Menopause in your 30s?

Somya (38) experienced menstrual irregularities over eight months. When she didn’t get her period for three months, she was excited about pregnancy. But the tests were negative, so she thought it to be menopause, but she got her period the next month itself. Confused, she visited her doctor who diagnosed her of Primary Ovarian Insufficiency (POI).

She was assured that she could still get pregnant as POI is different from pre-menopause. Follicle dysfunction being the major cause for her condition, she was put on Hormone Replacement Therapy (HRT), in which a combination of inducing oestrogen and progestin is induced into the body. Soon, she started having regular periods again and her luteinising hormone levels were found to be reduced, which indicates better ovulation.

It’s not menopause

In the past, POI used to be called “premature menopause” or “premature ovarian failure,” but those terms do not accurately describe what happens in a woman with the condition.

Many women naturally experience reduced fertility when they near their 40s. This age may mark the start of irregular menstrual periods that signal the onset of menopause. A woman who has gone through menopause will never have another normal period and cannot get pregnant.

A woman with POI may still have periods, even though they might not come regularly, and she may still get pregnant. For women with POI, irregular periods and reduced fertility occur before the age of 40, sometimes as early as the teenage years.

How to find out if you have it

Sudden menstrual irregularities or missing periods for at least three months are the first signs of POI. For many women with POI, trouble getting pregnant or infertility is the first symptom they experience. Some women may experience symptoms of natural menopause, which should not be ignored, and immediate consultation is required. The following symptoms should not be ignored if you are under 40: n Hot flashes leading to night sweat

Irritability and poor concentration
Loss of libido
Pain during sex due to vaginal dryness

What causes POI?

POI is related to problems with the follicles – small sacs in the ovaries in which eggs grow and mature. Normally a woman is born with 2 million primordial follicles (microscopic seeds which grow into follicles), which may get depleted or not function properly to cause POI- n Follicle depletion – If a woman runs out of working follicles before her natural menopause.

Follicle dysfunction – a woman has enough follicles in her ovaries but is not working properly.

The reasons for follicle depletion or dysfunction may include low number of follicles, autoimmune diseases or toxins from smoking, pollution or chemotherapy. It may also be genetic or idiopathic.

Diagnosis & treatment

A follicle-stimulating hormone (FSH) test, luteinising hormone (LH) test, an oestrogen test or a pelvic ultrasound may be required to diagnose the condition.

Though the functions of a woman’s ovaries cannot be restored to normal but chances of getting pregnant can be increased.

To restore the oestrogen levels, Hormone Replacement Therapy is useful along with IVF treatment for a woman to get pregnant. As they are at a higher risk of osteoporosis, calcium and vitamin supplements are also prescribed, along with a bone mineral density check.

(The author is IVF specialist, Indira IVF Hospitals, Bengaluru)