A mystery to many researchers, premature ovarian failure (POF) can be devastating to women. Affecting between 1 and 4% of women, anywhere between 250,000 and one million American women are impacted by POF.
What Is POF?
Often classified incorrectly, POF is not the same as premature menopause. Women who have premature menopause will no longer have a period and they cannot conceive a child because they are no longer producing any eggs in their ovaries. POF, on the other hand, occurs when the ovaries stop working properly for some reason either through the loss or dysfunction of their egg follicles.
Additionally, women with POF can go months without a period and then suddenly have a regular cycle for a few months before their periods temporarily cease again. While menopause is a naturally occurring phenomenon, POF is not and can happen to any woman under the age of 40, even teenagers.
The confusion between POF and premature menopause occurs because symptoms of POF can be similar to those of menopause. Signs of POF include:
- Amenorrhea (cessation of period) or irregular periods
- Hot flashes and night sweats
- Sleep problems
- Vaginal dryness
- Loss of energy
- Loss of sex drive
- Painful sex
- Bladder problems
Additionally, hormone levels in a woman with POF may be similar to those of a menopausal woman. However, while high follicle stimulating hormone (FSH) and low estrogen levels are normal for a menopausal woman, they are not normal in a woman with POF.
Why Does It Happen?
POF has been a problem for researchers and infertility experts for years. While there are many different explanations for POF, no exact cause has ever been identified. Possible reasons that eggs may cease to be produced include chemotherapy or radiation treatment and chromosomal abnormalities.
Follicle dysfunction may occur if a woman has a low amount of follicle or an abnormal autoimmune reaction that causes the body to attack developing follicles. There is also some suggestion that POF may be genetic. However, only about 10 to 20% of women with POF have a family history of the disorder.
Getting A Diagnosis
A woman’s menstrual cycle is usually a good indicator of her health. Missing a period is usually a sign that something is not right and warrants an appointment with your doctor.
For a doctor to diagnose POF, it is necessary to do a blood test that measures the level of FSH in your blood. While missing one period is reason enough to visit your doctor, it is usually necessary to have had no period for four consecutive months before POF can be diagnosed. When investigating the possibility of POF, you will need to do two FSH blood tests about a month apart. A diagnosis of POF is likely if your tests show your FSH levels to be above 40mlU/ml. In some cases, doctors will diagnose POF with FSH levels above 30mlU/ml.
POF can contribute to other health problems, therefore it is important to receive proper treatment for the disorder. POF can increase a woman’s risk of osteoporosis, heart disease, thyroid problems, diabetes as well as adrenal problems.
As with menopause, the most common treatment for POF is hormone replacement therapy (HRT). Although the doses of estrogen and progesterone (and occasionally testosterone) are higher than HRT in menopause, the levels are increased gradually so that the body has time to get used to the hormones.
Although there is some disagreement as to how long HRT can safely be used in menopause, most experts agree that HRT is safer for women with POF. This is because HRT is used to replace the levels of hormones that these women should have naturally. During menopause, HRT looks to prolong the levels of estrogen and progesterone in the body. Naturally, menopausal women do not have high levels of estrogen and progesterone.
By raising the amount of estrogen and progesterone back up to natural levels, most women with POF begin to have regular periods again. HRT can also help to lower a woman’s chances of osteoporosis. While hormone pills can be used, many doctors prefer to prescribe their patients HRT patches, which allow the hormones to constantly be released into the body.
Occasionally, birth control pills may be prescribed to provide a woman with increased levels of estrogen and progesterone. Following a healthy diet and exercising regularly can minimize your risk of osteoporosis as well as heart disease.
POF And Pregnancy
What can make POF so devastating to so many women is the fact that their chances of having a child naturally virtually disappear. Only 5 to 10% of women with POF will be able to successfully become pregnant without the aid of fertility treatments. However, since there is no way of determining which women are more likely to get pregnant, fertility treatments are recommended for women who wish to conceive.
It is usually suggested that women avoid trying unproven fertility treatments as these can compromise your fertility even more. Since it is your egg production that is affected by POF and not your uterus, it is still possible to carry a pregnancy. Going through in vitro fertilization with a donor egg has proven successful for some women. Adoption is another wonderful option that many parents have been more than satisfied with.
Researchers continue to explore new treatments that can help improve fertility in women with POF. If you would like to have children, discuss your options with your doctor and your partner to determine which choice is the best one for you.
Revision date: June 20, 2011
Last revised: by Jorge P. Ribeiro, MD