Premature Ovarian Failure

Premature ovarian failure and fertility

Early and premature menopause can affect your ability to have children naturally, although it does not entirely negate the possibility.

Women experiencing early or premature menopause do not ovulate (release an egg) every month. This makes it difficult to get pregnant.

If you want to have children, you might use IVF and donated eggs from another woman or use your eggs if you have some stored. Surrogacy and adoption may also be options for you.

Studies have shown that a small percentage of women (5-10%) who experience premature menopause (where the cause is unknown) sometimes ovulate and become pregnant.

If you don’t wish to become pregnant, you should consider contraception.

Women who have had a hysterectomy at an early age, even though their ovaries have not been removed, are more likely to develop POI.

Medical radiotherapy to the pelvis or chemotherapy for cancer may induce POI- though in some incidences, this is temporary, and women may start menstruating again sometime after their cancer treatment has finished.

Autoimmune is the cause in around 1 in 20 women with POI. Autoimmune disorders occur when the body’s natural defence system can’t distinguish between your and foreign cells and mistakenly attacks normal cells.

Examples of common autoimmune disorders are rheumatoid arthritis, type 1 diabetes, and some forms of thyroid disease.

Genetic causes: Much less commonly, there may be a genetic cause. A strong family history of POI and POI at a very young age makes this more likely. The most frequently found genetic problem is Turner’s Syndrome when one of a woman’s two X chromosomes is missing.

Anti-mullarian hormone (AMH)

Females are born with a finite number of eggs in their ovaries. This number starts to decline around puberty, with a dramatic decrease in eggs from the age of 35. AMH is a hormone produced by the eggs in the ovary. As such, a reduced number of eggs in the ovary will lead to a lower level of AMH, which has been used as a marker of ovarian reserve. There is research being done around the use of AMH in predicting and diagnosing menopause, but this test is not currently available on the NHS, and its use in this setting has not yet been confirmed.

Why is it so important to diagnose POI?

Females are born with a finite number of eggs in their ovaries. This number starts to decline around puberty, with a dramatic decrease in eggs from the age of 35. AMH is a hormone produced by the eggs in the ovary. As such, a reduced number of eggs in the ovary will lead to a lower level of AMH, which has been used as a marker of ovarian reserve. There is research being done around the use of AMH in predicting and diagnosing menopause, but this test is not currently available on the NHS, and its use in this setting has not yet been confirmed.

Psychological: Young women may struggle with distressing thoughts around the loss of oestrogen and its association with ageing and loss of femininity, in addition to the potential consequences for their fertility if they wish to have children in the future or add to their family. It can be hard to challenge social stereotypes attached to ageing and menopause, which can add to a woman’s distress.

Low hormone levels can cause problems with sexual function both psychologically and physically. Physically, the vagina changes in response to lower oestrogen levels. Libido may also drop with changes to hormone levels and in response to any negative thoughts about going through menopause and the link to feeling a loss of sexuality.

Women often find it challenging to discuss a diagnosis of POI and its potential consequences with a partner or a friend as it is perhaps an unexpected conversation to have at a young age, mainly if, like most women with POI, there is no explanation which can make the diagnosis harder to come to terms with. Consequently, women can feel very lonely and struggle to cope following a diagnosis. Women commonly express feelings of guilt attached to fertility and POI and can feel hopeless about the future. Providing psychological support is vital in the management of this condition.

Cardiovascular disease: This term encompasses the damage to blood vessels around our body- most notably in our hearts and brains. Oestrogen helps to keep our blood vessels healthy and flexible, and subsequently, the risk of heart disease and stroke increases after menopause as oestrogen levels fall. Again, ensuring that these additional risks are understood and discussed following a diagnosis of POI is vitally important.

Other considerations: Vaginal symptoms and psychosexual health: Oestrogen receptors all over the body, including the bladder and vagina. Falling oestrogen levels can cause symptoms of vaginal dryness and irritation, painful intercourse, and recurrent urinary tract infections.

Lower levels of testosterone and oestrogen: Can interfere with libido and sexual function in addition to vaginal symptoms. The symptoms of testosterone deficiency can be much more marked in women who have had surgical menopause from having their ovaries removed.

In addition, as the levels of oestrogen in the body fall, the womb can become smaller and much less able to accommodate a pregnancy. It is important to discuss fertility needs as part of managing POI, as giving hormones back may help to keep the womb healthy and more likely to support a pregnancy if this is desirable.

HRT

For more information on HRT options, please see our HRT section

Women with POI often require higher doses of oestrogen than women experiencing menopause later in life and may often require testosterone and oestrogen, which a specialist may prescribe.

Testosterone

Testosterone supplementation may help manage some of the critical symptoms of menopause, such as tiredness and reduced libido. This is commonly used in the management of these symptom however testosterone is currently not licensed in the UK and can usually needs to be prescribed in a specialist setting.

Topical oestrogen

Topical oestrogen can improve vaginal and vulval dryness and irritation.

CBT

It is common to feel overwhelmed and anxious following a diagnosis of POI and some women may also experience low mood. Cognitive Behavioural Therapy is a form of talking therapy that helps to reframe the way we think about things and can be incredibly helpful in coming to terms with a difficult diagnosis such as POI.