Has your period become irregular as you age? This could be due to primary ovarian insufficiency.

Have you been missing your periods for months? Or have they stopped suddenly? If this happens to you in your 30s, it's normal to feel a little scared and worried. Many people think this is menopause. But if it happens before the age of 40, it could be due to a condition called 'premature ovarian failure'. Let's take a look at what this is, why it happens, and what you can do about it.

Simply put, what is Primary Ovarian Insufficiency (POI)?

Let's understand this very simply. Every woman has two ovaries. These are located on either side of the uterus. These ovaries have two main functions. One is to release an egg every month. The other is to produce hormones that are essential for the female body, especially estrogen and progesterone .

Typically, a woman's ovaries gradually stop functioning and menstruation stops completely around the age of 51. We call this menopause .

However, in a condition called Primary Ovarian Insufficiency (POI) , the function of these ovaries decreases much earlier than normal, that is, before the age of 40. For some people, this can happen suddenly. That means menstruation stops suddenly. For others, this condition is diagnosed after menstruation has been irregular for months, sometimes even years.

Why does this happen? What are the factors that affect POI?

In most cases, about 90% of cases, no specific cause can be found for POI. In medicine, we call this ``idiopathic''. However, in some cases, certain factors have been identified that contribute to it.

What are the symptoms of this condition?

The main and most common symptom is irregular menstruation or the absence of menstruation for several months. However, other symptoms similar to those experienced during menopause may also occur. This is because in both conditions, the body's estrogen hormone levels decrease.

• Menstrual cycle irregularities: Menstruation may go for months without returning, or it may stop altogether.
• Sudden excessive sweating and hot flashes (hot flashes and night sweats): This can occur especially at night.
• Sleep problems: Night sweats can wake you up from sleep.
• Lower abdominal pain and vaginal dryness: This condition is caused by a decrease in estrogen. This can also cause pain during sex.
• Decreased sex drive.
• Difficulty concentrating and irritability.
• Dry eyes.
• Difficulty conceiving a child (Infertility).

How do you find this, Doctor?

When you go to see a doctor, he or she will first ask you about your menstrual cycle, family medical history, and any symptoms you're experiencing. Then, he or she will perform a physical exam.

In addition, several tests are ordered to confirm this condition.

• Hormone Level Testing: This is the most important test. A blood sample is taken and the levels of several hormones are checked.
• FSH (Follicle-Stimulating Hormone): A hormone that stimulates the ovaries. If the ovaries are not working properly, the brain sends out more FSH. Therefore, levels of this hormone are very high in POI.
• Estrogen: The main hormone produced by the ovaries. In POI, these levels are greatly reduced.
• Prolactin: This hormone level is also checked.
• Pregnancy test: To confirm whether pregnancy is the cause of your missed period.
• Pelvic ultrasound: This can check the condition of your ovaries and uterus. In POI, the ovaries may be smaller than normal.
• Genetic testing (Karyotype testing): This test can be done if there is a suspicion of a genetic cause, such as Turner syndrome.
• Antibody tests: These are done if there is a suspicion of an autoimmune disease.

If you are under 40 years old and your periods are irregular, your blood tests show elevated FSH levels, and your estrogen levels are low, your doctor will likely diagnose you with POI.

What are the treatments for this?

There is no cure for POI, meaning that the ovaries will function normally again. However, there are very effective treatments to control the symptoms and reduce the long-term health risks.

Treatment depends on your age, the nature of your symptoms, and whether or not you want to have children.

Hormone Replacement Therapy (HRT)

This is the main treatment. It involves administering the hormones estrogen and progesterone that your ovaries are no longer producing externally, in the form of pills, gels, skin patches, or vaginal rings.

Benefits of HRT:

• Symptoms such as hot flashes and vaginal dryness are controlled.
• It can protect against osteoporosis . Estrogen is a hormone that is essential for strong bones.
• Helps reduce the risk of heart disease.
• Mental well-being improves.

Doctors usually recommend taking this hormone therapy until menopause (age 51-52). Talk to your doctor about the pros and cons of this treatment and choose the method that suits you best.

Lifestyle changes and extras

In addition to hormone therapy, these things are very important for maintaining your overall health.

• Get enough calcium and vitamin D: These are essential for keeping bones strong. Eat foods like dairy products and small fish. If necessary, your doctor will prescribe you additional tablets.
• Regular exercise: Exercises like walking and running are good for the heart. Weight-bearing exercises are very important for the bones.
• Maintaining a healthy weight.
• If you are thinking about having children: Even with POI, about 5-10% of women have the ability to conceive naturally. But it is uncertain. So if you are expecting a child, you can talk to an obstetrician and gynecologist to discuss techniques like `(IVF)` and other options.

Living with POI and mental well-being

It's normal to feel sad, disappointed, and angry when you learn about a condition like this. This can be difficult to cope with, especially if you were still hoping for children.

If you are feeling anxious or depressed because of this condition, talk to your doctor about it. If necessary, you can seek help from a psychiatrist or counselor. With proper treatment and support, you can live a healthy, happy life with this condition.

Ovarian failure, Primary Ovarian Insufficiency, POI, Irregular menstruation, Menopause, Estrogen, Hormone therapy, Women's health