Premature Ovarian Failure

Premature menopause made headlines when scientists reported breakthrough news of a successful ovarian tissue graft giving hope to thousands of young women affected by early menopause. This is exciting news, but it's still experimental. Dr. Donnica discusses premature menopause and the treatments available.

What is Premature Menopause? 

Many patients prefer to call it "premature ovarian failure" or "POF". POF is menopause that occurs (for any reason) before the age of 40 as a result of lost ovarian function. For most women with POF, the cause of their condition is never identified. Known factors contributing to premature menopause include: autoimmune disorders (most common), genetics, chemotherapy, radiation, surgical removal of the ovaries for any reason (e.g. endometriosis, trauma, cancer, etc.), or endocrine disorders (e.g. thyroid or pituitary problems, diabetes). While it may seem disconcerting that this condition is increasing in frequency, the good news is that the increase is largely due to the large number of women who are being treated for cancer and surviving.

One explanation for POF of unknown origin is that some women are born with significantly fewer egg follicles than others; a recent paper based on mathematical models & autopsy studies estimated that range to be from 75,000 per ovary at birth to 2.5 million per ovary at birth. This information is not yet helpful clinically, as we have no way to measure the number of egg follicles that a woman has at any age. 

Menopause means more than just losing your periods.  This is a syndrome with clinical symptoms as well as long-term consequences.  An important distinction here is that women who have had a hysterectomy (surgical removal of the uterus) but whose ovaries function normally won't have periods, but they are not "in menopause."  They will go into menopause naturally when their ovaries cease functioning.

POF is estimated to affect apr. 250,000 American women or 1 to 3% of women between ages 15 and 39. The average age of onset is 27. There is no typical menstrual history for women with POF. Approximately 10 to 15% of females with POF have primary amenorrhea, which means they never had a period on their own.

The ovarian failure of POF may be temporary, periodic, or incomplete. Some patients may ovulate occasionally so contraception is still necessary if pregnancy is undesired. Pregnancies have occurred after the diagnosis of POF in about one in twelve women not using contraception.

Menopause means more than just losing your periods. This is a syndrome with clinical symptoms as well as long-term consequences. An important distinction here is that women who have had a hysterectomy (surgical removal of the uterus) but whose ovaries function normally won't have periods, but they are not "in menopause." They will go into menopause naturally when their ovaries cease functioning.