Working as a doctor can be really interesting sometimes. The human body really does some wondrous things that even science can’t find a reason for sometimes and getting to witness it all first hand is quite fascinating.
For example i recently saw a young lady who complained of not seeing her period for several months.
The first thing that came to mind was that she possibly had polycystic ovarian syndrome as that is one of the classic signs of PCOS, so she had to run some tests to check her hormone levels and the results showed that her female sex hormone levels were in the range expected for a menopausal woman, at the very young age of 29.
Sadly i had to inform the young lady that the reason why she hadn’t seen her period, and may not be seeing it regularly anymore was because her ovaries were no longer working as expected – a condition known as Premature ovarian failure.
Premature ovarian failure (POF) occurs when a woman’s ovaries-which store and release eggs-stop working before age 40. Such women may have no or few eggs. Depending on the cause, primary ovarian insufficiency may develop as early as the teen years, or the problem may have been present from birth.
Normally, the ovaries produce not just eggs but also hormones which are necessary to prepare the uterus for menstruation. These hormones from the ovary also act on a part of the brain to release even more hormones – FSH and LH which are very important for normal reproductive function. Therefore when the ovaries are not working like they should, periods start to disappear. Some women still have occasional periods. They may even get pregnant.
Missed periods are usually the first sign of POF. Later symptoms may be similar to those of natural menopause:
- Hot flashes
- Night sweats
- Irritability
- Poor concentration
- Decreased sex drive
- Pain during sex
- Vaginal dryness
Although the exact cause of primary ovarian insufficiency may be unknown, a genetic factor or a problem with the body’s immune system may play a role in some women. In an immune system disorder, the body may attack its own tissues-in this case, the ovaries.
It may also develop after a hysterectomy or other pelvic surgery or from radiation or chemotherapy treatment for cancer. In some of these cases, the condition may be temporary, with the ovaries starting to work again some years later.
Doctors diagnose POF usually by doing blood test to check hormone levels.
Serum follicle-stimulating hormone (FSH) measurement alone can be used to diagnose the disease. Two FSH measurements with one-month interval are usually done.
The dysfunction of the ovaries and the low estrogen levels leads to high levels of FSH and LH. Another blood test also may be done to measure the amount of estradiol (or estrogen) in the blood. Very low estrogen with a high FSH is a sign of primary ovarian insufficiency.
Most women with POF cannot get pregnant naturally. About 5 to 10 percent of women with this condition may spontaneously become pregnant.Currently no fertility treatment has officially been found to effectively increase fertility in women with POF, and the use of donor eggs with in-vitro fertilization (IVF) and adoption have become more popular options for women with POF who still want to have children.
There is no treatment that will restore normal ovarian function. However, taking hormones (especially estrogen) until age 50 can help to prevent some of the complications which may result.
Unfortunately, there is no way to prevent primary ovarian insufficiency. But you can take steps to protect your overall health. Women with this condition have a higher risk of bone thinning and fractures (osteoporosis), diabetes, and heart disease. A balanced and low-fat diet, regular exercise, and not smoking can help protect the bones and heart. Getting enough calcium and vitamin D may help slow bone loss. Talk to your doctor about other steps you can take.
