Female reproductive capacity depends on the complex and well-designed developmental maturation of the ovaries at puberty. It is defined as the period in which secondary sexual characteristics are observed including breast development, growth of pubic and armpit hair, and the onset of menstruation.
This process is characterized by cyclic hormonal changes that lead to menstruation every four to six weeks. Socially and biologically, it represents fertility and vitality.
The ovaries produce two important products, reproductive hormones and eggs. Female hormones, especially estrogen and progesterone, maintain normal uterine functioning, breast development, and bone and heart health.
The release of an egg during ovulation determines fertility. These functions gradually decline over time, until menopause, when hormones and eggs stop being released, marking the end of reproduction.
How common this problem?
In general, most women on average enter menopause at age 50. Classic symptoms are irregular periods until they stop, hot flashes, fatigue, and mood swings.
This age pattern is not uniform, and a small percentage of women experience similar symptoms before they reach the age of 40. It is medically referred to as premature ovarian insufficiency, which was previously known as premature menopause. Given the crucial role of the ovary in reproduction and other biological processes, premature ovarian insufficiency poses a major burden.
One in every 100 women suffers from premature ovarian insufficiency. Causes are varied and include surgery or chemotherapy for cancer, infections such as mumps or genetic conditions such as Turner syndrome. However, most cases have no known cause.
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While irregular menstrual periods are very common, doctors usually recommend tests to check ovarian function. These include a hormonal profile and pelvic ultrasound examination. It may be necessary to repeat the hormone profile after three months to confirm the diagnosis. More advanced tests such as genetic testing require referral to a specialist.
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When premature ovarian insufficiency is diagnosed, management focuses on different health areas including fertility, hormone replacement, quality of life and psychological support. The primary physician is the point of contact to ensure that the woman receives a comprehensive evaluation and plan for ongoing care.
It is beneficial to continue hormone replacement until age 50 when re-evaluation is needed to see if continuation is necessary. Fertility is an emotional issue and early referral to a specialist will help a woman navigate the complex web of choices. It may feel like you are on a roller coaster, in which case support and advice cannot be underestimated.
As a woman, what should I do?
When you find yourself in circumstances that may predispose you to premature ovarian insufficiency, such as cancer treatment, it is recommended to consult a fertility specialist who will provide you with the opportunity to discuss fertility preservation. This may include collecting eggs to keep on ice in case they are frozen for future use. It is a safe and effective technique with several thousand healthy babies being born in recent years.
Charles Muteshi, Consultant Gynecologist and Fertility Specialist at Aga Khan University Hospital, Nairobi.
