Frequently Asked Questions

• Are there any problems besides infertility I should be aware of?
• Why should I be concerned about my bones?
• What can I do to protect my bones?
• If I have a bone-density study which one should I have done?
• What about heart health?

I guess after my devastation (and I do mean devastation) about my chances for a baby I am still concerned about my health. Are there any problems besides infertility I should be aware of?

Yes, several things. First, if an underlying health problem was discovered during your examination, such as thyroid disease, it needs to be addressed. Women with POF need to be attentive to their heart and bone health. To protect yourself, it is generally recommended that women with POF take HRT. You should take a combination of estrogen and progesterone. However, if you’ve had your uterus and ovaries removed you do not need to take progesterone. In that case, estrogen alone is taken. If your ovaries and uterus are still there, you need to continue to take both to protect yourself from ovarian/uterine cancer.
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Why should I be concerned about my bones?

Loss of estrogen plays a part in the more rapid decrease in bone density that is common after menopause. As women with POF, we face many more years without the protective action of estrogen. Loss of bone density can lead to osteoporosis and fractures. In addition, until the age of about 30, your body is supposed to be building up your bone density. If you do not have adequate estrogen throughout this crucial period, you may not achieve your peak bone density and your chances of getting osteoporosis are greatly increased above that of a women who goes into menopause at age 51.
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What can I do to protect my bones?

There are a number of things that you can do:

• HRT
• Adequate calcium intake
• Weight-bearing and strength training exercise

More specifically…

Dietary changes that may be helpful: Look at your intake of protein and decrease it if it’s too high. Excessive protein in the diet can increase the loss of calcium through the urine. Common sources of protein are meats and poultry. In general, we (Americans) consume far more protein than we need. Women should consume 44 to 50 grams of protein per day. A lean hamburger patty contains about 26 grams of protein. One-half of a roasted chicken breast (without the skin) contains about 27 grams of protein. With the addition of protein found in vegetables, breads and other foods a diet with more than one serving of meat or poultry per day can easily exceed 50 grams of protein.

Drinks that contain caffeine (coffee, tea, or cola-based soft drinks) should be limited because excessive caffeine causes the body to lose calcium through the kidneys into the urine. A general recommendation is to limit your drinks with caffeine to no more than two per day and if you want more of those drinks to switch to decaffeinated ones.

Alcoholism is associated with osteoporosis. There are many reasons for the association between alcoholism and osteoporosis. Alcohol contains a lot of calories but they are “empty” calories, without nutritional value. Often alcohol is the “primary food” of people who abuse alcohol. So, instead of a nutritionally balanced diet they are deficient in a number of vitamins and minerals that can contribute to bone loss. There can be damage to the liver so that it may not be able to make a form of vitamin D which is necessary for calcium absorption.

Lifestyle changes that may be helpful: If you smoke, stop. If you don’t smoke, don’t start! Smoking limits the effectiveness of HRT. Estrogen levels in smokers taking HRT have been found to be significantly lower than in non-smokers who use HRT.

Exercise protects against bone loss. Both weight-bearing and strength-training exercises should be included. Examples of good weight-bearing exercises are walking (at least three mph), running and jogging. Swimming and bicycling are not weight bearing exercises. Free weights or dumbbells, ankle and wrist weights, weight machines and elastic tubing can be used in strength-training exercises. It is important to know that exercise is site specific. If you want a strong spine you need to exercise the spine. If you want strong legs, you need to exercise your legs.

Nutrients that may be helpful: You need 1,000 mg of elemental calcium per day if you are taking HRT. If you’re not taking HRT that amount increases to 1,500 mg per day. You can get it through your diet or through a calcium supplement. If your plan is to get enough calcium through your diet, make sure you really are getting enough. It would be a good idea to keep a “diary” of all the foods you eat for three to five days. The days should include both weekdays and weekend days because it is likely that you eat differently on the weekend than during the week.

If you are not getting enough dietary calcium, a supplement should be taken. The majority of supplements are either calcium carbonate or oyster-shell calcium. When you are determining the amount of calcium a supplement has, make sure you look at the amount of elemental calcium that it contains not just the total. In addition, the product should meet the United States Pharmacopoeia (USP) standards for disintegration and dissolution. If the information isn’t available on the packaging you can call the manufacturer or do “the vinegar test.” Vinegar test: place a calcium tablet in a glass of white vinegar (6 – 8 ounces) at room temperature. Stir it vigorously several times over 30 minutes. At the end of the 30 minutes, the tablet should have disintegrated into fine particles. If it hasn’t, it isn’t the brand to use as it will not be effectively absorbed in your stomach. The 1000 mg of elemental calcium cannot all be taken at one time. As your body can only absorb 600 mg of calcium at a time it needs to be divided over the space of the day. The calcium should be taken with a full glass (8 ounces) of water or juice in order for it to dissolve.

Vitamin D increases the absorption of calcium. The recommended daily allowance (RDA) for Vitamin D is 400 mg per day. An easy way to get Vitamin D is through 15 minutes of exposure to the sun (perhaps while you’re outside walking or running!). Sunscreen can’t be used during this exposure as it prevents the skin from making Vitamin D. One problem with getting Vitamin D from sun exposure is that in winter in some parts of the country the hours of sunlight are short. Only a few foods naturally contain Vitamin D. They include liver, fish and egg yolks. Some foods in the U.S., such as milk, are fortified with Vitamin D. If you don’t get exposure to the sun nor the necessary Vitamin D through food sources, a vitamin supplement can be taken. Check your calcium supplement because many calcium products have Vitamin D added to them.

Because other vitamins and minerals can enhance the absorption of calcium or help with bone synthesis, it is often recommended that women with POF take a multivitamin plus mineral supplement every day. Any major brand can be used. You don’t need a prescription. This way you know you have received 100% of the RDA for all the major vitamins and minerals.
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If I have a bone-density study which one should I have done?

The DEXA (dual energy X-ray absorptiometry) is considered the “state of the art” technique. Have this one done if at all possible. However, there is very good research showing that virtually any of the other tests (like SPA, DPA and QCT) can be used to measure the various areas of the skeleton and predict a woman’s future risk of osteoporosis.
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What about heart health?

The estrogen that dominates women’s lives during the reproductive years also protects us from heart disease. After the loss of estrogen there is an increase in heart disease. Data from the Nurses’ Health Study found that women who went through surgical menopause (removal of the uterus and the ovaries) before the age of 35 have two to seven times the risk of heart attack; the risk is also high in women who go through a natural POF. However, there has been a recent controversy about the relationship between HRT and heart disease and strokes. This recent study showed that HRT in normally postmenopausal women may increase their risk of heart attacks and strokes. However, this data does not apply to women with POF. At the present time, many doctors who specialize in POF are recommending that women with POF continue to take HRT.
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