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Home > Other > Gynae > Women Health & Safety > Disease & Condition > Early menopause (See: Premature ovarian failure)

Early menopause (See: Premature ovarian failure)

Definition

 

Premature ovarian failure refers to a loss of normal function of your ovaries before the age of 40. If your ovaries fail, they don't produce eggs or normal amounts of the hormone estrogen - which can lead to infertility and other problems.

 

Premature ovarian failure is sometimes referred to as premature menopause, but the two conditions are not exactly the same: Women with premature menopause stop having periods, while women with premature ovarian failure may have sporadic periods for years - and may even become pregnant.

 

When premature ovarian failure does cause infertility, however, fertility treatment is unlikely to be successful. Restoring estrogen levels helps prevent other complications of premature ovarian failure, such as osteoporosis.

 

Symptoms

 

Signs and symptoms of premature ovarian failure include:

  • Irregular or skipped periods (amenorrhea)
  • Hot flashes or night sweats
  • Vaginal dryness
  • Irritability or difficulty concentrating
  • Decreased sexual desire

 

Sometimes women with premature ovarian failure experience erratic periods for years, while others first notice skipped periods after a pregnancy or after discontinuing birth control pills. The signs and symptoms of premature ovarian failure are similar to those experienced by a woman going through menopause and are typical of estrogen deficiency.

 

When to see a doctor

If you notice that you've skipped your period for three months or more, see your doctor to help determine what may be the cause. You may miss your period for a number of reasons - including pregnancy, stress, a change in diet or exercise habits or, rarely, cancer of the uterus - but it's best to get evaluated whenever your menstrual cycle changes.

 

A diagnosis of premature ovarian failure can be difficult to cope with, especially if you had plans to conceive a child. If you're feeling particularly depressed or anxious, consider seeking counseling with a mental health provider to help you sort through the emotional consequences of premature ovarian failure.

 

Causes

 

Your ovaries hold thousands of immature follicles, which contain eggs. At the beginning of each menstrual cycle, your pituitary gland - which secretes a variety of hormones regulating processes throughout your body - secretes follicle-stimulating hormone (FSH). This hormone causes a small number of the egg-containing follicles in the ovaries to begin maturing, although usually only one follicle actually reaches maturity. Maturing follicles make estrogen. In turn, rising estrogen levels "notify" the pituitary gland that FSH is no longer needed.

 

If the follicles don't mature properly - and don't release adequate amounts of estrogen - the level of follicle-stimulating hormone continues to increase and remains elevated. This is why women with premature ovarian failure often have high levels of FSH circulating in their blood.

 

In women with normal ovarian function, the pituitary gland releases another hormone, called luteinizing hormone (LH). This hormone causes the mature follicle to open, releasing the egg (ovulation). The egg then enters the fallopian tube where it might be fertilized by sperm - resulting in pregnancy. Without the increased estrogen levels released by maturing follicles and subsequent spike of luteinizing hormone, ovulation doesn't occur.

 

Premature ovarian failure arises when there are few or no "responsive" follicles left in your ovaries (follicle depletion) or when the follicles aren't responding properly (follicle dysfunction).

 

What causes follicle depletion

Causes of follicle depletion resulting in premature ovarian failure include:

 

  • Chromosomal defects. Certain genetic disorders are associated with premature ovarian failure. These include Turner's syndrome, a condition in which a woman has only one X chromosome instead of the usual two, and fragile X syndrome, a major cause of mental retardation.
     
  • Toxins. Chemotherapy and radiation therapy treatments are the most common causes of toxin-induced ovarian failure. These therapies may damage the genetic material in cells. Other toxins such as cigarette smoke, chemicals, pesticides and viruses may hasten ovarian failure.

 

What causes follicle dysfunction

A cause of follicle dysfunction is damage arising from autoimmune diseases. Infrequently, a woman's body may produce antibodies against her own ovarian tissue, which may harm the egg-containing follicles. It's not certain why this occurs, but the process may be initiated by exposure to a virus.

Often, it's difficult to pinpoint an exact cause of premature ovarian failure. In most cases, the cause is unknown.

 

Risk factors

 

Factors that increase your risk of developing premature ovarian failure include:

 

  • Age. The risk of ovarian failure rises as you age. The incidence of developing premature ovarian failure is about one in 250 by age 35 and one in 100 by age 40.
  • Family history. Having a family history of premature ovarian failure increases your risk of developing this disorder. About 10 percent of cases are familial.

 

Complications

Several conditions may result from premature ovarian failure:

  • Infertility. Infertility is a troubling challenge for many women with premature ovarian failure. Yet, a very small percentage of women with the condition may become pregnant and deliver healthy babies, so natural conception remains a small possibility.
     
  • Osteoporosis. The hormone estrogen helps maintain strong bones. Women with low levels of estrogen are at an increased risk of developing weak and brittle bones (osteoporosis), which are more likely to break than are healthy bones.
     
  • Depression or anxiety. The risk of infertility and other complications arising from low estrogen levels may cause some women to become anxious or depressed.

 

Preparing for your appointment

 

Your first appointment will likely be with your primary care physician or a gynecologist. If you're seeking treatment for infertility, you may be referred to a doctor who specializes in reproductive hormones and optimizing fertility (reproductive endocrinologist).

 

Because appointments can be brief, and it can be difficult to remember everything you want to discuss, it's a good idea to prepare in advance of your appointment.

 

What you can do

To make the best use of the limited time, plan ahead and make lists of important information, including:

  • Detailed descriptions of all your symptoms and when they began. For instance, keeping track of the irregularity of your periods or lack of periods on a calendar provides your doctor useful information.
  • Names and dosages of all medications you take, including nonprescription drugs and supplements.
  • Questions for your doctor, such as what treatment options are available.

 

Questions your doctor may ask

To gain a better understanding of what you're going through, your doctor may ask you several questions. Think about how you'll respond - and even write out some answers - in advance of your appointment so that you're fully prepared and don't forget any important details.

 

Questions your doctor may ask include:

  • Do you have occasional menstrual periods or no periods at all?
  • Are you experiencing hot flashes, vaginal dryness or other menopausal symptoms?
  • How long have you experienced your symptoms?
  • Have you ever had ovarian surgery?
  • Have you undergone treatment for cancer?
  • Do you or any family members have any systemic or autoimmune diseases, such as hypothyroidism or lupus?
  • Have any members of your family been diagnosed with premature ovarian failure?
  • How much distress do your symptoms cause you?
  • Do you feel depressed?
  • Did you have any difficulties with previous pregnancies?
  • Have you experienced unexplained weight gain or weight loss?
  • What medications or vitamin supplements do you take?

During your appointment, speak up if you don't understand something. It's important that you understand the reason for any tests or treatments that are recommended.

 

Tests and diagnosis

 

To help make a diagnosis of premature ovarian failure, your doctor may ask about your signs and symptoms, your menstrual cycle, and a history of exposure to any toxins, such as chemotherapy or radiation therapy. Most women have few signs of premature ovarian failure, but you'll likely have a physical examination, including a pelvic exam.

 

Several blood tests are important in making a diagnosis. These include:

  • Pregnancy test. Pregnancy tests are often performed on women of childbearing age who have missed a period to rule out the possibility of an unexpected pregnancy.
  • Follicle-stimulating hormone (FSH) test. FSH is a hormone released by the pituitary gland that stimulates the growth of follicles in your ovaries. Women with premature ovarian failure often have abnormally high levels of FSH in the blood.
  • Luteinizing hormone (LH) test. Luteinizing hormone prompts a mature follicle within the ovary to release an egg. In women with premature ovarian failure, the level of LH is usually lower than the level of FSH.
  • Serum estradiol test. The blood level of estradiol, a type of estrogen, is usually low in women with premature ovarian failure.
  • Karyotype. This is a test that examines all 46 of your chromosomes for abnormalities. Some women with premature ovarian failure may have only one X chromosome instead of two or may have other chromosomal defects.

 

Treatments and drugs

 

Treatment for premature ovarian failure is usually tailored to address the problems that arise from estrogen deficiency:

  • Estrogen therapy. Replacing the estrogen that's normally produced by functioning ovaries is important to help prevent osteoporosis and relieve symptoms of estrogen deficiency, such as vaginal dryness and hot flashes. If estrogen is prescribed, usually you'll also be advised to use another hormone, progesterone, to protect the lining of your uterus (endometrium) from precancerous changes that can result if you take estrogen alone. Use of estrogen and progesterone may cause you to have menstrual periods again. Hormone replacement therapy may be taken as a pill, applied to your skin as a gel or a patch, or administered as a vaginal ring. You'll likely continue taking hormonal therapy until about the age of 50 or 51 - the average age of natural menopause.
     
     
    Some women express concern about taking hormone replacement therapy because of reported associations between long-term estrogen therapy and cardiovascular disease and breast cancer incidence in older women. However, in young women with premature ovarian failure, the benefits of hormone replacement therapy usually outweigh the potential risks.
     
  • Calcium and vitamin D supplements. Taken together, these supplements are important for bone health and help reduce the development of osteoporosis. Your doctor will probably advise you to have bone density testing done before starting supplements so that you'll have some idea of your baseline bone density measurement.

 

Addressing infertility

Infertility is a common complication of premature ovarian failure. There's no treatment proved to restore fertility in women with this condition. However, some women and their partners choose to pursue a pregnancy through in vitro fertilization using donor eggs. The procedure involves removing eggs from a donor and fertilizing them with your partner's sperm in a laboratory. The fertilized egg (embryo) is then placed in your uterus. During this process, you take medication that balances your hormones to support a pregnancy. Once the pregnancy is established, you stop taking the medication and the pregnancy proceeds naturally to the delivery.

Lifestyle and home remedies

 

These pointers may help you better manage premature ovarian failure:

 

  • Explore your options. If you'd like to start a family, talk to your doctor about alternative options, such as in vitro fertilization using donor eggs or adoption.
     
  • Keep your bones strong. Women who produce low levels of the hormone estrogen are at an increased risk of developing osteoporosis. Work on maintaining strong bones by eating a calcium-rich diet, taking calcium and vitamin D supplements, engaging in weight-bearing exercise such as walking, and refraining from smoking.

 

Learning that you have premature ovarian failure may be emotionally difficult, especially if you're planning on having biological children. But with proper hormone replacement therapy and self-care, you can expect to lead a healthy life.

 

Coping and support

 

A diagnosis of premature ovarian failure can bring on overwhelming feelings of loss for the children you'd planned to have someday. This is the case even for women who have already been pregnant and given birth to children. Grief is a normal feeling for women during this time.

 

To better cope:

  • Be open with your partner. Talk with and listen to your partner as you both share your feelings over this unexpected change in your plans for growing your family.
     
  • Explore your options. If you wish to have more children, look into alternatives to expand your family such as donor-egg in-vitro fertilization or adoption.
     
  • Seek support. Talking with others who are going through the same thing can provide valuable insight and understanding during a time of confusion and uncertainty. Ask your doctor if he or she knows of any local support groups or seek out an online community as an outlet for your feelings and as a source of information.
     
  • Avoid difficult or stressful situations. It's OK to decline an invitation to a baby shower or a child's birthday party if you just don't feel up to it.
     
  • Share your news in your own way. You may choose to be upfront with people who ask about your child-rearing plans, or you may wish to maintain your privacy. Some women may find relief and reassurance by telling friends and family about their circumstances; others may feel that it's an intensely personal matter too difficult to discuss with anyone but their partner.
     
  • Give yourself time. Coming to terms with your diagnosis is a gradual process. In the meantime, take extra good care of yourself by eating well, exercising and getting enough rest.