Premature Ovarian Failure

Premature Ovarian Failure (POF) or a premature menopause occurs when a woman’s periods stop before the age of 40. There is often some warning, just as there is at the time of the natural menopause (around the age of 50 for most women) with periods becoming irregular and more widely spaced. Sometimes, however, periods cease suddenly. The ovaries stop producing estrogen and so symptoms including hot flushes, mood changes and vaginal dryness occur. The ovaries also stop producing eggs and so conception is extremely unlikely. 

There is not always an explanation for a premature menopause. It sometimes is hereditary 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 ‘auto antibodies’ which prevent the ovaries from working and a few women can be affected by viral infections of their ovaries. In most cases, the ovaries cannot start working again on their own.

Some women can have quite a long period during which the ovaries are slowing down rather than stopping and ovulation may occur from time to time. During this time the ovaries are resistant to the two hormones that come from the pituitary and which stimulate the ovaries to release eggs and estrogen. These pituitary hormones are FSH (follicle stimulating hormone) and LH (luteinizing hormone). The levels of FSH and LH in the blood at the time menopause are very high as they are trying to encourage the ovaries to work. Premature Ovarian Failure is therefore diagnosed by at least two blood tests that show elevated blood levels of FSH and LH. 

The ovaries will not respond to the body’s natural FSH and LH and in turn will not respond to FSH/LH injections. At this time, there are no treatments that will make resistant or menopausal ovaries work again. Woman with Premature Ovarian Failure should be given hormone replacement therapy (HRT), which will provide the right amounts of estrogen (together with progesterone, another ovarian hormone) and an artificial menstrual cycle. It is recommended that the hormone replacement therapy is taken at least until the age of 50. The oral contraceptive pill is an alternative to HRT. Oral contraception will not allow ovulation to occur. For women desiring to conceive options include donor egg and adoption. 

For more information on Premature Ovarian Failure, please click here to contact LifeStart Fertility serving greater Los Angeles or call us at 818-889-4532 for an appointment.