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Premature ovarian insufficiency: when ovaries take an early retirement

<div><span style="font-family: helvetica;"><img src="/nairobi/PublishingImages/Excision%20endometriosis%201.jpg" alt="" style="margin: 5px;"/></span> </div><div><p><span style="font-family: helvetica;">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 start of menstruation.</span></p><p><span style="font-family: helvetica;">This process is marked by cyclic hormonal changes resulting in menstruation every four to six weeks. Socially and biologically, this represents fertility and vitality. </span></p><p><span style="font-family: helvetica;">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. Release of an egg during ovulation defines fertility. These functions progressively decline over time, till the menopause when release of the hormones and eggs cease, marking the end of reproduction.</span></p><p><strong style="font-family: helvetica;">Prevalence and symptoms</strong></p><p><span style="font-family: helvetica;">Generally, on average most women will enter the menopause aged fifty years. The classical symptoms being irregular periods till they stop, hot flushes, fatigue and mood fluctuations. </span></p><p><span style="font-family: helvetica;">This age pattern is not uniform and a small proportion of women experience similar symptoms prior to their fortieth 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.</span></p><p><strong style="font-family: helvetica;">How common</strong></p><p><span style="font-family: helvetica;">About one in a hundred women go through premature ovarian insufficiency. The causes are varied and include surgery or chemotherapy for cancer, infection such as mumps or genetic conditions like Turner&#39;s syndrome. However, most of the cases have no known cause. </span></p><p><strong style="font-family: helvetica;">Diagnosis</strong></p><p><span style="font-family: helvetica;">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. </span></p><p><strong style="font-family: helvetica;">Management</strong></p><p><span style="font-family: helvetica;">When premature ovarian insufficiency is diagnosed, management focusses 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 lady gets a comprehensive assessment and plan for ongoing care. It is useful that hormone replacement is continued till age fifty when reassessment is made for need to continue. Fertility is an emotive issue and early referral to a specialist will help the lady 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.</span></p><p><strong style="font-family: helvetica;">As a lady, what should I do?</strong></p><p><span style="font-family: helvetica;">When a lady finds herself in circumstances that could predispose to premature ovarian insufficiency, such as cancer treatment, prompt referral to a fertility specialist 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.
</span></p><p><em style="font-family: helvetica;"><strong>By Charles Muteshi, Consultant Gynaecologist and Fertility Specialist at Aga Khan University Hospital, Nairobi</strong></em></p></div>

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