Do I have Premature Ovarian Failure (POF)

by National Institute of Health

(Page 3 of 5)

One of the most common signs of POF is having irregular periods. Women should pay close attention to their menstrual cycles, so that they can alert their health care provider when changes occur in their periods.

If you are under age 40 and your periods are irregular, or if you miss your period altogether for three months or more, your health care provider may measure the level of FSH in your blood, to determine if you have primary ovarian insufficiency in its early stages, or possibly even fully developed POF. Remember that FSH signals the ovaries to make estrogen. If the ovaries are not working properly, as is the case in POF, the level of FSH in the blood increases. A higher level of FSH in the blood is a strong sign of POF. But, irregular periods alone are not a sure sign that you have POF - research shows that fewer than 10 percent of women who have irregular or skipped periods have high FSH levels and POF.

To do an FSH test, your health care provider will collect some of your blood and send 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 have POF.

Are there treatments for the symptoms of POF?

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.

One of the most common treatments for women with POF is hormone replacement therapy (HRT). In women with POF, HRT gives their bodies the estrogen and other hormones that their ovaries are not making. Replacing these hormones causes a woman with POF to start having regular periods again. In addition, HRT may help women with POF lower their risk for the bone disease osteoporosis.

HRT is usually a combination of the hormones estrogen and progesterone (or the man-made form of progesterone, called progestin). Women can take the therapy as a pill, or they can wear a patch that sticks to their skin to get the hormones into their bodies. Many health care providers suggest the patch for women with POF because it offers a continuous flow of hormones into the blood stream, which mimics the way the body naturally releases estrogen. The combination and amount of hormones used in HRT may differ for different women. If you have questions about HRT as a treatment for POF, talk to your health care provider.

Most health care providers suggest that women with POF take HRT until they are 50 years old. After that time, women should talk with their health care provider about stopping HRT because of risks associated with older women taking the therapy after menopause.

Current research is also looking into the benefits of replacing the hormone testosterone to prevent bone loss in women with POF. Most people think of men's health when they hear the word testosterone, but women's bodies also make testosterone, at a level about one-seventh that of men. Testosterone helps to maintain muscle and bone mass, and may be related to a woman's sex drive. The ovaries make testosterone, and its level is lower in women with POF. But, unlike estrogen and progesterone, testosterone is not usually replaced as part of HRT. A clinical trial is now underway to see if raising the level of testosterone in women with POF 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 other young women who are at risk for osteoporosis.

Is HRT safe for me to take if I have POF?

Most health care providers believe that HRT replaces what your body should be making naturally as a young woman, and that your body needs these hormones to function normally. HRT taken by women with POF is very different from the hormone therapy that is often taken by women who are going through or have already gone through natural menopause.

Recently, a study found that older women, who had gone through normal menopause, were at increased risk for certain health conditions when they took a certain type of hormone therapy for long periods of time. The study was part of the Women's Health Initiative, a large, multi-center study that involved more than 161,000 postmenopausal women in their fifties, sixties, and seventies. The researchers found that these women, who went through natural menopause at the expected age, were at greater risk for stroke, blood clots, heart disease, heart attacks, and breast cancer after taking a specific type of hormone therapy for more than five years.

These results do not apply to young women taking HRT; specifically, these results don't apply to young women with POF. Women in the study mentioned above were between the ages of 50 and 79 when the study began and had gone through menopause at the normally expected time; their bodies would not normally be making high levels of hormones. The type of therapy taken by women in the Women's Health Initiative study could be called hormone extension therapy, rather than hormone replacement therapy, as is often reported. These women took the hormones beyond the time that the hormones would naturally be present. Women with POF get hormone replacement therapy; that is, the HRT is providing something their bodies would normally be making, if they didn't have POF.

The type and amount of HRT prescribed to women with POF is different from the hormone therapy taken by women in the Women's Health Initiative study. For example, women with POF usually take full-dose estrogen replacement therapy, meaning the amount of estrogen is nearer or equal to the level normally found in a young healthy woman, whose ovaries are working properly, before menopause. Hormone therapy for women who have already gone through menopause is a much lower dose. And, women with POF typically use a patch to deliver the hormone estrogen, but take a pill that provides progestin. This regimen is different than the one used in the Women's Health Initiative, which had women take a pill that contained both estrogen and progestin.

Talk to your health care provider if you have questions about HRT as a treatment for POF. He or she can explain the benefits and risks of HRT for your specific situation as a young woman. It is important to remember that young women with POF differ from older menopausal women in many significant ways. Your health care provider should consider these issues when deciding on the best treatment for you.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.