At the time of birth, females have all the eggs they are ever going to develop. In this respect, they behave as opposed to males, who start producing sperm in their testicles once they have started puberty.

Women’s ovaries contain all their follicles and once they have started puberty, follicles develop each month releasing an egg. If that egg is not fertilised, the woman’s body expels it and then it becomes period. This cycle is repeated usually until age 45 (on average), when the ovarian reserve runs out of eggs and menopause begins.

In the cases of women suffering from premature ovarian failure (POF), also known as early menopause or premature menopause, the loss of function of the ovaries occurs before age 40 or even during adolescence. Women with POF stop ovulating, and therefore eggs stop making the relevant hormones (oestrogen and progesterone), which disappear as a consequence of the period.

It is a relatively common problem which affects around 14 per cent of women in reproductive age.

Symptoms

The group of symptoms which women with POF have are very similar to those displayed by natural menopause, and they are due to the effects of oestrogen deficiency.

The absence of menstrual period or amenorrhoea is the symptom which particularly stands out, especially in young women. Other symptoms may be:

  • Stifling sensation
  • Sweating
  • Emotional disturbances
  • Sleep disturbances
  • Drying of vagina
  • Decrease in sexual drive

Diagnosis

Physical and gynaecological examinations are the best ways of diagnosing this disease. Hormone blood tests are also important.

If you have POF, such blood test will show low levels of estradiol (an hormone produced by the egg) and, consequently, an increased amount of follicle-stimulating hormone or FSH.

Causes

In several occasions, the causes for premature ovarian failure cannot be found, although these are the most frequent:

  • Genetic alterations caused by chromosomal abnormalities, as in the case of the Turner syndrome or the Fragile X syndrome, among others.
  • Autoimmune diseases: in such case, the immune system produces antibodies against the egg, damaging or modifying the ovarian reserve.
  • Cancer treatments, such as chemotherapy or radiotherapy. The ovarian failure may be reversible depending on how intensively they have been applied.
  • Surgeries in which an egg have been partly or completely removed.
  • Toxic materials: tobacco, solvents, etc.
  • Family background: if a woman’s mother or sister has suffered from early menopause, she should inform her doctor, since it happens more frequently between relatives.

Consequences

As a consequence of the oestrogen deficiency, women with premature ovarian failure are much more likely to develop osteoporosis, and the risk of developing a cardiovascular disease also increases.

Another potential consequence of POF may be sterility. If the ovarian failure is not premature and the kariotype is normal, the egg can work intermittently so that 5% and 10% of women get a natural pregnancy.

However, there is not any test pointing out that it is likely to occur. Thus, and after some failed attempts of ovulation induction during in vitro fertilisation treatments, the best options for these women to have children are egg donation or adoption.

Treatment

The treatment is based mainly on hormone therapy with oestrogen. Either the hormone replacement therapy (HRT) or the combined oral contraceptive pills (oestrogen-progesterone) can be used.

It is very important that women suffering from premature ovarian failure understand and assimilate their situation, since accepting the diagnosis is sometimes hard for them. It is therefore essential that they are given the appropriate information and, if necessary, psychological support, especially in cases of women who have not had children.

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