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What effect will POF or insufficiency have on my long-term health?

 

The long term effects of premature ovarian failure (POF/POI) are largely due to the low oestrogen level.  This can have an effect on almost every tissue in the body. It is important to be aware of long term effects so that you can make an informed decision about taking oestrogen replacement and also take lifestyle measure to reduce their impact.

Bones

Bone health is a major concern in POF/POI.  We often think of our bones as an inert skeleton but in fact bone is a living tissue just like the skin or lungs.  Bone tissue is continuously in a state of turn-over, with old bone being resorbed and new bone being made.  This helps to keep the skeleton healthy and enables it to respond to stresses.  Oestrogen prevents bone resorption and also increases new bone formation.  Whern there is a lack of oestrogen (as in POF), more bone is resorbed than is made leading to bone loss. 

Taking oestrogen replacement, in the form of HRT or the combined oral contraceptive pill, can help prevent bone loss and sometimes increases bone density.

Other things you can do to keep your bones healthy are ensuring a healthy diet with enough calcium, keeping your vitamin D levels up with adequate sunlight exposure and regular weight-bearing exercise.

Bone density is assessed using a DXA bone scan of the lower spine and hip.  It is a good idea to have a DXA when you are first diagnosed with POF as a baseline measurement.  Frequency thereafter will depend on the initial values and whether you are taking oestrogen replacement or not.  The result of a DXA will be either normal, osteopenia (meaning thin bones) or osteoprosis.  Women with osteoporosis are more likely to experience fractures (broken bones). 

More information on bone health can be found in our leaflet on Osteoporosis and also on the National Osteoporosis Society website www.nos.org.uk .

Cardiovascular risk

Whilst there have not been any studies looking directly at cardiovascular risk (for example having angina, a heart attack or stroke) in women with POF, we know that women who have had their ovaries removed are at increased risk of these conditions.  We also know that in POF there is an adverse change in the cholesterol levels and that these changes have been associated with cardiovascular disease.

What is unknown is the exact risks in POF and whether or how much oestrogen replacement changes these risks. 

Nonetheless, it is important to be aware of your cardiovascular health and try to maintain a healthy diet and do regular exercise.  Your GP or hospital specialist may be able to arrange for you to have your cholesterol checked.

Psychological aspect

POF can be a very difficult diagnosis to come to terms with and many women have feelings of anxiety and low mood following the diagnosis.  It is important to seek help if you feel like this or feel that you are unable to cope.  Some women find that a support group and talking to other women with POF is helpful; others find talking to friends or family or having counselling sessions can help.