Primary Ovarian Insufficiency: Teenagers in Menopause
Nov 02, 2022
Primary ovarian insufficiency (POI) means that the ovaries have stopped working at a younger age than typical (before age 40). It used to be called premature ovarian failure and is often called premature menopause. In POI, the ovaries stop producing hormones and eggs, resulting in hormone deficiency and infertility.
Signs of POI may include missing periods (either never starting or skipping more than 6 months), delayed puberty, hot flashes, vaginal dryness, mood changes and trouble getting pregnant. Causes include a history of cancer treatment, genetic syndromes, and autoimmune conditions; but most often the cause is unexplained.
Why are hormones needed in POI?
The main treatment for POI is hormone replacement therapy (HRT), with estrogen and progesterone. HRT is needed during the time your body would typically have it around, or the average age of menopause (early 50s). Taking hormones is important for heart and bone health and helps decrease symptoms like mood changes, vaginal dryness and hot flashes. It also helps girls who haven’t gone through puberty develop secondary sex characteristics (breast tissue, pubic hair).
Estrogen helps build stronger bones and prevents heart disease. Estrogen patches (bandage-like stickers with medication that absorbs through the skin) are recommended because they are the best for bone health. Estrogen also comes in a pill form that some people prefer. Depending on if you’ve gone through puberty, you may start on a very low dose of estrogen and increase over time or you may start right away on a higher dose.
Progesterone helps to regulate periods and to prevent cancer of the uterus. It comes in many forms including pills, injection, arm implant or progesterone containing intra-uterine device. You may start it at the same time as estrogen or up to 2 years later depending on if you’ve gone through puberty yet.
What about fertility in POI?
For most people, finding out about how the condition affects their or their child’s future fertility is the hardest part to process. The condition means that there are either very few or no eggs left in the ovaries for future release, which leads to the inability to become pregnant with your own egg. There are also no current treatments for this. Treatments like in vitro fertilization or taking the recommended hormones don’t work to restore or create more eggs.
It is important to acknowledge that a diagnosis of infertility is very difficult for most people. Some teenagers might feel like they never want to be pregnant or become a parent, so they don’t have strong feelings about this aspect. Others may feel intense grief at the loss of this potential. Often feelings change with age and may vary depending on life circumstances. Parents may also feel grief about this diagnosis for their child and how it may affect them or their family. Some people find it helpful to go to therapy or to participate in organizations connecting those with similar conditions to help process the diagnosis.
There are other ways that people with POI may become parents. Pregnancy using a donor egg combined with a partner’s sperm or a donor embryo, surrogacy/gestational carrier or adoption are all options to become a parent. Some people become stepparents or prefer to be pet parents!
Why do teenagers with POI still need birth control?
For all teenagers who are or who are planning to be sexually active, but don’t want to become pregnant in the next year, birth control is recommended. This can be difficult to process when you are also told you have a diagnosis of infertility.
Even though having POI means the chances of becoming pregnant are very low, there is still a very small chance of an egg being released randomly leading to pregnancy. The timing of this can’t be predicted so birth control is still recommended during times in life when pregnancy would be medically unsafe or not welcome in your life. Balancing the desire for this small chance of spontaneous pregnancy with possible difficult life circumstances if that pregnancy were to occur is a very personal decision.
Chelsea Kebodeaux, MD is a member of the Pediatric and Adolescent Gynecology physician team as well as the Fertility and Reproductive Health Program physician team at Nationwide Children's Hospital.
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