Healthcare providers use the term Premature Ovarian Failure (POF) to describe a stopin normal functioning of the ovaries in a woman under the age of 40. Many womennaturally experience a decline in fertility at age 40; this age may also markthe beginning of irregularities in their menstrual cycles that signal the onsetof menopause. For women with Premature Ovarian Failure, the fertility declineand menstrual irregularities occur before age 40, sometimes even in the teens.Some health care providers also use the term primary ovarian insufficiencyto describe this condition.
In the past, health care providers called this condition premature menopause,but this term is not an accurate description of what happens in a woman withPremature Ovarian Failure. A woman who has gone through natural menopause willrarely ever have another period; a woman with Premature Ovarian Failure is muchmore likely to have periods, even though they might not come regularly. There isvirtually no chance for a woman who has gone through menopause naturally to getpregnant; in some cases, a woman with Premature Ovarian Failure can still getpregnant.
WhatCauses Premature Ovarian Failre?
Althoughresearchers have a general idea of what causes Premature Ovarian Failure, inmost cases the exact cause remains unclear.
To understand what happens in Premature Ovarian Failure, you need to understandwhat happens in a woman’s body when it’s functioning normally.
TheNormal Menstrual Cycle
Ingeneral, a woman’s reproductive health involves her:
Hypothalamus (pronounced high-poe-THAL-amus)—part of the brain that functions as the main control for the body’s reproductive system. The hypothalamus works like a thermostat in a furnace, in that it controls the levels of different hormones and other chemicals in the body. If the hypothalamus detects that there is too little of a hormone in the body, it orders the body to make more.
Pituitary (pronounced pitt-OO-ih-terry) gland—the body’s master gland. The pituitary sends out hormones, or chemical signals to control the other glands in the body. The pituitary gets orders from the hypothalamus about what the body needs.
Ovaries—the source of eggs in a woman’s body. The ovaries have follicles, which are tiny, fluid-filled sacs that hold the eggs. The ovaries also make hormones that help to maintain a woman’s health, such as estrogen, progesterone, and testosterone. The ovaries receive the chemical signals from the pituitary and respond by making certain hormones. In POF, the ovaries stop working correctly in both their egg production role, and in their hormone production role.
Uterus—where a woman carries a baby, also called the “womb.” The uterus has different layers; its innermost layer or lining is called the endometrium—endo means “inside” and metrium (pronounced MEE-tree-um) means “womb.” The endometrium functions as a bed for an embryo when a woman is pregnant. If no pregnancy occurs during the cycle, then the endometrium is shed as a menstrual flow, or a period, and the cycle starts all over again.
Theseparts interact with one another to coordinate a woman’s monthly menstrualcycle.
The hypothalamus keeps track of the level of estradiol (pronounced ess-trah-DYE-awl) in the body. Estradiol is the natural estrogen that a woman’s body makes, so we’ll call it estrogen from now on.
When the level gets low, the hypothalamus sends an order to the pituitary gland telling it that the body needs more estrogen.
The pituitary gets the order and responds by sending out follicle stimulating hormone (FSH), a hormone that causes the follicles on the ovary to grow and mature. Mature follicles make estrogen and other substances, such as inhibin. The pituitary continues to make FSH until the mature ovarian follicles make enough estrogen. If the follicles don’t make enough estrogen, the level of FSH goes even higher.
When the level of estrogen gets high enough, the hypothalamus and pituitary know that there is a mature egg in one of the follicles. To get this egg to the uterus so that it can be fertilized, the pituitary sends out a large burst of luteinizing hormone (LH). LH breaks open the mature follicle to release the egg, which allows it to move toward the uterus. The level of LH is only high during the time an egg is being released. This LH burst is the basis for home ovulation detection kits. Because LH may be high throughout much of the menstrual cycle in women who have Premature Ovarian Failure, home ovulation detection kits are unreliable in these women.
The empty follicle is then transformed into a yellowish, corpus luteum (pronounced CORE-puss loo-tee-um). Corpus means “body” and luteum means “yellow.” The corpus luteum makes progesterone, the hormone that prepares the uterus for pregnancy.
Increased levels of progesterone cause the endometrium to change in preparation for pregnancy, should it occur. Once the endometrium is properly prepared, it can support an embryo and allow the embryo to grow.
If the egg is fertilized, it sends out a hormone called HCG to let the body know that it’s there. HCG causes the corpus luteum to continue to make progesterone, the hormone needed for pregnancy. Pregnancy tests measure the level of HCG. If HCG is present, then it’s likely that a woman is pregnant.
If there is no signal, that is, no HCG is present because the egg wasn’t fertilized, the corpus luteum stops making progesterone. Without progesterone, the endometrium starts to break down, and the woman’s body sheds it as her period.
WhatHappens Differently in Premature Ovarian Failure?
Currently,researchers are unable to pinpoint exactly what happens in Premature OvarianFailure to stop normal function of the ovaries in most cases. Remember that theFSH levels are high when the ovaries fail to produce enough estrogen. LH levelsalso stay high in many cases, even during the occasional times that folliclessuccessfully grow. Mature follicles in the ovaries make estrogen, as well asother substances, including the protein inhibin. Because women with PrematureOvarian Failure have low levels of estrogen, scientists are focusing theirattention on the follicles in the ovary in their study of Premature OvarianFailure.
Folliclesin the ovaries start out as microscopic seeds, called primordial(pronounced prime-OR-dee-ul) follicles. These seeds are not yetfollicles, but can grow into them. In general, a woman is born with about twomillion primordial follicles, which should be enough to last her until she goesthrough menopause. But this may not be the case for a woman with POF. Women withPOF may fall into one of two groups.
FollicleDepletion
Awoman with follicle depletion has no responsive follicles left in her ovaries.There is no way for the body to make more primordial follicles. And, currently,there is no way for scientists to make primordial follicles. Although scientistshaven’t identified all the causes of follicle depletion, some known causesinclude:
Chemotherapy or radiation therapy—strong treatments for cancer.
An abnormal or missing X chromosome—the X chromosome stores genetic material that helps “build” a person. It also helps to determine whether a person is a male or a female. Females need two normal X chromosomes to make enough primordial follicles, and to use them properly. If a critical part of either X chromosome is missing, or if an entire X chromosome is missing, the body may not make enough primordial follicles to begin with, or it may use them up too quickly. This problem is the cause of Premature Ovarian Failure in 2 percent to 3 percent of women with the condition.
Even when it appears that all a woman’s follicles are depleted, it is possible that a very small number of surviving follicles can, without warning, begin to function on their own. This spontaneous function can cause ovulation or a menstrual period; if insemination occurs, this function could lead to pregnancy, although such a situation is uncommon. Currently, health care providers can’t predict which women with POF will experience this recovery of ovarian function.
FollicleDysfunction
Awoman with follicle dysfunction still has follicles in her ovaries, but forunknown reasons they are not working properly. Currently, scientists do not havea safe and effective way to make follicles start working normally again.Although they have yet to identify all the causes of follicle dysfunction, someknown causes include:
An autoimmune attack—the immune system normally protects the body from invading bacteria and viruses. In some women, though, for reasons researchers don’t understand, the immune system attacks developing follicles, which prevents the follicles from working the way they should. Current research suggests that this type of problem occurs in 5 percent of women with Premature Ovarian Failure.
A low number of follicles—even though only one mature follicle releases an egg each month, that follicle usually has less mature follicles developing along with it. Scientists don’t understand exactly how, but these supporting follicles seem to play a role in helping the mature follicle function normally. If these extra follicles are missing, the dominant follicle becomes luteinized and will not mature and release an egg properly. Current research estimates that this problem may occur in up to 60 percent of women with Premature Ovarian Failure, but this is not a definite number.
Researchalso shows that 10 percent to 20 percent of women with Premature Ovarian Failurehave a family history of the condition, which could mean that some cases ofPremature Ovarian Failure have a genetic component. But, inheritance patternsshow that Premature Ovarian Failure is not a purely genetic disorder. Researchinto the causes of Premature Ovarian Failure is ongoing, in hopes that knowingwhy it occurs will also help in developing treatments for the disorder.
HowMany Women Have Premature Ovarian Failure?
PrematureOvarian Failure affects approximately:
One in 10,000 women by age 20
One in 1,000 women by age 30
One in 250 women by age 35
One in 100 women by age 40
Whatare the Symptoms of Premature Ovarian Failure
Themost common first symptom of Premature Ovarian Failure is having irregularperiods. Health care providers sometimes dismiss irregular or skipped periods(sometimes called amenorrhea—pronounced AY-men-or-ee-uh) as being related tostress; but a woman’s monthly cycle is actually an important sign of herhealth, in the same way that blood pressure or temperature are signs of health.If you have irregular periods or skip periods, you should tell your health careprovider, so that he or she can begin to determine the cause of these problems.
Some women with Premature Ovarian Failure also experience other symptoms withPremature Ovarian Failure. These symptoms are similar to those experienced bywomen who are going through natural menopause and include (but are not limitedto):
Hot flashes
Night sweats
Irritability
Poor concentration
Decreased interest in sex
Pain during sex
Drying of the vagina
Infertility
HowDo I Know If I May Have Premature Ovarian Failure?
Oneof the most common signs of Premature Ovarian Failure is having irregularperiods. Women should pay close attention to their menstrual cycles, so thatthey can alert their health care provider when changes occur in their periods.
Ifyou are under age 40 and your periods are irregular, or if you miss your periodaltogether for three months or more, your health care provider may measure thelevel of FSH in your blood, to determine if you have primary ovarianinsufficiency in its early stages, or possibly even fully developed PrematureOvarian Failure. Remember that FSH signals the ovaries to make estrogen. If theovaries are not working properly, as is the case in POF, the level of FSH in theblood increases. A higher level of FSH in the blood is a strong sign ofPremature Ovarian Failure. But, irregular periods alone are not a sure sign thatyou have Premature Ovarian Failure—research shows that fewer than 10 percentof women who have irregular or skipped periods have high FSH levels andPremature Ovarian Failure.
Todo an FSH test, your health care provider will collect some of your blood andsend it to a laboratory. At the lab, a technician will check the level of FSH.If the level of FSH is in the menopausal range, it is likely that you havePremature Ovarian Failure.
Are there treatments for the symptoms of Premature Ovarian Failure?
Currently,no proven treatment will restore normal function to a woman’s ovaries. But,health care providers can suggest treatments for some of the symptoms of POF.
Oneof the most common treatments for women with POF is hormone replacementtherapy (HRT). In women with POF, HRT gives their bodies the estrogen andother hormones that their ovaries are not making. Replacing these hormonescauses a woman with POF to start having regular periods again. In addition, HRTmay help women with POF lower their risk for the bone disease osteoporosis.
HRTis usually a combination of the hormones estrogen and progesterone (or theman-made form of progesterone, called progestin). Women can take the therapy asa pill, or they can wear a patch that sticks to their skin to get the hormonesinto their bodies. Many health care providers suggest the patch for women withPOF because it offers a continuous flow of hormones into the blood stream, whichmimics the way the body naturally releases estrogen. The combination and amountof hormones used in HRT may differ for different women. If you have questionsabout HRT as a treatment for POF, talk to your health care provider.
Mosthealth care providers suggest that women with POF take HRT until they are 50years old. After that time, women should talk with their health care providerabout stopping HRT because of risks associated with older women taking thetherapy after menopause.
Currentresearch is also looking into the benefits of replacing the hormone testosteroneto prevent bone loss in women with POF. Most people think of men’s health whenthey hear the word testosterone, but women’s bodies also make testosterone, ata level about one-seventh that of men. Testosterone helps to maintain muscle andbone mass, and may be related to a woman’s sex drive. The ovaries maketestosterone, and its level is lower in women with POF. But, unlike estrogen andprogesterone, testosterone is not usually replaced as part of HRT. A clinicaltrial is now underway to see if raising the level of testosterone in women withPOF to that found in a woman with healthy ovaries can slow or stop bone loss.The results of this study could benefit not only women with POF, but also otheryoung women who are at risk for osteoporosis.
Is HRT safe for me to take if I have Premature Ovarian Failure?
Mosthealth care providers believe that HRT replaces what your body should be makingnaturally as a young woman, and that your body needs these hormones to functionnormally. HRT taken by women with POF is very different from the hormone therapythat is often taken by women who are going through or have already gone throughnatural menopause.
Recently,a study found that older women, who had gone through normal menopause, were atincreased risk for certain health conditions when they took a certain type ofhormone therapy for long periods of time. The study was part of the Women’sHealth Initiative, a large, multi-center study that involved more than 161,000postmenopausal women in their fifties, sixties, and seventies. The researchersfound that these women, who went through natural menopause at the expected age,were at greater risk for stroke, blood clots, heart disease, heart attacks, andbreast cancer after taking a specific type of hormone therapy for more than fiveyears.
Theseresults do not apply to young women taking HRT; specifically, these resultsdon’t apply to young women with POF. Women in the study mentioned above werebetween the ages of 50 and 79 when the study began and had gone throughmenopause at the normally expected time; their bodies would not normally bemaking high levels of hormones. The type of therapy taken by women in theWomen’s Health Initiative study could be called hormone extensiontherapy, rather than hormone replacement therapy, as is often reported.These women took the hormones beyond the time that the hormones would naturallybe present. Women with POF get hormone replacement therapy; that is, the HRT isproviding something their bodies would normally be making, if they didn’t havePOF.
Thetype and amount of HRT prescribed to women with POF is different from thehormone therapy taken by women in the Women’s Health Initiative study. Forexample, women with POF usually take full-dose estrogen replacementtherapy, meaning the amount of estrogen is nearer or equal to the level normallyfound in a young healthy woman, whose ovaries are working properly, beforemenopause. Hormone therapy for women who have already gone through menopause isa much lower dose. And, women with POF typically use a patch to deliver thehormone estrogen, but take a pill that provides progestin. This regimen isdifferent than the one used in the Women’s Health Initiative, which had womentake a pill that contained both estrogen and progestin.
Talkto your health care provider if you have questions about HRT as a treatment forPOF. He or she can explain the benefits and risks of HRT for your specificsituation as a young woman. It is important to remember that young women withPOF differ from older menopausal women in many significant ways. Your healthcare provider should consider these issues when deciding on the best treatmentfor you.
How will having Premature Ovarian Failure affect my overall health?
Becauseof lower hormone levels that result from POF, you are at greater risk for anumber of health conditions. These conditions, and what you can do to stayhealthy, are described below.
Osteoporosis
Osteoporosis (pronounced OWS-tee-oh-pour-oh-siss) is a bone disorder that decreases bone strength and increases the risk for breaks and fractures.
Estrogen helps to conserve calcium and other minerals in bones and protects against bone loss. In POF, the ovaries stop making estrogen, which can cause women to lose bone density, or bone strength, one of the major factors leading to osteoporosis.
Even though osteoporosis is more common in people ages 50 and above, women with POF may experience the condition at a much younger age.
Arethere ways to prevent or treat bone conditions in women with POF?
Toprotect against bone loss, the National Osteoporosis Foundation1recommends that women who are at risk for osteoporosis:
Get at least 1200 mg of calcium in their diets every day. If it is not possible to get this amount through diet, take a calcium supplement.
Get between 400 IU and 800 IU of vitamin D, which helps the body absorb calcium, every day.
Get regular, weight-bearing and muscle-building physical activity. Weight-bearing physical activity, such as walking, will help build bone strength. Activities like yoga or tai chi help build muscle strength and improve flexibility.
Anadequate level of estrogen in the body is an important factor in preventing boneloss that may lead to osteoporosis. The strategies listed here may slow boneloss, but none of them will prevent bone loss entirely.
Lowthyroid function
This problem is also called hypothyroidism (pronounced high-poe-THIGH-royd-iz-em).
The thyroid is a gland, like the ovary, adrenal, and pituitary glands. It makes and releases hormones. Specifically, the thyroid makes hormones that control the body’s metabolism and energy level. Low levels of the hormones made by the thyroid can affect metabolism, and can cause a woman to have very low energy.
Symptoms include a slow down in the body’s normal rate of functioning, which can lead to mental and physical sluggishness. Cold feet are also a feature of low thyroid function.
A recent study found that 27.0 percent of women with POF also had low thyroid function. In the general population, only two percent of all people (both men and women) have low thyroid function.
Arethere ways to prevent or treat low thyroid function in women with POF?
Replacingthe hormone that the thyroid is not making enough of treats this problem.Usually, you can take a pill to replace the hormone.
Addison’sdisease
Addison’s disease is an autoimmune disorder, meaning the body’s immune cells, which normally protect the body from invading cells and microbes, attack the adrenal glands, part of the endocrine system located above the kidneys. The adrenal glands produce hormones that regulate the body’s response to stress and its handling of salt.
Addison’s disease is also called primary autoimmune adrenal insufficiency.
Recent studies suggest that 3.2 percent of women with POF also have Addison’s disease, making them much more likely than members of the general population to develop the disease.
Symptoms of Addison’s disease include loss of appetite, weight loss, dizziness when standing, and fatigue. In later stages of Addison’s disease, salt craving, low blood pressure, and darkening of the skin may occur.
Current research indicates that an adrenal antibody test is the most effective way to detect Addison’s disease in women with POF. If the results of this test are positive, a health care provider may order a second test, called an ACTH stimulation test, to confirm the diagnosis. Both tests involve collecting blood samples.
Arethere ways to prevent or treat Addison’s disease in women with POF?
Whilethere is currently no way to prevent Addison’s disease, the best way to treatit is to find out whether you have it. You can easily manage the condition withthe help of your health care provider, by taking medication that replaces thehormones your adrenal glands are not making. If left untreated, however, thedisease can be life threatening because the body can’t respond properly tostressful events, such as severe illness, injury, or surgery.
Researchersnow recommend that health care providers screen all women who have confirmed POFfor Addison’s disease using the adrenal antibody test, although such screeningis not yet standard practice. If women with undetected Addison’s diseaseundergo an exceptional physical stress, such as surgery or a car accident, theyare at risk for an “adrenal crisis,” a situation that can lead to shock andeven death. Therefore, screening for the disease is especially important beforea woman with POF has surgery or undergoes other known physical stresses.
Heartdisease
While it is very rare for a young woman with POF to develop heart disease, certain factors related to the disorder might increase her chances of developing heart disease later in life.
Lower levels of estrogen in POF can lead to higher levels of low-density lipoprotein (LDL) cholesterol. LDL is known as “bad” cholesterol because it is the main source of the buildup and blockage in arteries that can lead to heart attacks.
Lower levels of estrogen in POF can also lead to lower levels of high-density lipoprotein (HDL) cholesterol, known as “good” cholesterol because it helps prevent buildup and blockage in the arteries.
After some time, buildup of cholesterol in the arteries can cause “hardening of the arteries,” which means that the blood flow to the heart is slowed down or blocked. Blood carries oxygen to the heart. If the heart can’t get enough oxygen, a person may have chest pains. If the blood supply to part of the heart is cut off completely, because of blockage, the result is a heart attack.
Arethere ways to prevent heart disease in women with POF?
Gettingadequate estrogen therapy may help guard against heart disease. Estrogen helpsthe body by:
Keeping the lining of the arteries healthy
Relaxing muscles that control arteries to allow better blood flow to tissues
Normalizing LDL and HDL levels to decrease cholesterol build up in the arteries that could lead to blockage Maintaining a healthy body weight and getting regular physical activity are important in reducing the risk of heart disease. These factors can affect your cholesterol level, which, in turn, can affect your risk for heart disease. Other risk factors for heart disease include:
Cigarette smoking
High blood pressure (defined as 140/90 mm/Hg or higher, or being on blood pressure medication)
High blood cholesterol
Family history of heart disease
Age: women—55 years or older
Talkto your health care provider about heart disease to determine what steps, ifany, you should take to lower your risk. For information on heart disease andhow to lower your risk of heart disease, see the Wherecan I get more information about POF? section of this booklet.
Arethere other health concerns for women who have POF?
Among women with POF, studies show that 13.8 percent of women with a family history of POF, and 2.1 percent of women without a family history of POF may also have a mild form of Fragile X syndrome.
Fragile X syndrome is a genetic condition that arises because of an error in a single gene. In women with an affected gene, the symptoms can range from none at all, to learning disabilities and problems with math, to a slightly higher risk of anxiety disorder. Women who have an affected gene may pass it on to their children, who may experience learning disabilities and other problems as a result.
But, simply having POF is not a sign of mild Fragile X syndrome. You must have other characteristics in addition to POF, such as a family history of unexplained mental retardation, for your health care provider to suspect the genetic error. If you do not have such a family history, this problem is likely not an issue for you.
If you have no family history of unexplained mental retardation, then it is unlikely that you have this genetic error, and it is probably unnecessary for you to be screened for the condition. If you do have a history of unexplained mental retardation in your family, and you have POF, you may want to be screened for the genetic error associated with Fragile X syndrome. Your health care provider can give you more information about screening, should he or she feel it is necessary.
For more information about Fragile X syndrome, talk to your health care provider, or contact the NICHD Information Resource Center at 1-800-370-2943.
Does having POF mean that I’ll be infertile or unable to have children?
Ifyou have POF, it will likely be very difficult for you to become pregnantbecause your ovaries aren’t working correctly. At this time, there is noproven medical treatment that improves a woman’s ability to have a babynaturally if she has POF.
Thereis a chance that you will become pregnant without fertility treatment. Between 5percent and 10 percent of women with POF do become pregnant, even though theyhave not had fertility treatment. Sometimes pregnancy can occur decades afterthe initial diagnosis. Researchers cannot explain why some women with POF getpregnant, while others do not.
Becausepregnancy is still possible for women who have POF, those who do not want tobecome pregnant should take steps to prevent pregnancy. In some women with POF,oral contraception may not be as effective for pregnancy prevention as it is inwomen who don’t have POF. In some cases, using a “barrier” method ofcontraception, such as a diaphragm or a condom, may be a better option for womenwith POF who don’t want to become pregnant. Discuss your contraception needswith your health care provider, if you have POF and don’t want to becomepregnant.
Ifyou have POF and want to become pregnant, you and your family have some options,explained below. You should also know, however, that some medical therapies forinfertility have been proven ineffective, through randomized clinicaltrials. These therapies include high-dose estrogen therapy, gonadotropin-releasinghormone (GnRH) agonist therapy, corticosteroid therapy, high-dose GnRH therapy,and treatment with danocrine. Health care providers recommend avoiding unprovenfertility treatments because such methods may actually reduce your chances ofgetting pregnant naturally.
Aspecial note about infertility associated with POF
Manywomen involved in POF support groups reported that, when they were diagnosedwith POF, they felt a sense of loss or grief, not unlike the sadness associatedwith the death of a loved one. Others reported that they felt guilty about nottrying to have children earlier in their lives. They noted that the diagnosisalso affected their partners, spouses, and families. For women with POF andtheir families, then, emotional support may be as important as medical treatmentfor dealing with POF.
Health care providers who care for women with POF often have to reassure theirpatients that these emotional responses are perfectly natural reactions to thenews of POF. Some health care providers suggest taking time to deal with thediagnosis and the emotions that surround it, before making any decisions abouthaving a family (see TheArt of Listening for more information).
Many providers recommend that women with POF and their families work with a“professional listener” to help deal with the powerful and sometimes painfulemotions associated with this diagnosis. A social worker, a psychologist, apsychiatrist, or another mental health professional can work with a womanindividually, together with a spouse, partner, or a family member, or in somecombination of these arrangements. For information on finding a professionallistener, talk to your health care provider, or go to the Wherecan I go for more information about POF? section of this booklet.
Many women in support group settings reported that talking to other women whohad POF was helpful in coming to terms with their diagnosis. Many hospitals andhealth clinics offer support groups for women and families affected by POF. Tolearn more about support organizations, go to the Wherecan I go for more information about POF? section of this booklet.
Whatare my options for having a child?
Familiesaffected by POF do have options for having a child. As mentioned earlier, avoidunproven fertility treatments and treatments that have been proven ineffectivebecause such methods may actually reduce your chances of getting pregnantnaturally.
Adopting a child is one option for starting a family if you have POF. Adoptioncan be one of the most rewarding experiences of a lifetime; but the process isnot without risks. Many health care providers recommend that familiesconsidering adoption learn about the process, its benefits and risks, and itslegal aspects, in addition to the possible emotional effects, before making adecision. For more information on adoption and adoption resources, go to the Wherecan I go for more information about POF? section of this booklet.
A certain type of assisted reproductive technology (ART), known as egg donation,may also be an option for having a child. In POF, the problem is in producinghealthy eggs; the condition does not affect a woman’s uterus, which means shemay be able to carry a child. Egg donation makes it possible to combine donoreggs and sperm in a laboratory, and then place the resulting embryos into theuterus of a woman who has POF.
All forms of ART arecomplex, and each carries its own benefits and risks, some of them serious.Because few insurance companies currently provide coverage for this procedure,families may have to cover the entire cost of the process. And, many familieshave to try ART several times before it is successful. The Centers for DiseaseControl and Prevention (CDC) provides statistics on success rates of ARTprocedures based on different factors. Go to the Wherecan I go for more information on POF? section of this booklet forinformation on how to obtain a copy of the CDC report.
If you and your family are considering ART, talking with a health care providerand/or a fertility specialist about the risks and benefits may help you makeyour final decision. The Wherecan I go for more information on POF? section provides information on how tofind a fertility specialist and lists resources on ART.
In addition, researchers are actively working to develop methods that improvefertility in women with POF and other conditions. As such methods and treatmentsimprove, women with POF and their families may have more options for havingchildren naturally.
The Art of Listening
NICHD researcher Larry Nelson, M.D., has been caring for women who have POF for decades. As the head of the NICHD’s Unit on Gynecologic Endocrinology, Dr. Nelson is working to understand POF, and to help women and families affected by it.
“Many women feel a sense of urgency to act right away when they get their diagnosis,” Dr. Nelson explains. But, based on his years of experience, he suggests a slower, more deliberate plan to his patients for dealing with infertility related to POF.
First, he recommends that women allow themselves time to feel and deal with the emotions that may accompany a diagnosis of POF. He explains that getting emotionally healthy, no matter how long it takes, is the best way to prepare for the tough decisions that may be down the road. Next, Dr. Nelson suggests that the women strengthen their relationships with their spouses, partners, and families. He feels that the help of a professional listener is very important in building strong, close relationships after a POF diagnosis.
The options for having a child if a woman has POF are risky, expensive, and often emotionally draining, he adds. He usually tells his patients and their families to take some time to really focus so they can make clear, informed decisions. After taking some time, families may decide that options for having a child simply aren’t right for them, he explains; or, they may decide to pursue the options for having a child.
Dr. Nelson received the 2001 Art of Listening Award from the Genetic Alliance for his commitment and dedication to caring for women with POF. The Genetic Alliance is a national non-profit organization that strives to help those affected by genetic disorders. To contact the Unit on Gynecologic Endocrinology, call 1-877-206-0911.
What are researchers doing to learn more about POF?
Currently,the NICHD is conducting and sponsoring a number of studies on POF:
Some researchers are exploring whether a low dose of a certain steroid can treat POF in cases caused by an autoimmune disorder. The steroid, called prednisone, decreases the function of the body’s immune system, which is thought to be attacking the ovary follicles in some women with POF.
Researchers are trying to determine the best combination and dosage of HRT for treating POF. Some work is trying to learn whether adding testosterone to a woman’s HRT can help to prevent bone loss. Other studies are trying to find the amount of estrogen and progestin that best treats POF without causing too many side effects.
Other research focuses on what happens in an ovary that is working normally. This information may help scientists develop a test for early detection of POF.
Clinicaltrials to explore these topics are already underway. To find out more aboutthese studies, contact the NICHD’s Unit on Gynecologic Endocrinology, at 1-877-206-0911.You can also learn more about all studies on POF by going to http://clinicaltrials.gov,and doing a search for “premature ovarian failure.” Or, you can call the NIHPatient Recruitment and Public Liaison Office at 1-800-411-1222.
In addition to these studies, the NICHD has a Reproductive Medicine GynecologyProgram in its Reproductive Sciences Branch that supports research on women’shealth conditions that aren’t cancerous, including POF. In 1998, the NICHDjoined other Institutes at the NIH in setting up 12 Women’s ReproductiveHealth Research Career Development Centers. These Centers support obstetriciansand gynecologists in becoming researchers, so that they can study topics onwomen’s health. Eight additional Centers, started in 1999, will allow thisvital research to continue until scientists know the causes and treatments forPOF and other reproductive diseases.
The NICHD’s Reproductive Sciences Branch also has other programs that supportresearch on POF, and on other topics that affect women’s health. TheSpecialized Cooperative Centers Program in Reproductive Research (SCCPRR),established in the late 1990s, relies on multidisciplinary approaches toresearch on reproductive health topics. SCCPRR has a number of basic,translational, and clinical scientific studies in progress at 14 sites aroundthe country that are aimed at finding the cause of POF, including genetics andthe factors that cause follicle depletion and dysfunction.
Watchfor our new book, now being reviewed by several leading publishers:
Gynecology for Guys "WhatEvery Dad and Husband Must Know about Gynecology and Gynecological Health"
*Copyrightand General Disclaimer Unlessotherwise noted, all material on this is website is copyrighted and may not becopied or reproduced without our express written consent.Information provided on this website is for educational purposes only.Always seek the advice of your physician with any questions you have regarding amedical condition, and before undertaking any diet, exercise or other healthprogram and before relying upon this or any other website's information. Whilewe have made every effort to check, update and verify the accuracy of ourinformation and resources, we cannot be held responsible for any inaccuracies.The information contained on this website has not been evaluated by the FDA andnot intended to treat, diagnose, cure or prevent any disease.
Healthcare providers use the term Premature Ovarian Failure (POF) to describe a stopin normal functioning of the ovaries in a woman under the age of 40. Many womennaturally experience a decline in fertility at age 40; this age may also markthe beginning of irregularities in their menstrual cycles that signal the onsetof menopause. For women with Premature Ovarian Failure, the fertility declineand menstrual irregularities occur before age 40, sometimes even in the teens.Some health care providers also use the term primary ovarian insufficiencyto describe this condition.
WhatHappens Differently in Premature Ovarian Failure?
Awoman with follicle dysfunction still has follicles in her ovaries, but forunknown reasons they are not working properly. Currently, scientists do not havea safe and effective way to make follicles start working normally again.Although they have yet to identify all the causes of follicle dysfunction, someknown causes include:
Oneof the most common signs of Premature Ovarian Failure is having irregularperiods. Women should pay close attention to their menstrual cycles, so thatthey can alert their health care provider when changes occur in their periods.
Currently,no proven treatment will restore normal function to a woman’s ovaries. But,health care providers can suggest treatments for some of the symptoms of POF.
Mosthealth care providers believe that HRT replaces what your body should be makingnaturally as a young woman, and that your body needs these hormones to functionnormally. HRT taken by women with POF is very different from the hormone therapythat is often taken by women who are going through or have already gone throughnatural menopause.
Thetype and amount of HRT prescribed to women with POF is different from thehormone therapy taken by women in the Women’s Health Initiative study. Forexample, women with POF usually take full-dose estrogen replacementtherapy, meaning the amount of estrogen is nearer or equal to the level normallyfound in a young healthy woman, whose ovaries are working properly, beforemenopause. Hormone therapy for women who have already gone through menopause isa much lower dose. And, women with POF typically use a patch to deliver thehormone estrogen, but take a pill that provides progestin. This regimen isdifferent than the one used in the Women’s Health Initiative, which had womentake a pill that contained both estrogen and progestin.
Becauseof lower hormone levels that result from POF, you are at greater risk for anumber of health conditions. These conditions, and what you can do to stayhealthy, are described below.
Whilethere is currently no way to prevent Addison’s disease, the best way to treatit is to find out whether you have it. You can easily manage the condition withthe help of your health care provider, by taking medication that replaces thehormones your adrenal glands are not making. If left untreated, however, thedisease can be life threatening because the body can’t respond properly tostressful events, such as severe illness, injury, or surgery.
Ifyou have POF, it will likely be very difficult for you to become pregnantbecause your ovaries aren’t working correctly. At this time, there is noproven medical treatment that improves a woman’s ability to have a babynaturally if she has POF.
Manywomen involved in POF support groups reported that, when they were diagnosedwith POF, they felt a sense of loss or grief, not unlike the sadness associatedwith the death of a loved one. Others reported that they felt guilty about nottrying to have children earlier in their lives. They noted that the diagnosisalso affected their partners, spouses, and families. For women with POF andtheir families, then, emotional support may be as important as medical treatmentfor dealing with POF.
Familiesaffected by POF do have options for having a child. As mentioned earlier, avoidunproven fertility treatments and treatments that have been proven ineffectivebecause such methods may actually reduce your chances of getting pregnantnaturally.
All forms of ART arecomplex, and each carries its own benefits and risks, some of them serious.Because few insurance companies currently provide coverage for this procedure,families may have to cover the entire cost of the process. And, many familieshave to try ART several times before it is successful. The Centers for DiseaseControl and Prevention (CDC) provides statistics on success rates of ARTprocedures based on different factors. Go to the 
Some researchers are exploring whether a low dose of a certain steroid can treat POF in cases caused by an autoimmune disorder. The steroid, called prednisone, decreases the function of the body’s immune system, which is thought to be attacking the ovary follicles in some women with POF.
