How Common is it?
POF affects about 1% of women - more than you'd think. It affects 100,000 women per year in the UK alone.

What causes it?
There may be obvious causes such as surgery to remove the ovaries or cancer treatments such as chemotherapy or radiotherapy.

But in the majority of women there is no apparent cause.

It's not uncommon to discover a family history of early menopause. As a rule, the earlier the onset of POF, the more likely there is to be a genetic cause.
In other cases POF may occur as a result of an immune system problem (called autoimmunity).

How do I know if it's happened to me?
In most cases, POF can be easily diagnosed by a simple blood test.

What are the implications of POF?
If you're a young woman the most upsetting result of POF is infertility. Having a premature menopause means you will no longer produce eggs, so there is virtually no chance of natural conception occurring. Ovarian function may return spontaneously in some women.

If you have POF and want to have a baby you'll need to use a fertility treatment called egg-donation, where another woman's eggs are fertilised using your partner's sperm and then replaced in your womb.

Long term effects of POF:
You'll be at risk of the same problems and diseases as older menopausal women. This means you'll have an increased risk of osteoporosis and heart disease much earlier than would otherwise be expected.

Coping with POF:
Psychologically, a diagnosis of POF can be devastating. It's a good idea to ask your doctor to refer you to a counsellor to help you come to terms with it.

Are there any treatments available for the menopause or POF?
YES.
Hormone Replacement Therapy (HRT):

What exactly is HRT?
In simple terms, Hormone Replacement Therapy (HRT) means replacing the hormone oestrogen, which a woman's ovaries stop producing naturally after the menopause.

Most women using HRT take a combination of oestrogen and another female hormone, progesterone. If you've had a hysterectomy (an operation to remove your womb) you can take oestrogen on its own with no ill effects. But of you haven't had a hysterectomy, it's not safe to take oestrogen on its own. That's because it will over-stimulate the lining of the womb, which may cause the cells to become cancerous. So it's essential that another hormone - progesterone - is taken for at least ten days per month.

How do I use HRT?
Most HRT users take it in the form of a daily tablet. Not everybody needs the same levels of hormones, so the dose is adjusted to suit the individual.

Taking most HRT regimes will mean you have a regular monthly bleed, just like a normal period. But if you start HRT at least a year after you've been through the menopause, you can take a different, period-free regime ( it works in around 80% of women).

Skin patches, oestrogen implants and creams:
This is another way of using HRT. They work like nicotine patches - you simply apply a skin patch once or twice a week, allowing the hormones to pass through your skin into your bloodstream.

Alternatively, you could use an oestrogen implant, a rod which is inserted under the skin by your doctor. New implants need to be fitted every four to six months.

In addition, you could try local oestrogen creams or vaginal pessaries which are particularly useful for women troubled by vaginal symptoms such as dryness or irritation.

Is HRT safe?
You've probably read countless articles in newspapers and magazines discussing
the pros and cons of HRT.

On one hand it's been promoted as an 'elixir of youth' and on the other as an unnatural and harmful affront to womanhood. In reality the answer lies somewhere in between.

The plusses:

There is ample scientific evidence that using HRT not only improves some of the short term symptoms of menopause but has a significant effect on osteoporosis and heart disease in the longer term.

It appears that HRT can halt or minimise the bone loss associated with menopause. Studies show that fracture rates are considerably lower in woman who have used HRT. The risk of having a heart attack or stroke may be reduced by up to half in HRT users. More recent evidence suggests HRT may also help prevent the onset of Alzheimer's disease.

The minuses:

1) Side effects
When you first start HRT, you may experience side effects. The most common of these are:

Breast or nipple tenderness

• Increased appetite
  
• Weight gain
  
• Calf cramps
  
• Irregular bleeding

Usually, these symptoms will ease or vanish within three months.
They tend to be more common in woman who have delayed starting HRT after the onset of menopause.

2) Cancer:
Many women are concerned that HRT gives them a higher risk of breast cancer.
The reality is that despite a number of scientific studies which have tried to prove a link between HRT and breast cancer, nobody has found conclusive proof.

The studies appear to reveal that there may be a small increase in breast cancer risk for long term users of HRT (longer than 8 years).

But the same studies also appear to show that women using HRT have a lower risk of dying from breast cancer than women who develop breast cancer and haven't used HRT.

3) Blood clots:
Recent evidence shows that in the first year of HRT use there is an increased risk of blood clots developing in the leg or the lung.

Can I take HRT if I have an existing medical condition?
Some medical conditions can potentially be aggravated by using HRT.
These include migraine headaches, liver disease , previous blood clots in the leg or lung and of course a previous history of breast cancer.

If you have any of these conditions, make sure your doctor is aware of your medical history.

I've got POF. Should I try HRT?
For women with POF the use of HRT is of particular importance. That's because you're at risk of the long-term post menopausal effects at a younger age.
Often, young women or teenagers with POF are prescribed the combined oral contraceptive pill, instead of HRT. It works in a similar way by providing the necessary levels of oestrogen, but carries less stigma than HRT.

Can I get pregnant while on HRT?
Documentary evidence shows that some women with POF have become pregnant while using HRT. Statistically, there's a five-to-10 per cent life time chance of pregnancy in this group. No-one's certain how this would happen, but it's possible that the hormones in HRT might cause a temporary return of activity within the ovary.

Alternatives to HRT:
1) There are many proported naturopathic remedies to treat menopausal symptoms, ranging from Chinese herbal medications to eating a diet made up of various foods containing natural oestrogens.

Unfortunately it is difficult to know whether these alternative treatments will reduce the long-term effects of the menopause such as thinning of the bones and heart disease. There are a number of studies underway, so the answer might not be too far off.

2) Drugs:
Some alternative drug therapies can be used for specific menopausal symptoms.
Clonidine is used to treat high blood pressure but may also be useful for improving troublesome hot flushes.

Raloxifene is a new drug that can be used to minimise osteoporosis. It behaves like oestrogen on bone but not on tissues such as the breast or uterus.

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