Premature Ovarian Deficiency

What is Premature Ovarian Failure (Premature Ovarian Failure), Does it Mean Early Menopause?

It is a condition of decreased ovarian function in women younger than 40 years of age. It is also called early menopause among the people, but unlike early menopause, ovarian functions continue a little longer in early ovarian failure.

It is also called primary ovarian insufficiency or premature ovarian dysfunction because it may have a long clinical course and may be reversible. It is observed with a frequency of 1% under 40 years of age. It shows characteristics similar to early menopause. These symptoms are

• Menstrual irregularities or a patient with regular menstruation suddenly starts to have no menstruation, that is, secondary amenorrhoea.
• (Menstrual irregularities and fluctuations in ovarian function)
• Never menstruation; primary amenorrhoea (may be accompanied by partial / partial puberty development or delayed development of puberty signs)
• Inability to conceive (infertility, infertility)
• Decreased sexual desire (sexual dysfunction; orgasm, pain, arousal difficulties)

There may be symptoms related to estrogen hormone deficiency. These; hot flushes, disturbances in sleep patterns and mood, pain during sexual intercourse, vaginal dryness, bladder problems, etc.

How is Early Menopause Diagnosed?

After your history is taken by your doctor, some tests should be applied to you after physical examination and genital examination. Your ovaries are examined by ultrasound and then your ovarian reserve is evaluated with blood tests. Apart from this, some additional tests such as thyroid, blood sugar, hormones produced from the adrenal glands will be requested. FSH levels >30-40 mIU/mL and low estradiol levels >30-40 mIU/mL at 1-month intervals are diagnostic for premature ovarian failure.

What should be done after early ovarian failure is diagnosed?

Firstly, the underlying causes should be investigated. A number of blood tests should be requested by your doctor and you should be directed for genetic examination. In some cases, bone density measurement may be requested in terms of osteoporosis risk. Whatever your main complaint is, then its treatment should be planned. With early diagnosis, it is promising for fertility that oocyte cryopreservation (egg freezing) option is offered to patients by collecting eggs before they are completely depleted.

If the patient presents with the complaint of inability to conceive, in vitro fertilisation can be offered to the patient. The highest probability of pregnancy is possible with egg donation (oocyte donation), but it is not legal in Turkey as in many countries.

Psychological/psychiatric support is important as the diagnosis of early ovarian failure significantly affects the mental and social life of the woman. In particular, the loss of reproductive ability may cause women to feel sadness, guilt, anger, helplessness, loss of self-confidence and may disrupt their social relations with their environment.

Women with sexual dysfunction may benefit from hormone therapy.

What are the Causes of Early Ovarian Failure or Early Menopause?

Although the cause of 90% is unknown, it is among the reasons held responsible;

• Genetic factors; mutations associated with the X chromosome; Turner syndrome, such as Fragile X, disorders associated with autosomal chromosomes; galactosemia, BRCA 1 mutation, etc.
• Early ovarian failure is observed more frequently in those with a family history of early menopause.
• Environmental factors; toxins (lead, pesticides, compounds used in chemical industry, solvents), viral infections (such as mumps, tuberculosis, varicella, CMV, HSV)
• Cigarette
• Treatments such as chemotherapy, radiotherapy
• Surgical interventions (ovarian operations, operations that reduce blood flow to the ovary)
• Pelvic surgery may reduce blood flow to the eggs. Studies have shown that the age of menopause is brought forward by 3.7 years in hysterectomies.
• Autoimmune diseases (autoimmune thyroid diseases (Hashimato thyroiditis, autoimmune polyglandular syndrome with aderenal autoimmune disease)), diabetes, paratioid diseases... is among the reasons.

Can Women with Premature Ovarian Failure Conceive?

Since ovulation may occur occasionally in about a quarter of them, 5-10% of them can conceive and give birth spontaneously.

When Should I Suspect Early Ovarian Insufficiency and Go to a Doctor?

Patients should be evaluated for premature ovarian failure in cases of no menstruation for at least 3-4 months or less than 9 menstrual periods per year.

Is FSH level >10 MIU/mL a sign of early menopause?

If it is above these values, that is, in the patient under the threat of ovarian insufficiency, AMH, antral follicle pool called egg counting on ultrasound should be examined and proceed accordingly. However, the patient cannot be told that she has entered menopause or when the patient will enter menopause.

What is the Treatment of Early Ovarian Failure, Popularly Known as Early Menopause?

The patient should be approached in a multidisciplinary manner. Treatment should be done individually according to the patient's complaints and findings.

Our aim should be to treat the symptoms caused by estrogen hormone deficiency, to reduce the possibility of bone resorption and cardiovascular diseases, to ensure the completion of secondary sex characteristics by replacing the missing hormones in adolescents and to continue this treatment until the age of menopause. If the patient wants to have children, treatment should be applied accordingly.

Does DHEA Treatment Increase My Ovarian Reserve?

Although the data are different in the literature, spontaneous ovulation and pregnancies are reported with DHEA treatment and an increase in response to egg stimulating drugs is mentioned.

Which disease risks increase in a woman who enters early menopause?

The risk of cardiovascular diseases increases. (Many studies have shown that estrogen deficiency has adverse effects on lipid profile, insulin resistance, and it is also mentioned that it increases plaque development in the vessels. Estrogen treatment reduces this risk).

The risk of osteoporosis (osteoporosis) increases. (Many studies have shown that estrogen use reduces the risk of fracture)

Does Estrogen Therapy in Early Menopause Cause Breast Cancer?

It is not clear whether the risk of breast cancer in women who enter early menopause is higher than the risk in women with normal menstruation. There is no need for early screening with mammography. However, your doctor will offer you a plan for your follow-up after your breast examination.