2024-10-17 11:29:00
What is premature ovarian failure?
“This ovarian failure means that the body stops producing estrogen (steroidal sex hormones) and, therefore, menstruation (amenorrhea) disappears earlier than usual,” adds the Catalan expert on women’s quality of life.
“Moreover they will become sterile, that is, they will not be able to have sons or daughters; and, as they age, they will suffer major physical and emotional consequences,” he warns.
The loss of estrogen, a key factor in the menopause phase, suppresses the protective shield of the woman’s heart, favoring the onset of hypertension, diabetes, dyslipidemia, obesity and the development of atherosclerosis.
Menopause is associated with a 10-15% increase in LDL (low-density lipoprotein); In fact, 77.6% of women over 65 suffer from hypercholesterolemia.
“And just as happens during menopause, women who suffer from premature ovarian failure may have an increased risk of myocardial infarction and death due to this loss of ovarian function,” she points out.
This organic situation, even more so when lifestyle habits such as smoking, being overweight and a sedentary lifestyle are added, together with stress, can start the countdown of a time bomb in the female body.
<img decoding="async" width="980" height="682" data-attachment-id="358767" data-permalink="https://efesalud.com/que-es-fallo-ovarico-prematuro/portada-monografico-iop-efe/" data-orig-file=" data-orig-size="980,682" data-comments-opened="0" data-image-meta="{"aperture":"0","credit":"efem0186","camera":"","caption":"","created_timestamp":"1729074300","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}" data-image-title="Videoblog de Ginecología: insuficiencia ovárica prematura." data-image-description="
IOP monographic cover.
” data-image-caption=”” data-medium-file=” data-large-file=” tabindex=”0″ role=”button” alt=”Monográfico IOP, premature ovum” class=”wp-image- 358767 lazyload” src=” srcset=” 980w, 300w, 768w” data-sizes=”auto” data-eio-rwidth=”980″ data-eio-rheight=”682″/>Cover of the monograph “Premature ovarian insufficiency” sponsored by the Spanish Association for the Study of Menopause (AEEM); “Consensus” document based on several research articles published internationally with which the gynecologist Carmen Sala establishes her professional criteria in the treatment of premature ovarian failure.
And is the diagnosis of ovarian failure easy?
“Well yes, yes, yes”, he certifies; All it takes is for the lady to come to the Gine-3 consultation and tell me, for example: “I haven’t had my period for eight months and I suspect I have the same thing as my mother, who lost her period at 36 years old.”
A young woman’s family history is just as important as correct and timely diagnosis, as premature ovarian failure is estimated to affect 1% of the female population.
Behind POI there may be genetic inheritance, autoimmune diseases, surgical interventions (oophorectomy and cystectomy), infections (inflammation of one or both ovaries due to mumps, tuberculosis, malaria, cytomegalorirus, chickenpox), chemotherapy, radiotherapy and embolization of ovarian blood vessels .
Other times the cause is not identifiable and in some cases can be associated with environmental toxins.
Premature ovarian failure will be confirmed by several tests and two analytical markers: the value of follicle-stimulating hormone (FSH) and the determination of 17 beta estradiol.
“FSH is produced in the pituitary gland and is used to make the ovaries work; The higher its value, the lower the function of the ovary. With 17 beta estradiol, the ovarian ability to produce oocytes“, he describes in broad terms.
Once the pathology is confirmed, it is appropriate to evaluate the possibility of reproduction in women who wish to become pregnant, between 1.5 and 10%, since ovarian function can be recovered intermittently in up to 25% of cases.
“We ask for an anti-Müllerian hormone (AMH) test to evaluate the ovarian reserve to advise the IOP woman on some assisted reproductive techniques before inevitably communicating the culmination of her gestational life“explains Dr. Sala.
Consequences of ovarian failure in a young woman
In general, their quality of life worsens, so they need a personalized plan to manage the new living situation.
“Mood disorders begin and sexual dysfunctions occur, such as vulvovaginal atrophy and genitourinary syndrome (vaginal dryness, urinary incontinence, etc.), as happens during menopause,” she says.
“And at the same time, two other hidden but devastating risks occur: a greater incidence of cardiovascular disease and a loss of bone strength,” he specifies.
The approach to IOP must be global, promoting healthy living: healthy diet, moderate daily exercise, giving up smoking, when applicable… and adding calcium or vitamin D if it were necessary.
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Dr. Carmen Sala Salmerón, gynecologist, obstetrician, pelvic floor specialist and expert in women’s quality of life at the Gine-3 Clinic in Barcelona.
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Acceptance of premature ovarian failure becomes more complicated when the patient has no maternal history of early menopause:
– It’s as if my ovaries don’t work!… But what is this, menopause? They blurt out in amazement.
– No, it is premature ovarian failure; not a menopause… For them it is something similar to a shock.
But the surprise doesn’t end there.
– I recommend hormonal treatment.
– Oh no; Hormones, no!
– It is necessary to start hormone replacement therapy as soon as possible, since every month, every year that passes without taking hormones, the physical deterioration will be greater.
– And how long should I take the hormones?
– Up to 50 or 51 years, the average age of a woman in the normal phase of menopause.
– Ten years!
– Yes, ten years. And the therapy will always be with hormone replacement therapy.
Hormones to treat ovarian failure
“First of all I want to make it clear that acupuncture, being a vegetarian or taking alternative medicines do not cure or relieve POI. They are of no use in this pathology. It can only be solved with thormone replacement therapy (THS)”.
HRT in patients with premature ovarian failure aims to replace the normal function of the ovary through estrogen and gestagenic therapy until the normal age of menopause.
And what risks does hormone replacement therapy entail?
“As for the dreaded breast cancer, there is no increased risk in women with IOP who take this type of hormone, again after the relevant studies, tests and previous analyses. It does not increase the chance of breast cancer,” he says based on his clinical experience.
“However, I must emphasize that hormone replacement therapy is contraindicated in women who have been treated and operated for breast cancer or in those who carry the BRCA 1 and 2 gene mutation.”specifies the gynecologist.
<img decoding="async" width="900" height="437" data-attachment-id="358885" data-permalink="https://efesalud.com/que-es-fallo-ovarico-prematuro/texto-6/" data-orig-file=" data-orig-size="1884,914" data-comments-opened="0" data-image-meta="{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"1729074380","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"1"}" data-image-title="Videoblog de Ginecología: insuficiencia ovárica prematura." data-image-description="
Detail of the article “Cardiovascular health in patients with premature ovarian failure, management of long-term consequences” included in the monograph “Premature ovarian failure (POI).
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But Dr. Carmen Sala Salmerón wants to focus today on consequences of IOP on the cardiovascular system; that’s why read and highlight some paragraphs of the article”Cardiovascular health in patients with premature ovarian failure, management of long-term consequences” which is included in the monograph.
“It has been hypothesized that women with premature ovarian insufficiency (POI) may have an increased risk of cardiovascular disease and death due to loss of ovarian function and subsequent endogenous estrogen deficiency.
Significantly lower levels of estradiol were observed in postmenopausal women with premature coronary heart disease compared to healthy women.
Currently, evidence is insufficient to recommend hormone replacement therapy (HRT) for the sole purpose of preventing cardiovascular disease, although data suggest that POI is associated with increased mortality from ischemic heart disease and reduced life expectancy if no treatment is given.
Despite the lack of longitudinal studies, early initiation of HRT in women diagnosed with POI is recommended to reduce the risk of cardiovascular disease. HRT should continue until the average age of natural menopause.
There is an inverse relationship between age at natural menopause and cardiovascular mortality. It has been described that the risk of ischemic heart disease increases by 80% in patients with POI compared to women whose menopause starts from the age of 49-55, with a decrease in the risk of cardiovascular mortality by 2% for each year of delay in the onset of menopause“.
“So please, when you turn to your gynecologist, do not categorically deny the possibility of receiving hormone replacement therapy, especially since it prevents or alleviates several physical and psychological ailments that would ruin a good number of sweet years,” he concludes.
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