who have POF often have irregular menstrual
cycles for years after the onset of POF symptoms
and do retain the ability to conceive, whereas men-
strual cycles completely cease with menopause,
ending the potential for pregnancy.
The reasons for POF are unclear though likely
are a mix of genetic, hormonal, and perhaps
autoimmune factors. Women who have POF have
lower than normal levels of ESTROGENSand higher
than normal FOLLICLE-STIMULATING HORMONE (FSH)
levels in the BLOODcirculation, suggesting deple-
tion or dysfunction of the ovarian follicles. Doctors
do not know whether the abnormal HORMONElev-
els cause or result from follicular factors. CHROMO-
SOMAL DISORDERSsuch as TURNER’S SYNDROMEand
GENETIC DISORDERSsuch as ACHONDROPLASIA(a form
of SKELETAL DYSPLASIA, often called dwarfism) also
are associated with POF.
Symptoms and Diagnostic PathThe symptoms of POF are similar to those of
menopause and commonly include
- HOT FLASHESand night sweats
- vaginal dryness and irritation (nonbacterial
VAGINITIS) - painful SEXUAL INTERCOURSE(dyspareunia)
- diminished LIBIDO
- low energy or fatigue
- irritability and mood swings
- irregular menstrual periods
The diagnostic path begins with a comprehen-
sive medical examination, including PELVIC EXAMI-
NATION, and blood tests to measure blood hormone
levels (usually including a PREGNANCYtest). The
doctor may desire genetic tests as well, such as a
KARYOTYPE, to evaluate the possibility of a genetic
or chromosomal disorder. Women who have very
mild Turner’s syndrome may first learn of this
diagnosis during evaluation for POF, as other
symptoms of the syndrome may be so nominal as
to escape detection.
Treatment Options and OutlookTreatment with estrogen and progestin supple-
mentation until closer to the age for natural
menopause may relieve many POF symptoms
though does not usually improve FERTILITY. How-
ever, pregnancy remains possible and is something
a woman should consider when her menstrual
period does not occur as expected when she is
taking hormone supplementation.
Women who have POF have increased risk for
OSTEOPOROSIS and CARDIOVASCULAR DISEASE (CVD),
and should follow lifestyle practices to support
BONEand cardiovascular health. Such practices
include calcium supplementation, daily physical
exercise such as walking or running for cardiovas-
cular health, resistance activities such as lifting
weights to maintain MUSCLEmass and BONE DENSITY,
nutritious EATING HABITS, and weight management.
ASSISTED REPRODUCTIVE TECHNOLOGY(ART) methods
using donor OVA(eggs) may provide pregnancy for
a woman who has POF and desires to conceive.Risk Factors and Preventive Measures
Known risk factors for POF are chromosomal or
genetic disorders affecting the sex chromosomes
or features of sexual development and ADDISON’S
DISEASE (an autoimmune disorder affecting the
ADRENAL GLANDS). Medical treatments such as
CHEMOTHERAPYand RADIATION THERAPY may cause
secondary POF. There are no known measures to
prevent POF.
See also AUTOIMMUNE DISORDERS; POLYCYSTIC OVARY
SYNDROME(PCOS); SEX CHROMOSOME; WEIGHT LOSS AND
WEIGHT MANAGEMENT.premature birth The delivery of an infant before
37 weeks gestational age, also called preterm
birth. Though viability is possible after 24 weeks,
many fetal organ systems do not reach maturity
sufficient for independent life until near full term.
Sometimes there are warning signs of premature
birth that allow the doctor to attempt to delay
CHILDBIRTHby administering medications to stop
uterine contractions. The doctor may also help the
FETUS prepare for independent life. Giving the
mother injections of betamethasone, a cortico-
steroid, accelerates the fetus’s lung development.
Though premature birth does not present any
unusual risk for the woman, it often results in
mild to moderate health challenges for the infant.
Very early premature birth, between 24 and 32
weeks, presents grave health risks for the infant,
who commonly requires extensive medical care324 The Reproductive System