Premature Ovarian Failure

The Devastating Impact of Premature Ovarian Failure
POF Strikes One Woman out of 100 Before Age 40

By MARC LALLANILLA
Jan. 12, 2006 — - Like many young couples, Bill and Molly Arbogast decided to wait before getting married and starting a family.
And after Molly, at age 36, gave birth to a healthy baby boy named Liam in 2002, she assumed she would have no difficulty conceiving again.
But Molly is one of hundreds of thousands of women in the United States who have been diagnosed with premature ovarian failure, or POF. Like many people, she had never heard of the ailment before.
To read a personal essay about POF, click here.
"My aunt is a medical transcriptionist, and even she said she'd never heard of it," said Molly, a freelance writer in Baraboo, Wis.
Medical Experts Are Baffled
POF remains little known partly because medical researchers are still unsure of what causes otherwise healthy women to suddenly stop ovulating. In some cases, POF is associated with autoimmune disease and enzyme or chromosomal defects.
It may also have a genetic component; some women with POF have a family history of the condition.
The syndrome is different from menopause, and researchers emphasize POF is not exactly the same as early menopause. A woman going through menopause will rarely if ever have another period, but women with POF often do have periods, though they are unpredictable and don't occur on a regular monthly cycle.
According to Dr. Sandra Carson, professor of obstetrics and gynecology at Baylor College of Medicine in Houston, the average age of menopause in the United States is about 51.8 years.
"The overwhelming majority have their menopause after age 40," Carson said. But for a small number of younger women -- estimates range from 1 to 4 percent -- POF can end their childbearing years.
But not always: Estimates vary, but according to researchers at the National Institutes of Health, pregnancies can still occur in 5 to 10 percent of the women who are diagnosed with POF.
And advances in fertility technology have helped too. Even with POF, a woman's chances of becoming pregnant are "very good if she uses someone else's eggs," Carson said.
Unknown but Not Uncommon
Though POF is more common among women in their 30s, the ailment can strike even teenagers.
According to the NIH, POF is found in one out of 10,000 women under the age of 20, and in one out of 100 women under the age of 40. After 40, however, reduced fertility is rarely referred to as POF; at that point, it is generally considered menopause.
The first and most common symptom of POF is an irregular menstrual cycle. Many doctors dismiss skipped periods as a byproduct of stress, but fertility experts recommend screening for POF after three missed periods.
Blood tests will reveal if levels of FSH, or follicle stimulating hormone, are high enough to indicate that POF is a possibility.
A woman with POF usually has to address the same issues that accompany menopause, including hot flashes, night sweats, decreased sex drive and the likelihood of developing osteoporosis.
Additionally, according to Carson, "women who have POF are at higher risk for autoimmune disease, thyroid disease, adrenal disease, myasthemia garvis, pernicious anemia and perithyroid disease."
There are additional concerns for young women with POF. "Women who are younger than 30, if they have POF, may have a Y chromosome or a portion of a Y chromosome. It's important that that be ruled out," Carson said.
"After these diseases are ruled out, then the woman needs to be treated just like an older menopausal woman," she added. Treatments typically include hormone replacement therapy and changes to diet and exercise to combat osteoporosis.
Devastating Emotional Impact
Even when health concerns are addressed, women with POF still face a barrage of emotional issues that catch many of them, and their families, by surprise.
"There was a time shortly after it happened when I was saying, 'This is not happening. This is some kind of mistake,'" said Molly.
Many women dealing with a diagnosis of POF must address the same grief that confronts someone who has lost a loved one. Guilt for not having children earlier can also strike many of these women.
But over time, women with POF can return to healthy, fulfilling lives, albeit with some changes.
"It's allowed me to embrace the idea of adoption," Molly said. "As far as the health consequences, it sort of snaps you to: I've got to get the exercise, I've got to have the balanced diet, et cetera."
Source: ABC News
http://abcnews.go.com/Health/print?id=1490924