Sexuality & fertility

Premature ovarian failure — you haven’t failed

by Marcelle Pick, OB/GYN NP

• What is premature ovarian failure (POF)?
• What causes POF?
• Health concerns for women with POF
• Tending to your body with POF

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. 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 support your body, this journey can bring you more wisdom about your body than ever before.

Let’s take a closer look at premature ovarian failure and how you can protect yourself from the associated health risks.

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 being the possibility of infertility, and the other being 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.
• Early menopause, as defined in medical literature, is when menopause occurs anywhere between ages 40 and 45.
• Premature menopause (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.
• In contrast, 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 luteinizing 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, may have 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. With high FSH readings and low estradiol readings, her doctor told her she had POF and there was no way she’d get pregnant again.

During our visit I learned that Sophia had been sexually abused starting at around age seven — the same age as her daughter. I explained that emotional stress can influence our reproductive function via connections between our HPA and HPG axes. These are hormonal feedback loops, where the hypothalamus (H) and the pituitary (P) in the brain are responsible for stimulating both our ovaries (G, for gonads) and our adrenal glands (A). These connections enable Nature to favor a life-saving stress response over reproductive function when a woman’s body doesn’t have enough resources to do both.

What’s more, emotional stressors sometimes reemerge when we pass an emotional milestone in our lives — in this case, her daughter’s seventh birthday.

After our visit, Sophia agreed to make the lifestyle and nutritional changes I suggested, and also 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. They sifted through some of the emotional trauma she’d experienced as a child. After a year and a half of physical and emotional work, Sophia’s FSH had dropped tremendously and her estradiol went 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 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. (Read more about this in my article on infertility.)

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 there are some very real health risks to protect yourself from. The good news is that I’ve seen women cultivate their knowledge of POF and gain new insight into themselves and their total well-being.

Prior to menopause, our ovaries are responsible for producing the majority of estrogen that is present in our bodies. 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 at an earlier age. After menopause, the body is able to adjust to lower amounts of estrogen, but for women in their 20’s, 30’s, and 40’s certain hormonal levels are necessary to maintain good health. This is why many women with POF benefit from hormone replacement therapy.

Your bones. Estrogen plays a crucial protective role in bone turnover 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 reach the density they were destined for. Learn more about the many powerful, completely natural ways to keep your bones strong! (See our section on bone health to learn more.)

Your heart. Your heart is also protected by estrogen, and could 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, this risk depends strongly on how close a woman is to menopause. Women who had the greatest risk in this study were those who went on hormones years after going through menopause. Those closer to menopause when they start hormones are more likely to experience heart-protective effects from HRT. The kinds of hormones used and how they’re delivered, also matters. Bioidentical hormones, for example, are identical to those we make in our own bodies and may therefore be less risky overall. (See our section on HRT to learn more.)

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 identifies 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. (See our section on thyroid health to learn more.)

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. 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. (See our section on adrenal health to learn more.)

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. With careful attention paid to your health, I promise you will find relief — in mind and body.

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. 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 is often the most immediate issue women with POF want addressed. I know these symptoms can severely impact a woman’s quality of life. But balancing your hormones can also protect you from some of the long-term health concerns detailed above. Talk to your provider about balancing your hormones and working out a plan based on your unique needs. Many practitioners will prescribe a course of hormone replacement 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 minimize 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 you’re considering getting pregnant, it’s also a good idea to get tested for autoimmune ovarian antibodies. If these are elevated, you can take measures to quiet the immune response that may improve your chances of conceiving. 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 digestion, absorption, and hormonal balance. Choose fresh fruits, vegetables, wild-harvested deep-water seafood, and grass-fed meats over highly processed, chemical-laden foods. Buy organic or local when 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 health? It’s also a good idea to cover your bases with a quality nutritional supplement and probiotics like those we offer in our Personal Programs.

Get regular exercise. Exercise affects your strength, weight, bones, heart, emotions, nerves and 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.

Lower stress levels and cultivate emotional wellness. We now know that thoughts and feelings manifest themselves in our physical bodies — even those buried in the distant past. This is especially true with disorders like premature ovarian failure that are intimately associated with the hypothalamus, pituitary, adrenal, and gonadal axes — as explained above. Many women have a habit of turning worries over and over in their heads, internalizing their emotions. Find ways to release stress and resolve buried emotions from the past. Exercise, yoga, and meditation provide welcome relief in the short-term, while deeper work with a trusted counselor or programs like the Quadrinity Process provide long-term benefit. A positive outlook and thoughtful introspection may lead you to causes, and possibly even solutions, your conventional doctor might 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. 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

 

Last Modified Date: 04/19/2011
Principal Author: Marcelle Pick, OB/GYN NP