In the U.S., the average age of onset for "natural" menopause is 51. However, because of genetics, illness, or medical procedures, some women go through menopause before the age of 40. Menopause that occurs before this age, whether natural or induced, is known as "premature" menopause or premature ovarian insufficiency.
In addition to hot flashes and night sweats, also known as vasomotor symptoms, that can accompany menopause, many women undergoing premature menopause have to cope with additional physical and emotional concerns. For example, because menopause signals the end of a woman's fertile years, a woman who wishes to get pregnant is likely to have trouble.
What Are the Symptoms of Premature Ovarian Insufficiency?
Symptoms of premature ovarian insufficiency are often the same as those experienced by women undergoing natural menopause and may include:
- Irregular or missed periods
- Periods that are heavier or lighter than usual
These VMS are a sign that the ovaries are producing less estrogen.
Along with the above symptoms, some women may experience:
- Vaginal dryness (the vagina may also become thinner and less flexible)
- Bladder irritability and worsening of loss of bladder control (incontinence)
- Emotional changes (irritability, mood swings, mild depression)
- Dry skin, eyes, or mouth
- Sleeplessness
- Decreased sex drive
In addition to the symptoms listed above, if you are under the age of 40 and experience any of the following conditions, you should see your doctor to determine whether you are undergoing premature ovarian insufficiency:
- You have undergone chemotherapy or radiation
- You or a family member has an autoimmune disorder such as hypothyroidism, Graves' disease, or lupus
- You have unsuccessfully tried to become pregnant for more than a year
- Your mother or sister experienced premature ovarian insufficiency
How Is Premature Ovarian Insufficiency Diagnosed?
To diagnose premature ovarian insufficiency, your doctor will most likely perform a physical exam and draw blood to rule out other conditions, such as pregnancy and thyroid disease. They may also order a test to measure your estradiol levels. Low levels of estradiol, a form of estrogen, can indicate that your ovaries are starting to fail. When estradiol levels are below 30, it may signal that you are in menopause.
However, the most important test used to diagnose premature menopause is a blood test that measures follicle stimulating hormone (FSH). FSH causes your ovaries to produce estrogen. When your ovaries slow down their production of estrogen, your levels of FSH increase. When your FSH levels rise above 40 mIU/mL, it usually indicates that you are in menopause.
Are There Other Health Issues That Affect Women in Premature Ovarian Insufficiency?
Like all menopausal women, women in POI experience lowered estrogen levels as the ovaries stop most of their production of this hormone. Low levels of estrogen can lead to changes in women's overall health and may increase their risk for certain medical conditions, such as osteoporosis. Other health risks associated with the loss of estrogen include increased risk for colon and ovarian cancer, periodontal (gum) disease, tooth loss, and cataract formation.
However, compared with women who go through natural menopause, women undergoing premature ovarian insufficiency spend a greater portion of their lives without the protective benefits of their own estrogen. This puts them at an even greater risk for the above mentioned menopause-related health problems.
How Is Premature Ovarian Insufficiency Treated?
The symptoms and health risks of premature menopause, as well as the emotional issues that may result from it, can be managed with methods similar to those used for natural menopause. Women dealing with infertility that is brought on by premature ovarian insufficiency may want to discuss their options with their doctor or with a reproductive specialist.
Can Premature Ovarian Insufficiency Be Reversed?
With premature ovarian insufficiency, women who have been tested and have 46 XX chromosomes have some intermittent ovarian function later (can be 50%) and about 5%-10% may be able to get pregnant even after the diagnosis. In general, however, POI is unlikely to ever be completely reversed.
