Sexuality & fertility

Premature ovarian failure — you haven’t failed

by Marcelle Pick, OB/GYN NP

It breaks my heart when a new patient comes in to see me devastated by her diagnosis of premature ovarian failure. I know that this diagnosis often hits young women at the heart of their self-esteem — and that many of them think they will never feel normal again, let alone get pregnant. Aside from hormone replacement therapy (HRT), conventional medicine doesn’t have a lot of answers when it comes to POF, nor does it offer much hope, and that’s a shame. Because there’s a lot you can do to help your body at this time. And the first thing you can do is to realize that POF is not the same thing as menopause, nor is it a failure on your part in any way.

I can’t promise you will regain the function of your ovaries, but I can promise that as you begin to understand the diagnosis and the ways you can protect yourself, you will realize that you have certainly not failed or lost control of your life. Educating yourself and tuning into your body on this journey can bring you more control and wisdom than ever before.

Let’s take a closer look at premature ovarian failure and how you can protect yourself from the associated health risks. You will see that neither you — nor your body — has failed.

POF: the wrong term

The term premature ovarian failure has always struck me the wrong way. Not only does the word “failure” make us feel like we’ve done something wrong, but women with POF may still have periods and may even get pregnant. So it stands to reason that the ovaries have not entirely failed.

When I’m writing the diagnosis in a chart, I make sure women understand that nothing about her has failed. If I could write it another way, I would. If I could take it out of the medical dictionary, I would. But the diagnosis has to be phrased this way so insurance companies will provide coverage for treatment. In my opinion, a more accurate (though still not ideal) description is ovarian hypofunction. What I mean by this is that your ovarian function has declined — not stopped entirely.

What is premature ovarian failure?

Premature ovarian failure happens when ovaries slow or stop production of mature eggs and reproductive hormones before the age of 40. This can prompt irregular periods and an eventual cessation of menstruation entirely, leaving women with two equally devastating concerns: one is the possibility of infertility, and the other is suffering from complicated symptoms, such as hot flashes, night sweats, mood swings, irritability, vaginal dryness, and a lowered sex drive.

On the surface, the symptoms of premature ovarian failure look suspiciously like early menopause, but let me assure you this is not menopause. Here are the important differences.

The first consideration is your age.

• Natural menopause occurs after the age of 45, usually around age 51.
• Premature menopause, or early menopause, can occur anywhere between ages 40 and 45.
• POF occurs anytime before the age of 40.

A second feature is whether a woman is still menstruating.

• A truly menopausal woman will have ceased menstruation for at least a full year.
• On the other hand, some POF patients may have occasional periods.

The third consideration is fertility.

• Menopausal women no longer produce eggs, so they cannot become pregnant naturally.
• Approximately 5–10% of women diagnosed with POF go on to conceive without any outside intervention.

Conventional wisdom tells us that we’re born with a finite number of follicles in our ovaries that grow into eggs with the help of follicle stimulating hormone (FSH) and lutenizing hormone (LH), and when the eggs run out, we are in menopause. One of the ways we can gauge where our bodies are in this process is to test FSH and LH levels. When they are too low for a woman younger than 40, she may have a pituitary or hypothalamic issue. When levels are consistently high, she is most likely perimenopausal or, depending on her age, I may be concerned about POF. Even if a woman has one high FSH reading, we have to prepare for the possibility of a premature ovarian failure diagnosis. But this doesn’t mean that there isn’t any hope.

Another piece to POF

Let me share this story with you about one of my patients. Sophia was 33 when she came in to see me. She had a beautiful seven-year-old daughter and wanted to get pregnant again. She had very high FSH readings and low estradiol readings. Her doctor told her she had POF and there was no way she’d get pregnant again. We talked for a long time that day, and I learned that Sophia was an avid kick-boxer. I also learned another important piece of her story, which was that starting at the age of seven — the same age as her daughter — she had been sexually abused. I explained that sometimes things resurface when we have a trigger. In this case, it may have been her daughter’s seventh birthday.

After our visit, Sophia decided to do some energy work around her childhood. She worked intensely with her kick-boxing coach, who also happened to be a trained psychotherapist. He acted as perpetrator, and they sifted through some of the emotional trauma she’d experienced as a child. The next time she came to see me, her FSH had dropped tremendously and her estradiol had gone up. She became pregnant shortly after that.

This is one of my favorite stories, but unfortunately, fertility issues don’t always resolve this way for everyone. I know that as a woman, it feels like bearing a child is a god-given right, and when that choice is taken away, it feels like a part of our womanhood has been stolen. But remember that POF is merely the decline of a biological function — not a decline in the desire or ability to be a mother. One thing I tell my patients is that there are many roads to becoming a parent, and you will get there if that is what you truly desire. (You can read more about this in my article on infertility.)

The honest truth is that you have not failed. As for the root causes of POF, there are several theories out there, but the majority of POF cases happen without a pinpointed cause. We just don’t know enough about it yet. I do know that women diagnosed with POF can have overwhelming emotional knots to untangle — and some very real health risks to protect themselves from.

Health concerns for women with POF

When the emotional impact of a premature ovarian failure diagnosis takes center stage, it can sometimes make the related health concerns seem insurmountable. But time and again, I’ve seen women cultivate their knowledge of POF and gain new insight into themselves and their total well-being.

Our ovaries are responsible for the majority of estrogen that is present in our bodies prior to menopause. One of the first things to understand is that women with premature ovarian failure need to take special care to protect themselves from the risks associated with lower estrogen production. With careful attention paid to your health, I promise you will find relief — in mind and body.

Your bones. Throughout life our cells and tissues are in a constant state of renewal. Estrogen plays a crucial protective role in the bone turnover process and, for younger women, the longer we go without it, the higher our risk for osteoporosis. Women who are under age 30 may still be building up peak bone density, and if estrogen levels begin to taper off before this peak is reached, a woman’s bones may never get to the density they were destined for.

Your heart. Your heart is also protected by estrogen and may be at risk with prematurely low levels. Hormone replacement therapy is often prescribed for women with POF in their 30’s to decrease the risk for heart disease. Although the Women’s Health Initiative showed that HRT may increase the risk for heart disease, I think this depends strongly on a woman’s age and the kinds of hormones she is using to replace her own. Bioidentical hormones, for example, are identical to those we make in our own bodies and may therefore be less risky overall.

Your thyroid. Decreased thyroid function is one of the most common disorders present in women with POF. A conclusive explanation for this has yet to be discovered, but it most likely has something to do with the fact that 65% of all POF cases are autoimmune-related. This means that the body’s immune system mistakenly gauges its own natural processes as foreign and attacks itself in an effort to “protect” the body. In many cases, as the body attacks the thyroid it also attacks the ovaries.

Your adrenals. Scientists are also finding that premature ovarian failure may give some women a predisposition to an autoimmune disorder that affects our adrenal glands known as Addison’s disease. A 2002 study completed by the National Institutes of Health found that women with spontaneous POF were 300 times more likely to develop Addison’s disease than the general population, and more importantly, many of these women did not show any of the early warning symptoms. Though I haven’t seen this in my practice, I do feel that there may be a connection between POF and our adrenals. The adrenal glands are central to our response to stress, and if their function is impeded, our health will suffer dramatically. Research shows that the best way to detect this condition is by getting an adrenal antibody test to see if your body is making the antibodies in question.

Your endocrine system is a delicately balanced web of organs, functions, and hormones that impacts far more than just your reproductive cycle. The younger you are, the more you stand to gain by getting back to the hormonal state most natural to a woman of your age. You may need to replace estrogen, progesterone, and possibly testosterone and DHEA, depending on your unique hormonal profile. Doses can be increased gradually, though, so your body can get used to having the hormones on board again, and you will also benefit from regular monitoring and readjustment over time.

Tending to your body through POF — naturally

Once you understand the risks associated with POF, the next step is to give your body the loving attention it deserves. The only way to prevent the associated health issues discussed above is to give honest consideration to what your body and mind require. Through all my years of practice, this is when women really begin to regain a vibrant perspective on their lives. They may have to rearrange previous plans and goals, but with a healthy mind and body, new dreams are laid down in place of the old, and slowly but surely life feels good again — sometimes even better.

Consider the following as you begin:

Balance your hormones. Calming hot flashes, night sweats, and moodiness are often the immediate issues addressed in treating POF. I know these symptoms can severely impact a woman’s quality of life. But as detailed above, there are also long-term health concerns to protect yourself from. I encourage you to talk to your provider about balancing your hormones and working out a plan based on your unique needs. Though some women feel strongly about recreating regular monthly cycles (even though they may not be ovulating per se), normalizing your hormones is essential for long-term wellness in women with POF.

Many conventional practitioners will prescribe a course of hormone replacement therapy (HRT) at a higher dose than what’s typically given to women in menopause. We recommend a combination of phytotherapy and prescription-strength bioidentical hormones, which are closest to those your own body makes, to reduce side effects and risks.

Consider testing. Associated thyroid and adrenal insufficiencies are a very real possibility for some women with POF. Talk to your practitioner about getting a full thyroid panel and an adrenal antibody test. Both may be easily treated to prevent more serious health consequences. If your practitioner doesn’t do this kind of testing, consider a lab, such as Genova, ZRT or Diagnos-Techs, that will work directly with you.

Maintain a healthy diet to support hormonal balance. Enjoy fresh fruits, vegetables, wild-harvested deep-water seafood, and grass-fed meats instead of highly processed, chemical-laden foods. Buy organic or local whenever possible, avoid trans fats, and limit refined carbs. Before you put anything in your mouth, ask yourself, Is this going to nourish my body and promote good health? For more information on healthy eating, take a look at our Nutritional Guidelines.

Get regular exercise. Exercise affects your weight, strength, bones, heart, emotions, and your stress levels — your total-body health depends on it. You don’t have to train for a marathon, just get your blood moving. Break a light sweat once a day, and your body will thank you for it. As a friend of mine once said, “Sweat is the fountain of youth. Bathe daily!”

Cover your bases with a high-quality nutritional supplement. Taking a daily nutritional supplement like the one we offer in our Personal Program is the best insurance against vitamin and mineral deficiencies that are the source of so many health problems.

Lower stress levels. Every day science sheds new light on how stress affects our physical and mental well-being. This is especially true with disorders like premature ovarian failure that are intimately associated with the hypothalamus, pituitary, and adrenal axis. Whether you release stress with a vigorous work-out or a calming meditative yoga class, find a way to rid your body of the extra tension.

Cultivate emotional stability. We now know that thoughts and feelings manifest themselves in our physical bodies — even those buried in the distant past. Many women have a habit of creating obsessive “self-talk loops,” where we worry about things, turning them over and over in our heads, and internalize many emotions. Remember that you have not failed and that premature ovarian failure can lead you to understand your body more fully. A positive outlook and thoughtful introspection may lead you to causes, and possibly even solutions, your conventional doctor could never imagine.

 

Changing your perspective on POF

I know receiving a diagnosis of premature ovarian failure is heartbreaking. I also know that it takes time to heal and understand what your life will look like afterwards. Give yourself time. But also understand that you haven’t failed. In the end, your body deserves the best health you can give it. Do this by learning more, taking care to prevent the health risks associated with POF and finding true happiness. Release yourself from what you thought would happen and create a new life picture, one that satisfies your goals and desires — whether that means becoming a mother or not. Devote yourself to being the best version of your unique self you can be! We are always here, if you need help along the way.

 

Related to this article:

References & further reading on premature ovarian failure

 

Original Publication Date: 02/04/2008
Last Modified: 02/16/2010
Principal Author: Marcelle Pick, OB/GYN NP