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Early Menopause? Get the Facts About Primary Ovarian Insufficiency

Early menopause can disturb the sense of well-being and health and affect the quality of life. Here we discuss its causes and signs with professor Lubna Pal - the director of two clinical programs at Yale Reproductive Endocrinology.

How often is the condition?

Primary ovarian insufficiency – POI – is a situation when chronologically young ovaries are behaving like a decade or more-older. Ovarian failure before age 40 is consistent with diagnosis of POI. Infrequent to absent menses are the most common presenting feature of POI. The hormone profile reflects low estrogen levels along with high levels of a hormone called FSH. 

Although POI affects only about one percent of the population, but when you look at millions of women in the world, then one percent becomes a huge number. Amongst the women in their 30s the number of POI incidents is much smaller than 1%. 

I just wanted to clarify that women with POI have about a 10 percent chance of spontaneous ovulation because unlike age-appropriate menopause, which in average takes place at about 51 years, women with POI still have a few eggs in their ovaries. Their ovaries are just not responding to their own hormones. So there is always a small probability they will ovulate and can even get pregnant. Pregnancy, however, is rare.  

What are causes of the condition?

In 50% of times we don’t know why it happens. That’s the saddest situation. Etiology may never be known. Genetic abnormalities may cause the condition. I may look fine, but my ovarian genetics may not be completely normal.  

Women with certain chromosomal abnormalities, such as mosaic Turner’s syndrome – when a piece of X-chromosome is missing in some but not all cells- are highly likely to have POI or premature ovarian failure at a much younger age

Women who have such conditions as galactosemia, which is another genetic disorder related to carbohydrate handling, metabolic disorder, are more likely to have POI. 

Women with autoimmune conditions are also at risk for POI. That doesn’t mean they should start worrying about it, but if I’ve been diagnosed with Hashimoto’s thyroiditis, I should have a conversation with my clinician about timely fertility planning.  

Read how Flo helped a couple with Hashimoto’s disease get pregnant.

What are the early signs of the condition?

Some women with POI have no signs till they stop having their periods. An irony is – and this is what I often see as a specialist – young women who are on birth control pills (on contraception) they don’t know their own biology is abnormal till they start planning their pregnancy. And when they stop a pill to try to get pregnant, they don’t get a period. The earliest sign that happens for them is no periods.

Another common case is when a woman has no trouble getting pregnant for the first time, she breastfeeds a baby, stop breastfeeding and she doesn’t have resumption of her menses. 

Other condition is when menses were regular, and they started becoming irregular and then they just stopped.

There is no single pattern. 

So, there is no opportunity to suspect the condition?

It’s important to recognize that those who have POI, their daughters and their sisters are more likely to be at risk for POI or early menopause. The women should not be panicking about this condition, but they should be aware of the relationships that link with this condition and have awareness around this concept. 

But there is no one symptom that defines it. 

Do women who step into menopause prematurely need support?

That’s a great question! I just want some clarity over assistance. Women who achieve POI and have good health, should be on estrogen based hormonal therapy because this population is in high risk for bone fractures, osteoporosis, cardiovascular disease, Parkinson’s disease and even dementia. There is a whole list of health concerns relating to POI that merits attention. 

As far as fertility is concerned, unfortunately, donor egg IVF and adoption are the only two realistic options available to women with POI. There are some research strategies that are going on that seem to suggest some promise, but they haven’t been materialized in the clinical world yet.

I just wanted to add one thing. Egg donation can be a very expensive undertaking unless someone within the family offers to donate her eggs. However, sisters of women with POI may not be the best egg donors as their ovarian response is likely to be less than someone else who is unrelated. 

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