What is premature ovarian insufficiency?

Symptoms of Primary Ovarian Insufficiency

Premature ovarian insufficiency (POI) can affect almost two per cent of the population.

The condition is the result of the ovaries not functioning normally before 40.

Dr. Wendy Wolfman of the department of obstetrics and gynecology at Mount Sinai Hospital in Toronto runs one of the only clinics in Canada for the condition.

READ MORE: What happens to your body during menopause

“The theory is that women are born with the number of eggs they will have for the rest of their life,” she said. Wolfman says during a woman’s lifetime, most of their eggs are depleted after the age of 35. “There is an accelerated loss of eggs.”

When a women, trans and non-binary person has POI, the ovaries don’t produce a normal amount of estrogen or release eggs, the Mayo Clinic noted.

Sometimes, people confused it with premature menopause — but this isn’t the case. Women with POI may still get their period, Wolfman said, and some even get pregnant.

POI can have several causes, she said. For some, it can be a genetic disorder. This can include Turner syndrome — the Mayo Clinic adds this is a result of a woman having one normal X chromosome and a second altered X chromosome. 

Wolfman says some research suggests toxins can also cause POI, this can be from radiation therapy or chemotherapy, but also other toxins like cigarette smoke and chemicals.

Other causes can include autoimmune disease (which is rarer), and often, the causes are unknown.

Signs and ramifications

Wolfman says there are several things women can look out for.

The symptoms can be similar to menopause and can include hot flashes, mood changes, difficulty concentrating, vaginal dryness or difficulty having sex.

READ MORE: What is ovulation? What you need to know about your cycle

Some women may also experience a decrease in sexual desire.

But the biggest indication is missed, irregular or skipped periods.

Dr. Georgina Wilcock, an obstetrician-gynecologist at Scarborough Health Network and assistant professor of obstetrics at University of Toronto, tells Global News POI could cause osteoporosis, infertility and increased risk of cardiovascular mortality.

POI could be misdiagnosed

Wilcock says POI could be misdiagnosed due to the nature of the condition.

“POI is characterized by a change in menstrual function … and estrogen deficiency symptoms such as hot flashes and vaginal dryness,” she said.

In the past, the terms “premature menopause” and “premature ovarian failure” were used for POI, but both are inaccurate, Wilcock said.

She said POI is a spectrum rather than a disorder.

Wolfman says it can be misdiagnosed for a long period of time. “Let’s say you have someone in their 20s and they’re having periods that are getting lighter and lighter and they’re not on birth control … and they may have hot flashes,” she said.

And while there are several reasons people may miss their periods, Wolfman says a doctor may not consider POI.

Before you get treatment options, Wilcock says it is important to rule out other causes first.

“After that, the only treatment available is hormone replacement,” she said. “This is often taken in the form of oral contraceptive. It is not contraindicated in POI as it will help to relieve the unpleasant symptoms and decrease the risks of heart disease and osteoporosis, and would be continued until age 50.”

Awareness on POI is needed

 Wilcock says many women are unaware of POI because there isn’t much information on the condition available to them.

“Women under 40 who have missed three or more periods in a row should be investigated,” she said. “The condition can be diagnosed by testing the (follicle-stimulating hormone) FSH and estradiol levels on the same day.”

A high FSH with low estradiol in a woman who is not getting periods could mean POI. 

READ MORE: Our eggs age as we age: What women should know about fertility

Wolfman says like POI, menopause itself is still not something women consider until they get to menopausal age. “If we had a good test that when you’re 25 it could tell when your menopause was going to be, that would be great … many women are delaying having children.”

She says there is also little awareness on the impact POI can have on your mental health.

“This is a huge loss, a huge blow,” she said.

“I think there is also a certain disbelief that this has occurred.”

The internet can also lead women to get false information on how to treat the issue.

If you have any symptoms or concerns, talk to your family doctor.

arti.patel@globalnews.ca

© 2019 Global News, a division of Corus Entertainment Inc.

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