At birth the woman has a predetermined number of cells in her ovaries, which will be consumed during her reproductive life. It is estimated that at the beginning of menstruations (between 10 and 14 years) an ovary body has about three hundred four thousand cells in the ovaries, and that throughout reproductive life these cells will be consumed.
Menopause is often expected around 48 years old. However, some women see this cycle arrive well before expected – often even before the age of 40. This condition is known as premature ovarian insufficiency (IOP), also called early ovarian bankruptcy, or early menopause, and although not very common, can affect up to 1% of women in this age group, according to data from the European Society of Human Reproduction (ESHRE).
IOP occurs when ovaries cease to function properly ahead of time, leading to the interruption of ovulation and falling sexual hormone levels such as estrogen and progesterone. The impact goes beyond fertility: the early absence of these hormones can compromise bone, cardiovascular, metabolic and emotional health of the woman.
Symptoms and early diagnosis are fundamental
The woman with IOP may have symptoms similar to those of menopause: menstrual irregularity, heat waves, vaginal dryness, libido loss, insomnia and mood swings. Some, however, only discover the condition by investigating difficulties to get pregnant.
The diagnosis is made through hormonal examinations, especially the dosage of follicle-stimulating hormone (FSH) and estradiol, as well as the evaluation of the ovarian reserve by dosage of the antimüllerian hormone (AMH). We usually associate these hormonal exams with the endovaginal ultrasound examination, which may show an amount of antiral follicles (small follicles distributed inside the ovaries) or absent, as well as the size of the ovaries. The sooner the condition is identified, the more effective the follow -up and planning of treatment will be.
Emotional challenges and impact on fertility
Receiving IOP diagnosis can be a significant emotional thud, especially for women who want to get pregnant. The news of early ovarian bankruptcy can generate feelings of frustration, sadness, anxiety and loss of female identity. Therefore, psychological support is an essential part of care, along with gynecological and endocrinological follow -up.
In the field of fertility, although the chance of spontaneous pregnancy is reduced, it is not impossible: some women with IOP still have sporadic ovulations. In addition, with the advancement of assisted reproduction techniques, in vitro fertilization with donated eggs can allow maternity in many cases.
Treatment and Brazilian reality
The main treatment of IOP is hormone replacement – which should be done with estrogen and progesterone to the average age of menopause (around 50 years). This helps to protect the heart’s heart, bones and metabolism. Still, in Brazil, one of the biggest challenges is access to diagnosis and specialized treatment, which often takes time to arrive, especially outside the large urban centers.
Another obstacle is at the low offer of public services aimed at assisted reproduction. Although Brazilian legislation ensures access to infertility treatments in SUS, in practice, the waiting line and limited resources make it difficult to attend.
Premature ovarian insufficiency is a serious and poorly spoken condition. The sooner it is diagnosed, the greater the chances of preserving women’s health and well-being. It is essential to talk more about the subject, so that all have access to information, care and possibilities – including the dream of motherhood.
*Text written by gynecologist Luiz Eduardo T. Albuquerque (CRM -SP 61351 / RQE No. 30799 -RQE No. 307991), Specialist in Assisted Reproduction, Medical Director of the Fertiviter Human Reproduction Center and member of Brazil Health
This content was originally published in early menopause: understand how premature ovarian insufficiency occurs on the CNN Brazil website.
Source: CNN Brasil
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