to control your body’s metabolism and energy levels. It has been found that about 27% of women with POF also have hypothyroidism. In the general population, hypothyroidism affects about 2% of women and men.

Woman with POF also have an increased chance of getting an autoimmune disorder, whereby the immune cells of the body attack the adrenal glands that regulate the body’s response to stress and its handling of salt. Women with POF are more likely ot develop this disease, with about 3.2% of POF sufferers experiencing an autoimmune disorder. Initial symptoms can include weight loss, dizziness, and fatigue. Eventually, you may also develop low blood pressure and salt cravings. The use of of additional drugs to induce the secretion of hormones that the adrenal glands are not able to make can help curb the disorder.

Diabetes, anaemia, cardiac problems, vitiligo, and lupus are some of the other women’s health problems associated with POF.

POF and Infertility

Premature Ovarian failure can affect a woman at any age in her life. This may be after the birth of a baby, or even before she starts getting her menstrual cycles. Thus, the most overwhelming part of this issue is the factor of infertility or getting pregnant. Because POF causes the cessation of your periods, getting pregnant can be nearly impossible without treatment. Luckily, there are a variety of treatment options nowadays for women with POF hoping to get pregnant.

Treatments

Treatment for women with POF can vary depending on your circumstances and can include fertility treatments, fertility drugs, donor eggs or child adoption. The most common among these is hormone replacement therapy, or HRT, which can help even out hormones and induce ovulation.

HRT is a combination of estrogen and progestrone that can be taken as a pill or by using a patch that sticks to the skin. The combination and the amount of hormones may differ from person to person and usually the dosage is increased gradually. However, it is not uncommon for full-dose estrogen therapy to be prescribed, which means that a woman will receive the amount of estrogen nearer or equal to the level normally found in a young healthy woman, whose ovaries are working properly. It is important to note that the hormone therapy given to woman with natural menopause is different from that given to someone with POF. It is advisable to stop taking this treatment after the age of 50 as it may lead to other health problems.

Assisted reproductive therapy (ART) or use of donor eggs is also an option to have a child. Although woman suffering from POF cannot mature an egg, they do have a normal, functioning uterus. With the use of modern techniques, like in vitro fertilisation, a donor egg fertilised in lab conditions with your partners sperm can be replaced inside your uterus for pregnancy to occur. But this procedure has its pros and cons. Many cycles may have to be performed before conception is achieved and the cost can also be a concerning factor for many. Families considering this option should first research and prepare themselves before deciding on donor eggs.

Adopting a child can also be a very rewarding experience and a natural way of looking beyond POF. Families thinking about adoption should learn about the legalities, process, risk factors and the emotional effect it can have on the child as well as the family before making a firm decision.

Although the decision to go for one option or the other lies with you and your family, it is essential to know that certain fertility treatments, like estrogen therapy and GnRH therapy, have proven to be ineffective in the case of POF. And if you feel as though all hope is lost, remember that between 8% and 10% of woman with POF have indeed given birth to a child without the help of any fertility treatments.

POF Support

Dealing with POF is a very emotional experience. Women need to be strong and also need strong emotional support from family and loved ones. There are many support groups available online or in clinics and hospitals that can help you deal with and overcome the mental trauma associated with POF.