Too Young for Hot Flashes

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When Menopause-Like Symptoms Come Too Soon

Hot flashes, night sweats, loss of regular menstrual periods and sleep difficulties. These recognizable signs of menopause seem in many women around age 50. But if they arise before age 40–that happens for approximately 1 in 100 women–it is a sign that something is wrong. Early symptoms like these may be a sign of a little-understood illness called primary ovarian insufficiency (POI).

Most girls with POI are sterile. They are also at risk for bone fractures and heart disease. And most aren’t aware they’ve POI.

“Symptoms of POI may be missed because young women may not realize they are having symptoms related to menopause. They may not believe hot flashes are well worth mentioning to some doctor,” says Dr. Lawrence M. Nelson, a researcher and doctor at NIH. “Some adolescents and young ladies think of the menstrual cycle for a nuisance, and they don’t mind missing phases. They don’t take it badly, and that’s a mistake.” Missing or irregular intervals are a significant indication of POI.

When young girls have POI, their ovaries do not work normally. They stop regularly releasing eggs and cut back production of estrogen and other reproductive tissues. These same things occur when older women go through menopause, which is why the indicators are alike. As with menopause, POI symptoms can often be relieved by hormone replacement therapy, usually a estrogen patch. And as with menopause, POI puts girls at risk for bone loss. But using a proper identification of POI and early therapy, bone health may be protected.

POI was formerly known as “premature menopause” or “premature ovarian failure.” However research has since demonstrated that ovarian function is unpredictable in these girls, sometimes turning on and off, which is why a lot of doctors now favor the term primary ovarian insufficiency.

Many facets of POI stay mysterious–including its own origin. Only 10 percent of cases could be traced to either to a hereditary illness or to autoimmunity–a disease in which the immune system attacks the body’s cells.

Nelson’s study has proven that the sudden loss of fertility frequently leads to grief and symptoms of anxiety and depression in women with POI. But a recent study from his lab indicates that most young women and teenagers with POI still have immature eggs in their ovaries. The finding raises the possibility that future treatments might be developed to restore fertility to some affected ladies. Even without treatment, up to 1 in 10 women with POI may unexpectedly become pregnant following their illness is diagnosed.

Irregular or stopped intervals might be a sign of other conditions, such as eating disorders or too much exercise. A simple blood test for elevated levels of a molecule called follicle stimulating hormone (FSH) can help confirm a diagnosis of POI.

“Having regular menstrual intervals is a indication that the ovaries are functioning correctly,” says Nelson. “If that is not happening, it’s important for girls and young girls to speak to their health care provider and find out why.”

Nelson is now searching for 18- to 42-year-old girls with POI to register in clinical trials at NIH.

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