Premature Ovarian Insufficiency
Dr. Alan Martinez discusses premature ovarian insufficiency.
Featured Speaker:
After graduating with distinction with a B.S in biology and B.A. in psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. He completed his obstetrics and gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School. He completed his fellowship training at the University of Cincinnati Medical Center.
Alan Martinez, MD
Dr. Alan Martinez is a specialist in reproductive endocrinology and infertility. He was drawn to this specialty because it is an ever-evolving field of medicine that allows him to partner with patients and provide personalized treatment plans. He also appreciates that the field is filled with the latest laboratory technology, which continues to advance success rates.After graduating with distinction with a B.S in biology and B.A. in psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. He completed his obstetrics and gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School. He completed his fellowship training at the University of Cincinnati Medical Center.
Transcription:
Premature Ovarian Insufficiency
Introduction: The Reproductive Science Center of New Jersey is a leading provider of advanced reproductive technologies. Sharing its knowledge with you. It's time for Fertility Talk with RSC&J. Here's Melanie Cole.
Melanie Cole: Welcome to Fertility Talk with RSC&J, the Reproductive Science Center of New Jersey. I'm Melanie Cole, and I invite you to listen. As we discussed premature ovarian insufficiency. Joining me is Dr. Alan Martinez. He's a Specialist in Reproductive Endocrinology and Infertility at the Reproductive Science Center of New Jersey. Dr. Martinez, it's a pleasure as always, please tell the listeners, what is premature ovarian insufficiency or POI.
Dr. Martinez: Thank you for having me today, Melanie. I appreciate it. So yes, premature ovarian insufficiency is when you have a decrease or dysfunction of the follicles in the ovary, which results in a stopping or, you know, not having periods on any regular frequency before the age of 40 years of age.
Host: So, do we know what causes it?
Dr. Martinez: The causes are several folds. One is common, because it can be associated with chromosomal abnormality. So somethings such as Turner's syndrome can either in adolescents or adults can cause this and you can have chemotherapy, radiation and cancer therapies. You can have pelvic surgery. So those are all atrogenic causes. They can also be associated with a specific genetic conditions such as fragile X, and you can sometimes even have an infectious or some sort of a tumor growth in the, what we call the hypothalamic pituitary axis of the female. And then it can have an auto-immune source as well. So there's several sources of potential causes that are directly relevant to the development of the premature ovarian insufficiency.
Host: Well then based on those causes that you know about, do you have a way to assess who is at risk and who you most often see this in?
Dr. Martinez: Yes. Oftentimes patients they can present at a very young age in adolescents with either delayed period, not having a period. And then they undergo an evaluation. In those patients and many other patients, there may be a family history that comes to light when you talk with them. And so they have, you know, my grandmother, my mother went through menopause at a very early age. They have some chromosomal issues in the family. There are historical factors that definitely point us in that direction. Obviously anybody that's undergoing medical therapies and that have either undergone an ovarian surgery have had cancers and cancer treatments that is obvious risk factors. And then some of the other conditions are not identified or investigated until the diagnosis is made, you know, through hormone testing. And then it comes to light through actual testing, but there may not have any family history or historical events that predict those conditions.
Host: You said that it often presents early in adolescents. Are there other symptoms that a parent might notice or that a young girl would notice what would send her to the doctor in the first place? And while you're telling us that, is it sometimes missed? Is it difficult to diagnose? What other problems can it cause, you know, if it is difficult to diagnose and a relative lack of population awareness, I imagine people don't really hear much about this. Can that delay the diagnosis?
Dr. Martinez: Absolutely it can. So the primary symptom is the lack of a menstrual period or what we call amenarea. Sometimes patients will also have hot flashes or vaginal symptoms like dryness and painful intercourse and things like that. And their early years, those are due to a lack of estrogen level, because that's a by-product of the ovaries. And if the ovaries fail, less estrogen is made and you can have some of those symptoms, most of the patients will have the lack of the period, obviously. And then in some cases there will even be delayed puberty. So delayed development of breasts, delayed growth spurts. And so you have person in short stature not going through their normal pubertal events. And that will kind of alert the physicians to evaluate for this condition.
Host: So, Dr. Martinez beyond the psychological burden that a diagnosis like this can inflict on a woman health and wellbeing of women with POI can be sensitive to any delay in the diagnosis. Correct? I mean, so if we rely on this timely initiation of therapy, tell us a little bit why it's so important that need for treatment to be addressed as soon as possible and speak about the treatment options that may be available.
Dr. Martinez: Yes. So the premature ovarian insufficiency can be associated because of lack of estrogen and going through what we call quote unquote, an earlier menopause that can have direct implications on people can be prone to fractures. Your bones can become brittle. They can also lead to cardiovascular events as well as just overall quality of life issues. So in these patients, once identification of the condition has been made and the diagnosis, then depending on where they're at, if they haven't gone through puberty, then they're sequential hormones. And it involves hormone replacement therapy as a primary goal. And this is estrogen, often given to a patient, not at a normal oral contraceptive kind of dosing. So that's not appropriate for these patients as firstline, but then replacement of estrogen for bone health, for cardiovascular health and, you know, proper counseling, like you had mentioned.
It's very important to get, you know, have them see a psychologist, a counselor about this because it does involve several aspects that they're going to now have to deal with in their life. And if they haven't initiated puberty, then you use sequential estrogen. And that helps them go through a growth spurt, helps them develop breasts and mature in a normal fashion. And then you add on or add back progesterone later on to kind of complete the pubertal growth. So a lot can be done for these women. If it happens early, once the diagnosis is made, you want to become really proactive. If it's later on in life, then you're dealing more with the symptoms and preventing long-term disease. And that becomes a primary focus, but people can be treated very well for this and their quality of life can be very good.
Host: Well, I imagine with my next question is where you come in, can they still get pregnant if they have only a few functional follicles or they've been in treatment? Tell us about what happens next.
Dr. Martinez: It's interesting because you can have spontaneous ovary function in these female patients and actually can have a five to 10% of spontaneous pregnancy, which you would think would be much lower if they're not having any cycles, but it just shows the variability of the human body itself. So if patients do not want to become pregnant, then it's still recommended to use some sort of a barrier control to keep them from getting pregnant. If they desire pregnancy, then in that case, you know, as an infertility specialist, our practice becomes involved in assessing, you know, improving that the ovary function is at a very low level. Sometimes the use of donor eggs in order to help get them pregnant because they can still carry a pregnancy. It's just that the ovary function is not to the level that you would desire it to be, and they struggle, but they're spontaneous pregnancy rates, although they're lower than normal fertility, a person can spontaneously conceive. So sometimes we see that with these patients.
Host: Wrap it up for us. Dr. Martinez, really a great topic and something that we can learn from people don't know a lot about it. So tell us a little bit more, or give us your best advice as we're talking about premature ovarian insufficiency.
Dr. Martinez: Whether you're a young female around the time of puberty, you haven't gotten a period or you've had a change in your periods from normal monthly cycles to, you know, missing periods over a period over a span of a few months, go talk to your obstetrician, Gynecologist, go seek out consultation because there's a lot of hormonal testing that could be done. It can give you answers that can help you either in your quality of life, family planning and your long-term health genetics, looking for certain conditions, looking for an auto-immune source. This can all help you answer your questions. So alleviate any fears have, especially if you have any family history, do not be afraid to reach out because that's what we're here for as women health specialist in this area. And we want to educate, we want to empower and just help you through the process, whatever that may be if still working on starting a family, quality of life, informational purposes, and such
Host: Very well said, Dr. Martinez, thank you so much. You are such a great guest and such an incredible expert in this department. So thank you again for joining us. That wraps up this episode of Fertility Talk with RSC&J, the Reproductive Science Center of New Jersey. For more information, please visit fertilitynj.com to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Reproductive Science Center of New Jersey podcasts. I'm Melanie Cole.
Premature Ovarian Insufficiency
Introduction: The Reproductive Science Center of New Jersey is a leading provider of advanced reproductive technologies. Sharing its knowledge with you. It's time for Fertility Talk with RSC&J. Here's Melanie Cole.
Melanie Cole: Welcome to Fertility Talk with RSC&J, the Reproductive Science Center of New Jersey. I'm Melanie Cole, and I invite you to listen. As we discussed premature ovarian insufficiency. Joining me is Dr. Alan Martinez. He's a Specialist in Reproductive Endocrinology and Infertility at the Reproductive Science Center of New Jersey. Dr. Martinez, it's a pleasure as always, please tell the listeners, what is premature ovarian insufficiency or POI.
Dr. Martinez: Thank you for having me today, Melanie. I appreciate it. So yes, premature ovarian insufficiency is when you have a decrease or dysfunction of the follicles in the ovary, which results in a stopping or, you know, not having periods on any regular frequency before the age of 40 years of age.
Host: So, do we know what causes it?
Dr. Martinez: The causes are several folds. One is common, because it can be associated with chromosomal abnormality. So somethings such as Turner's syndrome can either in adolescents or adults can cause this and you can have chemotherapy, radiation and cancer therapies. You can have pelvic surgery. So those are all atrogenic causes. They can also be associated with a specific genetic conditions such as fragile X, and you can sometimes even have an infectious or some sort of a tumor growth in the, what we call the hypothalamic pituitary axis of the female. And then it can have an auto-immune source as well. So there's several sources of potential causes that are directly relevant to the development of the premature ovarian insufficiency.
Host: Well then based on those causes that you know about, do you have a way to assess who is at risk and who you most often see this in?
Dr. Martinez: Yes. Oftentimes patients they can present at a very young age in adolescents with either delayed period, not having a period. And then they undergo an evaluation. In those patients and many other patients, there may be a family history that comes to light when you talk with them. And so they have, you know, my grandmother, my mother went through menopause at a very early age. They have some chromosomal issues in the family. There are historical factors that definitely point us in that direction. Obviously anybody that's undergoing medical therapies and that have either undergone an ovarian surgery have had cancers and cancer treatments that is obvious risk factors. And then some of the other conditions are not identified or investigated until the diagnosis is made, you know, through hormone testing. And then it comes to light through actual testing, but there may not have any family history or historical events that predict those conditions.
Host: You said that it often presents early in adolescents. Are there other symptoms that a parent might notice or that a young girl would notice what would send her to the doctor in the first place? And while you're telling us that, is it sometimes missed? Is it difficult to diagnose? What other problems can it cause, you know, if it is difficult to diagnose and a relative lack of population awareness, I imagine people don't really hear much about this. Can that delay the diagnosis?
Dr. Martinez: Absolutely it can. So the primary symptom is the lack of a menstrual period or what we call amenarea. Sometimes patients will also have hot flashes or vaginal symptoms like dryness and painful intercourse and things like that. And their early years, those are due to a lack of estrogen level, because that's a by-product of the ovaries. And if the ovaries fail, less estrogen is made and you can have some of those symptoms, most of the patients will have the lack of the period, obviously. And then in some cases there will even be delayed puberty. So delayed development of breasts, delayed growth spurts. And so you have person in short stature not going through their normal pubertal events. And that will kind of alert the physicians to evaluate for this condition.
Host: So, Dr. Martinez beyond the psychological burden that a diagnosis like this can inflict on a woman health and wellbeing of women with POI can be sensitive to any delay in the diagnosis. Correct? I mean, so if we rely on this timely initiation of therapy, tell us a little bit why it's so important that need for treatment to be addressed as soon as possible and speak about the treatment options that may be available.
Dr. Martinez: Yes. So the premature ovarian insufficiency can be associated because of lack of estrogen and going through what we call quote unquote, an earlier menopause that can have direct implications on people can be prone to fractures. Your bones can become brittle. They can also lead to cardiovascular events as well as just overall quality of life issues. So in these patients, once identification of the condition has been made and the diagnosis, then depending on where they're at, if they haven't gone through puberty, then they're sequential hormones. And it involves hormone replacement therapy as a primary goal. And this is estrogen, often given to a patient, not at a normal oral contraceptive kind of dosing. So that's not appropriate for these patients as firstline, but then replacement of estrogen for bone health, for cardiovascular health and, you know, proper counseling, like you had mentioned.
It's very important to get, you know, have them see a psychologist, a counselor about this because it does involve several aspects that they're going to now have to deal with in their life. And if they haven't initiated puberty, then you use sequential estrogen. And that helps them go through a growth spurt, helps them develop breasts and mature in a normal fashion. And then you add on or add back progesterone later on to kind of complete the pubertal growth. So a lot can be done for these women. If it happens early, once the diagnosis is made, you want to become really proactive. If it's later on in life, then you're dealing more with the symptoms and preventing long-term disease. And that becomes a primary focus, but people can be treated very well for this and their quality of life can be very good.
Host: Well, I imagine with my next question is where you come in, can they still get pregnant if they have only a few functional follicles or they've been in treatment? Tell us about what happens next.
Dr. Martinez: It's interesting because you can have spontaneous ovary function in these female patients and actually can have a five to 10% of spontaneous pregnancy, which you would think would be much lower if they're not having any cycles, but it just shows the variability of the human body itself. So if patients do not want to become pregnant, then it's still recommended to use some sort of a barrier control to keep them from getting pregnant. If they desire pregnancy, then in that case, you know, as an infertility specialist, our practice becomes involved in assessing, you know, improving that the ovary function is at a very low level. Sometimes the use of donor eggs in order to help get them pregnant because they can still carry a pregnancy. It's just that the ovary function is not to the level that you would desire it to be, and they struggle, but they're spontaneous pregnancy rates, although they're lower than normal fertility, a person can spontaneously conceive. So sometimes we see that with these patients.
Host: Wrap it up for us. Dr. Martinez, really a great topic and something that we can learn from people don't know a lot about it. So tell us a little bit more, or give us your best advice as we're talking about premature ovarian insufficiency.
Dr. Martinez: Whether you're a young female around the time of puberty, you haven't gotten a period or you've had a change in your periods from normal monthly cycles to, you know, missing periods over a period over a span of a few months, go talk to your obstetrician, Gynecologist, go seek out consultation because there's a lot of hormonal testing that could be done. It can give you answers that can help you either in your quality of life, family planning and your long-term health genetics, looking for certain conditions, looking for an auto-immune source. This can all help you answer your questions. So alleviate any fears have, especially if you have any family history, do not be afraid to reach out because that's what we're here for as women health specialist in this area. And we want to educate, we want to empower and just help you through the process, whatever that may be if still working on starting a family, quality of life, informational purposes, and such
Host: Very well said, Dr. Martinez, thank you so much. You are such a great guest and such an incredible expert in this department. So thank you again for joining us. That wraps up this episode of Fertility Talk with RSC&J, the Reproductive Science Center of New Jersey. For more information, please visit fertilitynj.com to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Reproductive Science Center of New Jersey podcasts. I'm Melanie Cole.