A cause of infertility known as premature ovarian failure, or POF, can have effects on different areas of the body, as well as "profound" emotional effects, according to three clinicians in a recent article on the topic.1
As such, management of this condition should include an integrative approach centering on both the physical and emotional issues that may surface in patients, write Lawrence Nelson, MD, with the National Institutes of Health, Sharon Covington, a licensed clinical social worker in Rockville, Maryland and Robert Rebar, MD, Executive Director of the American Society for Reproductive Medicine (ASRM).
Emotional Toll
"Hearing the news of this diagnosis has been described as similar to learning about a death in the family," they write. "These feelings of loss and grief, combined with the disturbed sleep and other physical symptoms of estrogen deficiency, create a special set of needs."
In these instances, support groups may be beneficial, as well as professional counseling, at least initially, the experts advise.
Docs: POF is Not Menopause
In assessing the characteristics of the condition, the authors point out that POF is not a form of premature menopause, since menopause is considered irreversible and POF amounts to "intermittent and unpredictable ovarian function that can continue for many years." In fact, citing the medical literature, the clinicians noted that spontaneous pregnancies have been documented in up to 10 percent of women diagnosed with POF. But, so far, no proven therapies have been identified to date to improve fertility in these cases.
While making a definitive diagnosis of the condition isn't always easy due to its "mysterious" nature, women with at least 4 months of amenorrhea (no periods), as well as abnormal spikes in levels of the reproductive hormone FSH (follicle stimulating hormone) similar to those found in menopause can be definitive indicators of the condition.
Because of its cyclic nature (ovulation followed by no ovulation followed by resumption of ovulation), the term premature ovarian failure is inaccurate, the authors stressed and can be "both offensive and psychologically hurtful." What may be more accurate is the term ovarian insufficiency, Nelson, Covington and Rebar stated, which doesn't incorrectly imply that the condition is irreversible.
"To facilitate clinical research and communication regarding patient care for this disorder, there is a need to delineate standardized diagnostic criteria and terminology," they wrote.
Diagnostic Considerations
Other challenges that remain include the need to diagnose POF in a timely manner, despite the varying nature of the condition; as well as the need to be sensitive to patients when making the diagnosis since "many women describe feeling emotionally devastated" afterwards."
The authors also discussed the known cause of POF, including chromosomal or genetic abnormalities or secondary amenorrhea. But in 90% of cases of spontaneous POF, there is no known cause.
About one-fifth of those with the condition are found to have an autoimmune disorder, such as autoimmune hypothyroidism. Other potentially associated conditions include androgen (male hormone) insufficiency and dry eye syndrome.
A small percentage of women with POF face a higher risk of adrenal insufficiency, an abnormal reduction in certain hormones produced by the adrenal gland (Addison disease). If pregnancy later occurs, women with this disease can face a higher risk of developing complications, the authors stress. Thus, women presenting with POF should be screened for adrenal insufficiency.
Therapy for POF: Hormone Replacement
In terms of treatment, the authors recommend hormone replacement. "Our clinical judgment suggests that remaining sex steroid deficient as a young woman carries a greater long-term health risk than does replacing the hormones normally supplied by the ovaries," they wrote. However, this is not the same as hormone replacement therapy, or HRT, they point out. The risk/benefit considerations of extending hormone therapy for women in menopause is different than replacing ovarian hormones in younger women diagnosed with POF, "and this needs to be clarified for patients."
But, due to lacking scientific research, there is no standard hormone replacement strategy that can be devised, so therapy should be customized for patients, the authors stated.
Fertility Considerations
Finally, since ovarian function varies in women with POF, timed intercourse to attempt pregnancy is "useless", and couples, instead, should have intercourse 2 to 3 times per week so that sperm is present in the fallopian tubes in the event ovulation occurs, the authors advise.
"Sufficient time needs to be given for grieving and emotional healing after couples receive the diagnosis of POF before making a decision about alternative family building options, such as donor egg IVF," they wrote.
1. Nelson LM, Covington SN, Rebar RW. An update: spontaneous premature ovarian failure is not an early menopause. Fertil Steril 2005 May;83(5):1327-32.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
