Early Menopause: It is Not What Physicians Thought. New Perspective on Primary Ovarian Insufficiency

A young woman, in her 30s, may be given a diagnosis of menopause, but it's not always true that she's actually transitioned permanently though menopause. The normal age of menopause is menopause occurring the age of 40. Menopause before 40 has been called premature, or premature ovarian failure (POF), or Premature ovarian insufficiency (POI). The understanding physicians have had previously was that the ovaries have a set number of eggs, and when a woman’s eggs are all used up then we go into menopause. We have a preset number of eggs (genetically), we can lose eggs when we have disease of the ovaries or surgery of the ovary, and those things can cause individual cases of premature menopause. But something was discovered to be off in the thinking of most cases of POF. As far back as 1996 we discovered that even if the whole picture appears to be premature menopause, in research settings when the patients underwent ovarian biopsies they were actually found to still have eggs and follicles left. It is not just running out of egs, something else must be occurring to put a woman into early menopause. The newest thought is that these women just go into a phase where their eggs won’t respond well, but they actually do exist. In some women it’s that their pituitary FSH no longer works to wake up any eggs, in others it apparently was a type of self induced (auto-immune) inflammation. Networks of white cells called lymphocytes would invade the ovary and this is perhaps why the eggs wouldn’t respond.So this is the reason some women can transiently go into menopause, but actually recover and begin to have normal cycles again.The women who have POI may or may not be able to have donor eggs to be able to have children, and the current guidelines for this condition are undergoing extensive review.

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