Ovarian insufficiency: When ovaries take an early retirement
When you find yourself in circumstances that could predispose you to premature ovarian insufficiency, it is recommended you consult a fertility specialist
Female reproductive potential is reliant on a well-choreographed and complex developmental maturation of the ovaries at puberty. This is defined as a period when secondary sexual characteristics are observed including breast development, pubic and axillary hair growth and the start of menstruation.
This process is marked by cyclic hormonal changes resulting in menstruation every four to six weeks. Socially and biologically, this represents fertility and vitality.
The ovaries produce two important products, reproductive hormones and eggs. Female hormones, mainly oestrogen and progesterone maintain normal functioning of the uterus, breast development, bone and heart health.
The release of an egg during ovulation defines fertility. These functions progressively decline over time, till menopause when the release of the hormones and eggs ceases, marking the end of reproduction.
How common is this problem?
Generally, on average most women will enter menopause aged 50. The classical symptoms being irregular periods until they stop, hot flushes, fatigue and mood fluctuations.
This age pattern is not uniform and a small proportion of women experience similar symptoms prior to their 40th birthday. Medically it is referred to as premature ovarian insufficiency, previously known as premature menopause. Given the crucial role of the ovary in reproduction and other biological processes, premature ovarian insufficiency poses a great burden.
About one in 100 women go through premature ovarian insufficiency. The causes are varied and include surgery or chemotherapy for cancer, infections such as mumps or genetic conditions like Turner's syndrome. However, most of the cases have no known cause.
Diagnosis
Whereas irregular menstrual periods are a very common occurrence, doctors usually recommend tests to check ovarian function. These include a hormone profile and pelvic ultrasound scan. It may be necessary to repeat the hormone profile after three months to be certain of the diagnosis. More advanced tests such as genetic testing require referral to a specialist.
When premature ovarian insufficiency is diagnosed, management focuses on various areas of health including fertility, hormone replacement, quality of life and psychological support. The primary doctor is the liaison person to ensure the woman gets a comprehensive assessment and plan for ongoing care.
It is useful that hormone replacement is continued until age 50 when reassessment is made for the need to continue. Fertility is an emotive issue and early referral to a specialist will help the woman to navigate through the complex web of options. It may feel like going on a roller-coaster, in which case support and counselling cannot be understated.
As a woman, what should I do?
When you find yourself in circumstances that could predispose you to premature ovarian insufficiency such as cancer treatment, it is recommended you consult a fertility specialist who will provide the opportunity to discuss fertility preservation. This may include harvesting of eggs to preserve on ice in frozen condition for future use. It is a safe and efficient technique with several thousand babies born healthy in recent years.
Charles Muteshi, Consultant Gynaecologist and Fertility Specialist at Aga Khan University Hospital, Nairobi.
