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5 things you need to know about premature ovarian failure

Although “ovarian failure” is technically what happens with the patients, it is not really white and black—you’re ovaries don’t just quit working overnight.

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Ah, menopause, the official farewell of our dear friend, Flo. For the majority of the women, the final farewell of our fertility occurs in about 51 years old. But that is not the case for everyone. In fact, it is possible for the menopause, and all its challenging symptoms (think: hot flashes, night sweats, the list is endless) may occur in the years thirty, twenty, and even younger. Those who start to experience signs of early menopause at this young age can have premature ovarian failure—medically known as premature ovarian insufficiency (POI) is a condition that causes the ovaries to stop working before the age of 40. It affects about 1 percent of the women.

Although “ovarian failure” is technically what happens with the patients, it is not really white and black—you’re ovaries don’t just quit working during the night, said Kristin Bendikson, M. D., a fertility specialist at USC Fertility. On the contrary, Bendikson explained that POI is a gradual process in which a patient may have many of the symptoms associated with menopause for months to years before they officially stopped its time. When the ovary is, in fact, stop working, this means that you stop releasing eggs (ovulating) regularly, or not at all and stop making hormones such as estrogen and progesterone.

Besides the fact that this sends you into an early menopause, POI also puts you at an increased risk of additional health complications such as heart and bone disease. In addition, young women with POI have a hard time to be pregnant. Because of these consequences, Bendikson urges patients who missed their period for three months in a row to ask for advice and medical attention of their gynecologist or health care provider first to rule out pregnancy and then to focus on other tests to determine the cause.

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Here is exactly what you need to know about POI, especially if you’ve noticed changes in your menstrual period and experienced any of the following signs.

The Symptoms are Similar to Menopause

One of the most obvious is the loss of the period, but for some patients that does not happen immediately. Instead, you can have irregular or occasional periods of months or even years before Flo officially leave the city. In combination with a changing and less frequent menstrual cycle, you could also experience—as you probably guessed by now—hot flashes, sleep problems, mood swings, vaginal dryness, and discomfort during sex. There is not a specific order in which the symptoms occur for all patients. For example, hot flashes tend to happen when the ovary is not because it is related to the decline of estrogen, in comparison with, say, vaginal dryness, that seems not right away, Bendikson said.

A word about hot flashes: still hot is not a hot flash. On the contrary, the hot flashes are “rushes where your skin is really hot and then you sweat all of a sudden and, for many, are very uncomfortable, explained Sheeva Talebian, M. D., a reproductive endocrinologist and fertility specialist in New York. If you begin experiencing feelings like this, speak to your doctor as soon as possible.

You Might Have Trouble Getting Pregnant

Not surprisingly, POI-patients are also going to have a very hard time to become pregnant. The ovary is very few eggs left and is no longer release eggs (ovulate) on a regular basis, making it less possible for a woman to become pregnant, Bendikson explained. While the American Society of Reproductive Medicine reports that about 10 percent of women with POI may be to become pregnant using their own eggs, fertility rates are difficult to predict and the pregnancy can be the result of modern methods, such as freezing.

If you have problems becoming pregnant, a doctor may check your ovarian reserve and hormone levels by a battery of examinations. The main test for the detection of menopause, according to Bendikson, is a blood test evaluates your follicle-stimulating hormone, or FSH, which then at a very high level shows that there are considerable problems with the function of the ovaries. A doctor can also ask for another test to examine anti-mullerian hormone, or AMH levels, which reflect ovarian reserve, or remaining number of eggs.

The Cause is often Unclear

“Most of the time we don’t understand why a woman has POI,” Bendikson said. “It Is because she was born with less eggs than normal, or because she was losing them faster than normal? There is no way to tell the difference.”

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Nevertheless, it is well known that medical treatments, such as chemotherapy and radiation can lead to ovarian failure and ovarian multiple operations can also reduce the number of remaining eggs. The condition is also associated with autoimmune diseases, such as those affecting the thyroid and adrenal glands, according to the American Society for Reproductive Medicine (ASRM). There are also a number of genetic disorders such as Turner Syndrome and Fragile X that are connected with the NP.

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If a woman has a family history of early menopause, she may have a higher chance of undergoing an early menopause themselves. If you have a brother or sister, mother or aunt who made the transition to the menopause at a young age and/or NP, Talebian said: this is a “red flag” and encourage you to be evaluated by a doctor to ultimately determine if you are also at risk through a blood test. That said, there is no single test for the diagnosis of NP itself.

Your Bones and the Health of the Heart is in Danger

In addition to the symptoms listed above, low estrogen levels caused by an NP can make you more likely to develop bone diseases such as osteoporosis. Because estrogen stimulates the cells that help our bones constantly grow, as reduce the level of your bones are weaker and prone to fracture and diseases, Bendikson explained. Women with POI, such as those who enter menopause at a later age, are also at risk for heart disease and dementia.

“All these long-term consequences, plus the symptoms of women are at a higher risk for depression and anxiety,” Bendikson said.

The treatment Options are Limited

There are no existing treatments that reverse NP, so most just focus on relieving symptoms and preventing long-term medical problems. Hormone therapy is usually prescribed for patients in the form of the oral contraceptive pill or hormone-replacement therapy (think patches), and up to the age of natural menopause. While hormonal therapy does not help with fertility, it will support bone, heart, brain, and health, Bendikson said. In addition, it is recommended that women with POI, Vitamin D and calcium supplements to prevent osteoporosis and to consider local treatments for the treatment of vaginal complaints, such as long-term moisturizers or lubricants for sex.

As for the fertility of the women with POI must consider alternative methods such as the use of IVF with donor eggs.

“As soon as you’re identified as a POI, the number of eggs is so low and the function of the ovaries is so bad that you are not able to freeze a large number of eggs,” Bendikson explained.

Both Bendikson and Talebian stress the importance of talking with your mother to find out if they experienced early menopause, so that you can consider freezing your eggs before it’s too late.

This article first appeared on Women’s Health.

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