What is it?
Premature Ovarian Failure (POF) or a premature menopause occurs when a woman’s periods stop before the age of 40. (natural menopause is usually around the age of 50 for most women) with periods becoming irregular and more widely spaced. The ovaries stop producing the estrogen hormone and so symptoms of estrogen deficiency can occur, including hot flushes, night sweats, mood changes and vaginal dryness. The ovaries also stop producing eggs and so conception is extremely unlikely.
There is not always an explanation for a premature menopause. Approximately 1- 4% of the female population has Premature Ovarian Failure (POF). That equates to about 250,000 to 1 million women in the United States alone.
It sometimes runs in families, with women having their menopause at a similar age to their mother. Some women have abnormalities of the genes that control ovarian function, others make ‘autoantibodies’ which prevent the ovaries from working and a few women can be affected by viral infections of their ovaries. The ovaries can rarely start working again on their own, although this is the exception rather than the rule, and studies that have examined women with POF report only a minority of woman resuming spontaneous ovulations.
How long will it last?
Some women can have quite a long time during which the ovaries are slowing down and ovulation may occur from time to time.
Can I still get pregnant?
The ovaries will not respond to the body’s natural FSH and LH and this is why they will not respond to FSH/LH injections, which are used to stimulate ovulation successfully in other women who have ovaries with eggs but a break down in the natural mechanisms that stimulate the ovaries. In fact there are, unfortunately, no treatments that will make resistant or menopausal ovaries work again. Nowadays it is possible to have ‘in vitro fertilisation’ (IVF) using donated eggs, usually from an anonymous donor, which have been fertilised by the sperm of the recipients partner. Egg donation provides an approximately 25-30% chance of a pregnancy with each attempt.
Is their any treatment I need?
Woman with POF should be given hormone replacement therapy (HRT) which will provide the right amounts of estrogen (together with progesterone, another ovarian hormone) and this will treat any symptoms and prevent premature ageing from premature estrogen deficiency. Estrogen is important to both prevent the above mentioned symptoms and to prevent the long term effects of estrogen deficiency (thinning of bones) and cardiovascular disease (heart attacks and strokes). It is recommended that HRT is taken at least until the age of 50. HRT is preferable to the contraceptive pill, which will also provide an artificial menstrual cycle but will not allow ovulation to occur and if pregnancy is desired it can occur whilst taking HRT, even though the chances of ovulation are extremely unlikely.