Although I’m well aware that I’m no spring chicken, I don’t consider myself over the hill either; I was thus a little surprised to find out that, at forty, I have now officially reached the age where it would be considered within the realms of normality for my ovaries to give out. Before that age, however, it counts as premature ovarian failure, so here are a couple of interesting points about POF:
Firstly, how long should a woman be amenorrhoeic before you start investigating? Three to four months is apparently the point at which you should be looking into it further. A raised FSH should be repeated four weeks later with oestradiol levels. It’s also worth checking prolactin levels, TFTs, and, if the FSH does suggest ovarian failure, pelvic ultrasound for an antral follicle count. Also, since you’re now looking at an increased risk of osteoporosis, consider a DEXA scan for baseline assessment of bone density to assess risk of osteoporosis developing.
Picking POF up at an early stage can be worthwhile, as, if it’s picked up in the early stages and the woman wishes to conceive, it may be possible to get the last bit of use out of the ovaries by trying ovulation induction with timed intercourse or IUI. However, as far as conception goes, it’s worth noting that the prognosis for women with POF wishing to conceive is not as bleak as I would have assumed. Ovarian function can return intermittently in up to 50% of patients, and, in around 5 – 10% of patients with POF, this is enough to lead to a spontaneous pregnancy. (The flip side of that, of course, is that patients who do not wish to conceive should still use contraception – the COC may be more suitable for oestrogen replacement in such patients than HRT, not to mention being more acceptable psychologically for many women.)