Frequently Asked Questions

• When I see my doctor what medical information should she/he ask me about?
• Is there a special doctor I should see for POF?
• What should I expect my doctor to do during an examination?
• Are there any tests that I don’t need to have done?

When I see my doctor what medical information should she/he ask me about?

Your visit will be more productive if you’ve thought about the following and are prepared with as much information as possible. Your doctor should ask you about:

• Menstrual cycle changes
• Menopausal symptoms (see above)
• Surgery you’ve had on your reproductive system, particularly ovarian surgery
• Chemotherapy
• Radiation therapy
• Recent infections (an example is PID – Pelvic Inflammatory Disease)
• Family history of POF
• A history of autoimmune disorders in yourself or in your family such as: Hypothyroidism; Addison’s disease; Diabetes; Graves’ disease; Vitiligo; Lupus; Rheumatoid arthritis; Sjogren’s syndrome; Inflammatory bowel syndrome (IBS).
• Deafness in yourself or a family member
• Because symptoms of some diseases can start very subtly (such as Addison’s disease) your doctor will ask you about loss of appetite, nausea, weight loss, vague abdominal pain, weakness, tiring easily, salt craving or increased skin pigmentation.

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Is there a special doctor I should see for POF?

There is no medical specialty specifically for POF. However, a reproductive endocrinologist (RE) is especially helpful and more likely to know something about POF with detailed knowledge of the different types of hormone replacements available. While we cannot recommend any particular doctor, the POFSG website keeps a list of doctors that others with POF have recommended.
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What should I expect my doctor to do during an examination?

The Physical Examination might include:

• Physical inspection to see if you have the physical characteristics of Turner syndrome (includes nails that are soft and turn up at the ends and short pinkie fingers)
• Physical inspection to look for physical characteristics of autoimmune disorders associated with POF such as: Changes in pigmentation including premature graying of the hair (associated with Hashimoto’s thyroiditis), vitiligo, increased pigmentation of the gums or the skin folds of the hands (associated with Addison’s disease); Loss of axillary or pubic hair (associated with Addison’s disease); Butterfly rash on face (associated with Lupus); Thyroid enlargement (associated with Hashimoto’s thyroiditis or Graves’ disease).
• A pelvic examination

Blood tests generally include:

• FSH: generally this is done at least two times and at least one month apart. There is debate about the time of the month the FSH is done (such as Day Two, Three or Four of the menstrual cycle). It is important that more than one test be performed. Obviously, if you’re not menstruating how would you know when Day Two or Three was?
• Estradiol (abbreviated as “E2” in many medical papers).
• Karyotype: some doctors will say that this does not need to be done if you’ve had children or if your POF occurred after the age of 35. However, neither age nor having children rules out a chromosomal abnormality. Some insurance companies may not pay for this test.

Screening for associated autoimmune disorders might include:

• Thyroid-stimulating hormone (TSH) – Ultrasensitive
• Antithyroid antibodies (ANA)
• Antinuclear antibody titer
• Fasting glucose
• Electrolytes
• Corticotropin stimulation test – for women with signs and symptoms of adrenal insufficiency. Do not have a random plasma cortisol level done instead. They are not helpful because they can be in the normal range even with impaired adrenal reserve.
• CBC (Complete Blood Count)
• Urinalysis
• In addition, these may be obtained if clinically indicated: Sedimentation rate; Rheumatoid factor; Quantitative serum IgA – for women with a history of recurrent respiratory tract infections>

Radiology: A bone-density study can be useful. The best available test is a dual energy x-ray absorptiometry (DEXA) of the lumbar spine and hip. Before starting HRT, a baseline study can document any bone loss and future studies can be compared to it. Remember, there is no way to predict a person’s risk of having a future fracture by having a regular x-ray taken.
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Are there any tests that I don’t need to have done?

• Progesterone challenge test: this test is often done but it’s not necessary. For this test women are given 10 mg of progesterone (pills) for approximately 10 days and at the end of the 10 days the woman is asked if she’s had any vaginal bleed. However, women with POF intermittently have estrogen levels high enough for endometrial growth and withdrawal bleeding in response to the progesterone. A positive withdrawal test suggests there’s some estrogen secretion. Unfortunately, it is not enough to reach the threshold required to allow ovulation. If withdrawal bleeding occurs in response to a Progesterone challenge test, women may be falsely reassured that ovarian failure is a possibility. This can delay the timing of the diagnosis.
• Antiovarian antibody testing: one readily available test is positive in nearly 1/3 of the general population of women.
• Pelvic ultrasound: this detects structures that look like ovarian follicles in 30 – 40% of women with POF. Showing follicles on ultrasound doesn’t change how it’s treated so it’s not routinely recommended. It can, however, rule out other conditions such as ovarian cysts and tumors that might be responsible for your symptoms. Ovarian cysts are very common in women of childbearing age, and you should be under the care of a physician if you have them.
• Ovarian biopsy: it is invasive, provides little information and is generally considered a research tool.

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