The incidence of premature ovarian failure (POF) or the early menopause is on the increase, however, there is still hope for women who want to have a baby, says a new review published today in The Obstetrician & Gynaecologist (TOG).

POF affects approximately 1 in 100 women and refers to the loss of the function of the ovaries before the age of 40. However, steadily improving cure rates of cancer among children and young women are likely to increase the incidence of POF as the condition has been linked to radiotherapy and chemotherapy, says the review. Previous studies have found that 8% of all survivors of childhood cancers experience non-surgical POF and this increases to 30-40% among those who receive a combination of radiotherapy and alkylating agents.

The cause of POF is still largely unknown. The condition is usually permanent but ovarian activity can resume and fertility has been noted among 5-10% of women with the diagnosis. The main symptoms of POF include irregularity of the menstrual cycle, oestrogen deficiency in the form of hot flushes, night sweats and loss of libido.

A physical examination, including height, weight and body mass index, is essential. Once POF is confirmed the main areas of treatment include education, counselling and psychological support, treatment of oestrogen deficiency symptoms and fertility management.

The review states that the first step is to help the woman deal with the diagnosis. The role of the clinician is to provide relevant information about the cause and outlook of POF and treatment options available. Professional counsellors and psychologists can also play a part in multidisciplinary management.

For women who wish to have a baby, the options include either adoption or achieving a pregnancy by oocyte or embryo donation.

In oocyte donation it is necessary to prepare the endometrium for implantation. This can be successfully achieved by incremental doses of estradiol valerate and then progesterone therapy. This creates an endometrium receptive to embryo implantation.

In addition, young women with POF are at an increased risk of osteoporosis, coronary heart disease, cardiovascular accidents and depression states the review. Hormone replacement therapy (HRT) should be used as oestrogens have been shown to have beneficial effects on cardiovascular status and bone density.

Apart from HRT, other things to consider in avoiding bone loss include physical activity, a calcium-rich diet, vitamin D supplementation and avoiding smoking and alcohol.

Puneet Arora, Registrar in Obstetrics and Gynaecology at Hope Hospital, Salford and co-author of the review said:

"Premature ovarian failure is usually permanent but ovarian activity can resume in some cases. Women who are diagnosed with the condition need support as these women are often anxious and depressed. However recent scientific advances in assisted conception provide hope to women."

TOG's Editor -in-Chief, Jason Waugh said:

"Premature ovarian failure can be very distressing however there is some hope for women who wish to go onto have a baby. It is essential that women receive the right support after diagnosis and this review highlights the importance of this and raises awareness of this condition which is on the increase."

Reference

Arora P, Polson DW. Diagnosis and management of premature ovarian failure. The Obstetrician & Gynaecologist 2011;13:67-72.

Source:
Royal College of Obstetricians and Gynaecologists