Premature Ovarian Failure (POF) or a premature menopause occurs when a woman’s periods stop before the age of 40. This is devastating news for anyone diagnosed with POF as it usually occurs before the age of 39 and often taking away the opportunity or decision to have children.

There is often some warning, just as there is at the time of the natural menopause (around the age of 50 for most women) with periods becoming irregular and more widely spaced. Sometimes, however, periods cease suddenly. The ovaries stop producing the hormone oestrogen and so symptoms of oestrogen deficiency can occur, including hot flushes, mood changes and vaginal dryness. The ovaries also stop producing eggs and so conception is extremely unlikely.

There is not always an explanation for a premature menopause. It sometimes runs in families, with women having their menopause at a similar age to their mother. Some women have abnormalities of the genes that control ovarian function, others make ‘autoantibodies’ which prevent the ovaries from working and a few women can be affected by viral infections of their ovaries.

The ovaries can rarely start working again on their own, although this is the exception rather than the rule, and studies that have examined women with POF report only a minority of woman resuming spontaneous ovulations. Some women can have quite a long period during which the ovaries are slowing down rather than stopping and ovulation may occur from time to time. This is a condition called the ‘resistant ovary syndrome’, during which time the ovaries are resistant to the two hormones that come from the pituitary and which stimulate the ovaries to release eggs and oestrogen. These pituitary hormones are FSH (follicle stimulating hormone) and LH (luteinising hormone).

The levels of FSH and LH in the blood at the time of the menopause are very high as they are trying to encourage the ovaries to work. POF is therefore diagnosed by at least two blood tests which show elevated blood levels of FSH and LH. It is usual to check other hormones at the same time (prolactin, thyroxine, and, sometimes oestradiol). The ovaries will not respond to the body’s natural FSH and LH and this is why they will not respond to FSH/LH injections, which are used to stimulate ovulation successfully in other women who have ovaries with eggs but a break down in the natural mechanisms that stimulate the ovaries. In fact there are, unfortunately, no treatments that will make resistant or menopausal ovaries work again.

Women with POF will usually be prescribed HRT, and it is recommended this is taken until they reach 51. You should take a combination of estrogen and progesterone. However, if you've had a hysterectomy you do not need to take progesterone. In that case, estrogen alone is taken (ERT)