Premature Ovarian Failure: A Guide for Teens

Premature Ovarian Failure (POF) affects approximately 1 out of every 1000 women between 15-29 years of age. If you have been diagnosed with POF, you may feel be feeling alone and different. It might help you to know that there are thousands of other young women who have POF, too. It can also help you feel better to learn more about POF, and to know that doctors and scientists are also doing research to learn more about POF. The following guide was created to answer your most common questions about POF as well as offer information about fertility options.

What is premature ovarian failure (POF)?

Most girls who have POF report that they went to their doctor when they stopped having periods. Girls with POF may have one or more of the following symptoms:

• lack of breast development during puberty
• lack of menstrual periods
• decrease in breast size
• hot flashes
• vaginal dryness
• mood swings
• insomnia (not being able to sleep)

The two most common symptoms that adolescents with POF report are lack of breast development and lack of menstrual periods.

Is it normal to feel upset when your body doesn't work the way it should?

Yes. If you are diagnosed with POF, you may feel sad, angry, or depressed, and you may have feelings of loss. You may also feel bad because your friends do not have POF. You are most likely going to have these feelings soon after you have been told you have POF. Emotional support from a counselor or therapist can help you with your feelings and help you think about your future. It may also be of great help to speak to other teens with POF, so you will know you are not alone.

How is POF diagnosed?

Your doctor can find out if your ovaries are working by doing a simple blood test to check the hormone level, FSH (Follicle Stimulating Hormone). It's usually necessary to repeat the blood test to make sure the first test was correct. High levels of FSH in a blood test usually mean that you have POF.

Why is the FSH level high?

In menstruating women, the pituitary gland in the brain can sense if the ovaries are making the right amounts of estrogen. If a woman is not getting her period and there is no estrogen being made, the pituitary gland in the brain will release a hormone called the follicle-stimulating hormone (FSH). This hormone sends a signal to the ovaries telling them to start making estrogen.

Your ovaries should respond to this signal and begin to release estrogen. When the estrogen is released, the pituitary gland then stops sending out FSH and the level of FSH in your blood stream decreases. However, if you have POF, your ovaries can't make estrogen so the amount of FSH in your blood stays very high.

Is POF permanent?

POF can be unpredictable, but it is almost always permanent. Unfortunately, at this time there are no medical tests that can tell for sure whether your POF will be permanent.

How is POF treated?

The treatment for POF is to replace the hormones that your body is no longer making. The name for this type of treatment is called hormone replacement therapy, or HRT. The hormones that need to be replaced are estrogen, progesterone, or both. These hormones are necessary for breast development, menstrual periods, and healthy bones.

There are many different types of HRT. HRT is available as pills, skin patches, vaginal rings, and shots. Pills are usually the easiest types of HRT for young women to take, although some women prefer using patches that are applied to the skin once or twice a week. Birth control pills are often used as an HRT because they contain both estrogen and progesterone.

What are the effects of Hormone Replacement Therapy (HRT)?

Your breasts may increase in size if they have not finished growing. You may also start having menstrual periods, cramps, and even PMS symptoms such as mood swings, just like you would if your body was making the progesterone and estrogen.

If you are having any side effects from the HRT, it is important to discuss them with your health care provider. There are more than 25 different types of HRT, and your provider can work with you to find the one that is best for you.

Fertility Issues

Who should I talk to about fertility issues?

The first person you should talk to about fertility issues is your gynecologist or a reproductive endocrinology specialist. If needed, your gynecologist can refer you to a fertility specialist who can discuss your options with you.

What fertility treatment options are available for women with POF?

Fertility treatment is available to help you have a baby. Your gynecologist or reproductive endocrinologist can talk to you about this issue whenever you are ready. He or she will be able to give you advice based on your specific situation.

In-Vitro Fertilization (IVF)- with donor eggs

IVF is a procedure that involves removing another woman's egg from her ovary, fertilizing it with your partner's sperm, and putting that fertilized egg into your uterus. You would then carry and give birth to the baby. This type of fertility treatment is offered to women who have POF (premature ovarian failure) and do not make eggs. Since the success rate depends on many factors, it is important to discuss this with a fertility expert when you are ready to have children.

Adoption

This is an important option for young women who have POF. There are many children who need a home and are adopted by couples who can't have their own children.

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If you think you have POF, the best thing to do is to talk to your health care provider since other medical conditions may cause the same or similar symptoms. If you have already been diagnosed with POF and you are taking hormone replacement therapy, it is important to take your medicine as prescribed. Eating right, taking a daily multivitamin, and getting enough calcium in the food you eat will help protect your bones, while learning more about POF will empower you to be pro-active about your health. You may also want to give this guide about POF to people who are close to you, to help them understand what you are going through.

Remember that there are options available to you if you decide that you want children, and new research may offer even more alternatives over the next few years. You can live a healthy life with POF!

Written by Phaedra Thomas, RN, BSN and Judith Seigel, MSW, LCSW
Edited by The Young Women's Resource Center Staff

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