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Conceiving Concepts > Causes of Infertility > Female Factor > Premature Ovarian Failure (POF)

Premature Ovarian Failure (POF)
by Angie Best-Boss, Contributing Writer


Premature ovarian failure“Imagine how insane you feel when you seem to be going through menopause at the age of 22—especially when you go to professionals and they don’t believe you,” says Carmen Simpson, who was in the military when she experienced her first symptoms. “I knew there was something really wrong, but I was misdiagnosed for years. It got so bad that my doctors sent me to a psychiatrist. They thought I was a hypochondriac.” Finally a blood test revealed that she had Premature Ovarian Failure, or POF,” from the NIH, Clinical Research department.


What is it?

Premature ovarian failure occurs when your ovaries, which store and release eggs-stop working before age 40. You may have no or few eggs, or your eggs do not develop properly. It affects about 1% of women and is typically preceded by irregular periods, which might continue for years. In this condition, follicle-stimulating hormone (FSH) levels are elevated, as they are during perimenopause.

Most women develop the condition before the age of 32, and it has been diagnosed in girls as young as 14.

Premature Ovarian Failure Symptoms can happen suddenly or over time and include:

• hot flashes
• no menstrual period
• night sweats
• irritability
• moodiness
• sleep disturbance
• decreased libido
• hair coarseness
• vaginal dryness


Is it menopause?

Not exactly. Although the symptoms are often similar and POF was once thought to be a form of premature menopause, there are many differences in the two conditions. Normal menopause occurs as a result of aging, which results in follicle depletion and the onset of menopause with related symptoms. Women with POF can still get pregnant on their own and may still release random eggs – meaning there isn’t complete failure of the ovaries.


How is Premature Ovarian Failure diagnosed?

According to Dr. Michael Heard, a Reproductive Endocrinologist in private practice in Houston, Texas and POF specialist, “the diagnosis of Premature Ovarian Failure is made with a through medical evaluation that begins with a complete history and physical examination along with a simple blood test off hormonal therapy measuring an FSH level, or follicle stimulating hormone. When this value is over 40 mIU/ml on at least two occasions over a four weeks period, the diagnosis can be made.”


How is Premature Ovarian Failure treated?

No treatment is available to make the ovaries work properly and improve fertility. Your health professional may prescribe hormone replacement therapy, certain types of antidepressants (such as Prozac or Paxil), or other medications to treat hot flashes and other symptoms. Talk to your health professional about which treatments may be appropriate for you.


Can I get Pregnant?

Getting pregnant with POF isn’t easy – and it may not be possible. But it does happen. It may not be encouraging to you, but long-term studies of women with POF indicate that about 10% of them have babies all on their own, without fancy treatments, and not including things like egg donation.

“Donor eggs provide the best opportunity for pregnancy (usually better than 50% per attempt.) Because we do not now have the ability to effectively induce ovulation in women with POF, we recommend donor eggs but do point out that pregnancy is a rare but real possibility,” explains Robert Rebar, MD, a Reproductive Endocrinologist, and Associate Executive Director of the American Society for Reproductive Medicine.


How can improve my odds?

“There isn't much that can be done to influence the course of POF. If you are a smoker, QUIT NOW. Smoking reduces ovarian function and accelerates a woman's course towards menopause. It reduces fertility overall and will make menopausal symptoms, such as hot flashes, worse,” says Nanette Santoro, MD directs the Division of Reproductive Endocrinology at Albert Einstein College of Medicine in the Bronx, NY.


Clinical research

Dr. Larry Nelson, who has been studying POF at the National Institute of Child Health and Human Development (NICHD) for 18 years, has been working to better understand the type of ovarian failure that occurs when the immune system of young women attacks their egg–producing machinery. They are researching a similar problem in mice and are trying to find the mechanism in humans. They know that the disorder causes the ovaries to prematurely stop producing eggs, cutting off the hormones needed for bone strength and to ward off heart disease.

The National Institute of Health is working on Premature Ovarian Failure and they may have clinical studies in which you can participate. Keep informed by checking in at: http://clinicalresearch.nih.gov/s


Resources:

International Premature Ovarian Failure Association

Definition of POF from University of Maryland Medical Center

Lawrence M. Nelson, M.D., MBA, in Spontaneous Premature Ovarian Failure: Young Women, Special Needs, Menopause Management, July/August 2001



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