I’ll never forget the look on the patient's face as I pulled her test results off the drawer. I made the lady and her husband sit down in my cabin. Time slowed to a crawl as I drew a diagram of her body and gently explained that the reproductive part of it was dying. There was nothing I could do to fix it. I told them “I’m so sorry. It looks quite difficult for you to get pregnant naturally". Tears started rolling and they made their way for another patient to enter my cabin.
After few years I met her again, this time she was looking all different. I could see signs of aging but the reason she was here was a fracture of one of the arms due to a trivial injury. She kept on asking me if this is due to my diagnosis of POI? The answer was simply yes, but it took a little more time for her to understand. So point here is that getting aware of your future health complications can help you to prevent them.
Here are the important long term health concerns of POI
POI is diagnosed many times due to infertility. During infertility work up this shocking revelation happens. As ovaries stop functioning chances of getting pregnant naturally are significantly reduced. Ovarian activity may occur occasionally in the early period, this gives the possibility for spontaneous conception, which occurs in up to 5%. The conditions where POI is expected as a part of treatment like cancer, autoimmune disorders, organ transplant, fertility preservation in advance can be life-changing. It can be in the form of egg freezing, embryo or ovarian tissue freezing. For others females with idiopathic POI where the cause is not found, IVF (In vitro fertilization) with donor eggs can be one of the options.
There is a new advanced technique named “IN VITRO ACTIVATION”, where pregnancy can be achieved with your own eggs.
The beneficial effects of female hormone (estrogen) on bone have long been recognized. As hormone levels fall, bone breakdown occurs at a faster rate than bone build-up resulting in decreased bone mass. This can lead to osteoporosis, brittle bones and even minor trauma can cause a fracture. The loss of bone measured as Low bone mineral density (BMD), usually assessed by dual-energy X-ray absorptiometry (DEXA) scan. So maintaining a balanced diet, adequate calcium and vitamin D intake, weight-bearing exercises, healthy body weight and cessation of smoking, and moderation of alcohol intake will definitely help in reducing fracture risk. In some females who have other bothersome symptoms too, starting hormone replacement therapy can improve BMD and reduce fracture risk also. It is important to consider bone health after the diagnosis of POI. Measurement of BMD at initial diagnosis of POI should be considered for all women, but especially where there are additional risk factors.
In women with POI, there is an increase in LDL (bad) cholesterol, lipoprotein, and a decrease in HDL (good) cholesterol. This predisposes to the formation of blood clots (thromboembolism), thickening of blood vessels (atherosclerosis). The overall risk of heart attack, stroke, high blood pressure is increased. At least blood pressure, weight, and smoking status should be monitored annually. It is associated with reduced life expectancy, largely due to cardiovascular disease if we don’t pay attention. These risk factors can be modified through behavioral changes like stopping smoking, taking regular weight-bearing exercise, maintaining a healthy weight, balanced diet, adapting stress-reducing techniques. So regular follow-up with lifestyle modification will definitely help in avoiding future complications.
Quality of life
The quality of life is definitely hampered in women with POI. I remember one of the patients saying “ I went from 30-50 in one day!!! I feel unattractive, useless, different, an outsider….
The incidence of anxiety, depression, poor body image, low self-esteem, low life satisfaction, negative outlook, signs of early aging, mood changes is much higher than normal. The stress of infertility is another negative factor affecting the quality of life. The presence of hot flushes and night sweats can be very disturbing in day-to-day life. Many women feel embarrassed to ask for help but psychological intervention should be approached when required.
Due to the fact that POI can result in vaginal dryness, there is a sexual health concern. Pain during sexual intercourse due to dryness can create a vicious cycle of pain, fear, and avoidance of sexual activity. This can put a strain on the relationship with your partner. The use of vaginal lubricants and moisturizers helps in reducing dryness.( refer to blog on vaginal dryness to know more about lubricants and moisturizers)
There are chances of memory loss, dementia in some females.
Looking at overall long-term health effects, there is an absolute need for regular follow-up and investigations. Most of the time women are unaware of future complications. So it is necessary to talk about ill health effects associated with premature ovarian insufficiency at the time of diagnosis only.
All suggestions and comments are welcome.
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