The New York Times recently cited a 2008 report which showed that birth rates for women over 40 years of age rose 4 percent over the previous year and a 2009 survey indicated that 14 percent of people in their prime childbearing years decided to delay becoming pregnant due to the economic recession. For some of these women, this decision may have dire consequences on future pregnancies.

For nearly 1 in 1,000 women (1 percent to 4 percent, or 250,000 to 1 million) between ages 15-29 years old who delay pregnancy, it may already be too late. These women may have a condition called premature ovarian failure (POF). It is also referred to as primary ovarian insufficiency, premature menopause, or hypergonadotropic amenorrhea.

When girls are born, we generally have enough eggs in our ovaries to menstruate monthly from puberty until the supply is depleted and menopause ensues. But in women with POF, there either aren't enough eggs at birth or there is something genetically wrong or dysfunctional with the ones they have. (There is also a possibility of surgical intervention, such as removal of the ovaries, and radiation or chemotherapy that can bring on early menopause.)

When this occurs at an early age, it is considered a natural, yet premature menopause and the symptoms are the same as in older women: cessation of menstruation, hot flashes, night sweats, decrease in breast size (or lack of breast development in puberty), vaginal dryness, mood swings, loss of energy, dry eyes, low sex drive, painful sex, bladder control problems, and insomnia. While these symptoms usually accompany POF, some women with the condition have periods and hot flashes, or no periods and no other symptoms.

A simple blood test to check the levels of FSH (follicle-stimulating hormone) can indicate the presence of POF. High levels of FSH usually confirm the diagnosis. However, that same blood sample can be used to test for other genetic causes of POF, and these should not be overlooked. A positive result for any genetic causes may have a significant effect on the carrier's long-term health, if not her immediate fertility.

Genetic or chromosomal causes of POF may include: Turner syndrome (the absence of two functioning X chromosomes affecting 1 in 2,500 women), Swyer syndrome (a condition also called XY gonadal dysgenesis or the lack of functioning gonads), Androgen Insensitivity syndrome, or premutation of Fragile X (the most common inherited cause of cognitive impairment, global developmental delays, seizure disorders, carried by 1 in 259 women worldwide [and 1 in 800 men]. Approximately 20 percent of women who carry the defective gene have POF).

There may be a family history of early menopause or some enzymatic or metabolic defects such as galactosemia (when the body is unable to metabolize galactose), thalassemia major (an inherited blood disorder where the body makes an abnormal form of hemoglobin), or hemochromatosis (wherein the body cannot break down iron and blood levels escalate).

Autoimmune diseases may also be causative for POF: thyroid dysfunction, rheumatoid arthritis, polyglandular failure I and II, diabetes, pernicious anemia, adrenal insufficiency, vitiligo, and lupus erythematosus.

But missing a period and its fertility sequelae are only part of the concern with POF. Women with POF are at higher risk for osteoporosis and heart disease. And of course, infertility, although 6 percent to 8 percent of women with POF can become pregnant.

The current medical treatment for POF is hormone replacement therapy (HRT). The dose generally starts out low to give the woman's body a chance to acclimate itself. Then the dose is gradually increased to a level higher than menopausal women. Sometimes birth control pills are prescribed in lieu of hormone replacement therapy. About 1-2 months after the start of HRT, a menstrual cycle may begin, accompanied by increased breast size, cramps, and even PMS.

Acupuncture and massage can have palliative effects on the symptoms of POF, helping reduce the discomforts associated with this condition. Points that support the reproductive system and hormone production are very useful.

Having a baby is still not out of the question, however. IVF with donor eggs may work for some women, while adoption may be the better choice for others. And while there is no current cure, support groups can be a great help and benefit. With so many young women experiencing this dramatic change in their lives, it's wonderful to know you are not alone.

Resources

1. Center for Young Women's Health Staff. "Premature ovarian insufficiency." http://youngwomenshealth.org/premature_ovarian_insufficiency.html. 1/25/2010.
2. Ceylaner G, Altinkaya SO, Mollamahmutoglu L, Ceylaner S. "Genetic abnormalities in Turkish women with premature ovarian failure." Arch Med Res 2010 Feb;41(2):110-8.e2.
3. Cronister A, Rosenblum L. "Fragile X intermediate allele frequency in women referred for premature ovarian failure/primary ovarian insufficiency." Genzyme Genetics, Westborough, MA, 2010.
4. International Premature Ovarian Failure Association. "Premature ovarian failure (POF) fact sheet." Alexandria, VA, 10/09.
5. "Drop in birth rate in 2008 may be tied to recession." NYTimes, April 7, 2010.