Premature ovarian failure (POF): What can you do?

Reviewed by Dr. Sarika Arora, MD

A diagnosis of premature ovarian failure can be devastating. For young women, POF means many will never feel normal again, or get pregnant. Aside from hormone replacement therapy (HRT), conventional medicine doesn’t offer much for POF, and that’s a shame. In fact there’s a lot you can do starting with realizing that POF is not the same thing as menopause, and it isn’t a failure on your part in any way.

It’s not guaranteed that you will regain the function of your ovaries, but you can begin to understand the diagnosis and how to support your body.

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. This leaves women with two equally disturbing concerns: the possibility of infertility, and plenty of complicated symptoms related to hormonal imbalance, including 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 make no mistake, this is not menopause.

Differences between “natural” menopause and POF

Your age

• “Natural” menopause occurs after the age of 45, usually around age 51.
• Early menopause, as defined in medical literature, occurs anywhere between ages 40 and 45.
• Premature menopause (POF) occurs any time before the age of 40.

Whether you are still menstruating

• A truly menopausal woman will not have had a period for a full year.
• Some POF patients may have occasional periods.

Fertility status

• Menopausal women no longer produce eggs and cannot become pregnant naturally.
• Approximately 5–10% of women diagnosed with POF go on to conceive without any outside intervention.

Testing for POF

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). 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 have FSH and LH levels tested. If they are too low for a woman younger than 40, it may be caused by a pituitary or hypothalamic issue. If levels are consistently high, a woman is most likely perimenopausal though depending on her age, she may have POF. Even if a woman has one high FSH reading, there’s the possibility of a premature ovarian failure diagnosis. But this doesn’t mean that there isn’t any hope.

Emotions are another piece to POF

There 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 prioritize life-saving stress response over reproductive function when a woman’s body doesn’t have enough resources to do both. Emotional stress can influence reproductive function via connections between our HPA and HPG axes.

What’s more, emotional stressors sometimes reemerge when we pass an emotional milestone in our lives.

Health concerns for women with POF

When the emotional impact of a premature ovarian failure diagnosis takes center stage, the related health concerns may seem insurmountable. And there are some very real health risks to protect yourself from. Knowing more about POF helps you do just that.

Prior to menopause, our ovaries are responsible for producing the majority of estrogen. Women with premature ovarian failure need to take special care to reduce the risks associated with having lower estrogen production at an earlier age. After menopause, the body can 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 HRT.

Your bones. Estrogen plays a crucial protective role in bone turnover and, for younger women, the longer we go without it, the higher the risk for osteoporosis. A woman under age 30 may still be building toward peak bone density. If estrogen levels taper off before this peak is reached, her bones may never reach optimal density.

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 with the greatest risk in this study went on hormones years after going through menopause.

The closer a woman is to menopause when she starts HRT the more likely she is to experience its heart-protective effects. The kinds of hormones used and how they’re delivered also matter. Bioidentical hormones, for example, are identical to those we make in our own bodies and may therefore be less risky overall.

Your thyroid gland. Decreased thyroid function is one of the most common disorders present in women with POF. We don’t have a conclusive explanation for this, but it probably is connected to the fact that 65% of all POF cases are autoimmune-related. The body’s immune system mistakenly identifies its own natural processes as foreign and attacks them in an effort to “protect” the body. In many cases, as the body attacks the thyroid it also attacks the ovaries.

Your adrenals glands. 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. Since the adrenal glands are central to our response to stress, and if their function is disrupted, our health will suffer — dramatically. Research shows that the best way to detect this condition is with an adrenal antibody test to see if your body is making the antibodies in question.

Your endocrine system is a delicately balanced web of organs, functions, and hormones that affects far more than just your reproductive cycle. The younger you are, the more you stand to gain by restoring the natural hormonal state for women of your age. You may need to replace estrogen, progesterone, and possibly testosterone and DHEA, depending on your unique hormonal profile. By paying close attention paid to your health, you can find relief — in mind and body.

If you have POF, take care of your body — naturally

After a POF diagnosis, the next step is to give your body the attention it deserves. At this stage, women may have to rearrange previous plans and goals. But POF can be a beginning of sorts, and you can take steps to feel good again, both physically and emotionally.

Balance your hormones. The most immediate need for women with POF is usually relief for hot flashes, night sweats, moodiness and other symptoms. Balancing your hormones addresses this and can also offer protection from some of the long-term health concerns above. Talk to your healthcare provider about how to balance your hormones and work out a plan based on your unique needs. Many practitioners prescribe HRT at a higher dose than that typically given to menopausal women. You may want to consider a combination of phytotherapy and prescription-strength bioidentical hormones, to help minimize side effects and risks.

Consider testing. A full thyroid panel and an adrenal antibody test can show if there are associated thyroid and adrenal insufficiencies, both possible for some women with POF. These can be treated to prevent other health consequences so talk to your practitioner. If you’re considering getting pregnant, 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 Genova, ZRT or Diagnos-Techs, labs that will work directly with you.

Eat right for digestion, nutrient 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. It’s also a good idea to cover your bases with a quality nutritional supplement and probiotics.

Allow for regular exercise. Exercise positively affects your strength, weight, bones, heart, emotions, nerves and stress levels. Break a light sweat once a day and your body will thank you for it.

Lower stress levels and cultivate emotional wellness. Thoughts and feelings— even those buried in the distant past — can underlie disorders like POF that are intimately associated with the hypothalamus, pituitary, adrenal, and gonadal axes. If you usually internalize your emotions, you can release stress and resolve buried emotions with exercise, yoga, and meditation. A positive outlook and some introspection may lead you to factors your conventional doctor might never consider.

What causes POF?

There are no fast answers to this question. The truth is, for a growing number of women, we simply don’t know the cause of premature ovarian failure. Scientists have divided POF into two basic subgroups: 1) primary ovarian failure, when there are problems with the ovaries; and 2) secondary ovarian failure, when the underlying problem is in the pituitary gland or the hypothalamus, which then affects the ovaries.

• Primary ovarian failure. Between 10–20% of women with POF have a family history of premature menopause. Common causes are:
  • Autoimmune diseases. Virtually every autoimmune disorder has some associated incidence of POF, including those that involve the thyroid and adrenal glands. Autoimmune disorders account for 65% of all POF cases.
  • Pelvic surgery. Surgeries on the reproductive organs such as repeat ovarian surgeries, tubal ligations or partial hysterectomies can lead to POF because the ovaries are either damaged, or their function or blood flow is somehow compromised during or after the operation.
  • Cancer treatments. Ovarian cells are particularly vulnerable to damage from chemotherapy and radiation treatments.
  • Chromosomal abnormalities. Genetic anomalies involving the X chromosome, such as Turner’s syndrome and fragile X syndrome, have been linked with POF. Geneticists have also isolated a FOXL2, specific gene that could be responsible for the development of adequate follicles that last until natural menopause. POF and premature menopause have also been found to be about three times more common in both identical and fraternal twins than in the general population of women, though it does not always affect both twins. It is still not a common occurrence in twins — only three to five out of 100.
• Secondary ovarian failure. The hypothalamus is the brain’s control center for the endocrine system and releases gonadotropin-releasing hormone (GnRH), which stimulates the pituitary to secrete luteinizing hormone (LH). During a normal menstrual cycle, LH and FSH rise and fall in a characteristic pattern. When regular hormone secretion is disrupted due to a lack of GnRH or LH, the follicles aren’t stimulated, ovulation does not occur, and menstruation is absent.

These issues can sometimes be solved conventionally with drugs or surgery. Practitioners of functional medicine and some reproductive endocrinologists hope to produce equivalent results more in line with Mother Nature.

Change your perspective on POF, change your life

With a diagnosis of premature ovarian failure, it takes time to heal and understand what your life will look like going forward. Give yourself time. Take steps to have the best health possible by learning more, preventing the health risks associated with POF, and finding true happiness. Release what you thought would happen and create a new life picture that satisfies your goals and desires — whether that means becoming a mother or not. We are always here, if you need help along the way.