Ah, menopause, the official goodbye to our dear friend Flo. For the majority of women, the final farewell to our fertility happens at around 51-years-old. But that’s not the case for everyone. In fact, it’s possible for menopause and all its challenging symptoms (think: hot flashes, night sweats, the list goes on) to occur in your thirties, twenties, and even younger. Those who start to experience signs of premature menopause at such young ages may have premature ovarian failure—medically known as premature ovarian insufficiency (POI)—a condition that causes the ovaries stop working before the age of 40. It affects about 1 percent of women.
Although “ovarian failure” is technically what happens to patients, it’s not actually that black and white—you're ovaries don't just stop working overnight, said Kristin Bendikson, M.D., a fertility specialist at USC Fertility. Rather, Bendikson explained that POI is a gradual process during which a patient may experience a lot of the symptoms associated with menopause for months to years before she officially stops having her period. When your ovaries do, in fact, stop working, this means that you stop releasing eggs (ovulating) regularly or at all and cease making hormones such as estrogen and progesterone.
Beyond the fact that this will send you into early menopause, POI also puts you at an increased risk of additional health complications such as heart and bone disease. Additionally, young women with POI have a hard time getting pregnant. Because of these implications, Bendikson urges patients who’ve missed their period for three months in a row to seek guidance and medical attention from their gynecologist or primary care provider—first to rule out pregnancy and then to focus on other testing to determine the cause.
Here’s exactly what you need to know about POI, especially if you’ve noticed changes in your menstruation and experienced any of the below signs.
The Symptoms are Similar to Menopause
One of the most obvious ones is the loss of periods, but for some patients that doesn’t happen right away. Instead, you can have irregular or occasional periods for months or even years before Flo officially leaves town. In conjunction with a changing and less frequent menstrual cycle, you might also experience—as you probably guessed by now—hot flashes, difficulty sleeping, mood disturbances, vaginal dryness, and discomfort during sex. There is not a specific order to which symptoms occur for all patients. For example, hot flashes tend to happen as soon as the ovaries are failing because it’s related to the drop in estrogen, compared to, say, vaginal dryness, which doesn’t appear right away, Bendikson said.
A word about hot flashes: getting increasingly warm is not a hot flash. Rather, hot flashes are “rushes where you skin gets really, really hot and then you sweat all of a sudden” and for many, are very uncomfortable, explained Sheeva Talebian, M.D., a reproductive endocrinologist and fertility specialist in New York. If you start experiencing sensations like this, speak to your doctor ASAP.
You Might Have Trouble Getting Pregnant
Not surprisingly, POI patients are also going to have a very hard time getting pregnant. The ovary has very few eggs left and is no longer releasing any eggs (ovulating) on a regular basis, making it less possible for a woman to conceive, Bendikson explained. While the American Society of Reproductive Medicine reports that approximately 10 percent of women with POI may be able to conceive using their own eggs, fertility rates are difficult to predict and pregnancy may be the result of modern methods like freezing.
If you're having trouble getting pregnant, a doctor might check your ovarian reserve and hormone levels through a battery of examinations. The main test to detect menopause, according to Bendikson, is a blood test that evaluates your follicle-stimulating hormone or FSH, which when at a very high level reveals significant issues with ovarian function. A doctor might also call for another blood test to examine anti-mullerian hormone or AMH levels, which reflect ovarian reserve or remaining number of eggs.
The Cause is Often Unclear
“Most of the time we don't understand why a woman has POI,” Bendikson said. “Is it because she was born with less eggs than normal or because she was losing them faster than normal? There is no way to tell the difference.”
Nevertheless, it’s known that medical treatments such as chemotherapy and radiation can induce ovarian failure and multiple ovarian surgeries can also diminish the number of remaining eggs. The condition is also associated with autoimmune disorders, such as those affecting the thyroid and adrenal glands, according to the American Society for Reproductive Medicine (ASRM). There are also a few genetic disorders like Turner’s Syndrome and Fragile X that have been linked with POI.
If a woman has a family history of early menopause, she may have a higher chance of undergoing early menopause herself. If you have a sibling, mother, or aunt who transitioned to menopause at a young age and/or has POI, Talebian said this is a “red flag” and urges you to be evaluated by a doctor to ultimately determine if you’re at also at risk through blood tests. That said, there is no singular test to diagnose POI itself.
Your Bone and Heart Health is Jeopardized
In addition to the symptoms above, low estrogen levels caused by POI can make you more likely to develop bone disease like osteoporosis. Because estrogen boosts cells that help our bones continuously grow, as levels decrease your bones will become weaker and prone to fracture and illnesses, Bendikson explained. Women with POI—like those who enter menopause at a later age—are also at risk for heart disease and dementia.
“All of these long-term implications, plus the symptoms put women at a higher risk for both depression and anxiety,” Bendikson said.
Treatment Options are Limited
There are no existing treatments that reverse POI, so most just focus on alleviating symptoms and preventing long-term medical issues. Hormone therapy is typically prescribed for patients in either the form of birth-control pills or hormone-replacement therapy (think: patches) and is taken until the age of natural menopause. While hormone therapy won't help with fertility, it will aid bone, heart, and brain health, Bendikson said. Additionally, it’s recommended that women with POI take Vitamin D and calcium supplements to prevent osteoporosis and consider localized treatments to treat vaginal symptoms, such as long-term moisturizers or lubes for sex.
As for fertility, women with POI must consider alternative methods such as the use of IVF with donor eggs.
“Once you're identified as POI, the number of eggs is so low and ovarian function is so bad that you’re not going to be able to freeze a large number of eggs,” Bendikson explained.
Both Bendikson and Talebian emphasize the importance of talking to your mother to find out if she experienced early menopause so you can consider freezing your eggs before it’s too late.
This article first appeared on Women's Health.