Premature ovarian failure – or primary ovarian insufficiency refers to failure of the ovaries to produce the required amount of oestrogen before the age of 40. It affects 1% of women in the UK
POF is NOT the same as premature menopause. Women with POF may still have occasional periods and can even become pregnant unlike those who have experienced premature menopause. The most common cause of POF is as a side effect of chemotherapy treatment given for various malignant diseases in young women. However certain genetic disorders like Turners Syndrome are also associated with premature ovarian failure. If occurring spontaneously it is thought to be due to autoimmunity as POF is associated with certain autoimmune diseases such as Hashimoto’s thyroiditis.
Symptoms
Confusion often arises because the signs and symptoms of POF are similar to those during menopause:
- hot flushes
- night sweats
- palpitations
- headaches
- difficulty in concentrating
- weight gain
- dryness of the vagina and painful intercourse
- urgency and stress incontinence.
Long term consequences
Women with premature menopause are at increased risk of low bone density, early onset osteoporosis and fractures.
Given the high risk of infertility it is not perhaps surprising that many POF patients suffer from high levels of depression, perceived stress, sexual difficulties and lower levels of self-esteem & life satisfaction compared to the general population.
Premature menopause is also associated with an increased risk of premature cardiovascular disease and stroke.
Getting a Diagnosis
If you haven’t had a period for three months of more you should see your GP to identify the cause. They will then carry out a series of blood tests. A persistently raised FSH and LH with a low oestradiol level is required for the diagnosis.
Treatment
In order to provide bone protection, hormone replacement therapy (HRT) is usually prescribed.
There is some evidence that this reduces the later development of cardiovascular disease, osteoporosis and possibly dementia. Clinical data also suggests that collagen changes (leading to increased ageing and wrinkles) may be minimised with oestrogen levels being boosted by HRT
Young women will require a higher dose of oestrogen than that used in older age groups in order to more closely match the natural hormone levels in their youth. Vitamin D and calcium may also be prescribed.