Primary ovarian insufficiency (POI) happens when your ovaries stop working normally before you are 40.

As you get older, fertility naturally decreases. This usually starts around age 40 or later. Menstrual periods may also become irregular as you transition to menopause. If you have POI, these changes happen earlier, before age 40. Sometimes POI can start as early as the teenage years.

POI is different from premature menopause. With premature menopause, your periods stop before age 40. You can no longer get pregnant. The cause can be natural or it can be a disease, surgery, chemotherapy, or radiation. With POI, some women still have occasional periods. They may even get pregnant. In most cases of POI, the cause is unknown.

In about 90% of cases, the exact cause of POI is unknown.

Research shows that POI is related to problems with the follicles. Follicles are small sacs in your ovaries where eggs grow and mature. One type of follicle problem is that you run out of working follicles earlier than normal. Another is that the follicles are not working properly. In most cases, the cause of the follicle problem is unknown. But sometimes the cause may be:

• Genetic disorders such as Fragile X syndrome and Turner syndrome
• A low number of follicles
• Autoimmune diseases, including thyroiditis and Addison disease
• Chemotherapy or radiation therapy
• Metabolic disorders
• Exposure to toxic substances, such as cigarette smoke, chemicals, and pesticides

Certain factors can raise your risk of POI:

• Family history. If you have a mother or sister with POI, you are more likely to have it.
• Genes. Some changes to genes and genetic conditions put you at higher risk for POI. For example, women with Fragile X syndrome or Turner syndrome are at higher risk.
• Certain diseases, such as autoimmune diseases and some viral infections.
• Cancer treatments, such as chemotherapy and radiation therapy.
• Age.You can get POI when you're young, but it becomes more common between the ages of 35 and 40.

The first sign of POI is usually irregular or missed periods. Later symptoms may be like those of natural menopause, including:

• Hot flashes
• Night sweats
• Irritability
• Poor concentration
• Decreased sex drive
• Pain during sex
• Vaginal dryness

You may see a health care provider because of difficulty getting pregnant or trouble with infertility.

Since POI causes you to have lower levels of certain hormones, you are at greater risk for other health conditions, including:

• Anxiety and depression. Hormonal changes caused by POI can contribute to anxiety or lead to depression.
• Dry eye syndrome and eye surface disease. Some women with POI have one of these eye conditions. Both can cause discomfort and may lead to blurred vision. If not treated, these conditions can cause permanent eye damage.
• Heart disease. Lower levels of estrogen can affect the muscles lining the arteries and can increase the buildup of cholesterol. These factors increase your risk of atherosclerosis (hardening of the arteries).
• Infertility.
• Low thyroid function. This problem also is called hypothyroidism. The thyroid is a gland that makes hormones that control your body's metabolism and energy level. Low levels of thyroid hormones can affect your metabolism and can cause very low energy, mental sluggishness, and other symptoms.
• Osteoporosis. The hormone estrogen helps keep bones strong. Without enough estrogen, women with POI often develop osteoporosis. It is a bone disease that causes weak, brittle bones that are more likely to break.

To diagnose POI, your provider may do:

• A medical history, including asking whether you have relatives with POI
• A pregnancy test, to make sure that you are not pregnant
• A physical exam, to look for signs of other disorders that could be causing your symptoms
• Blood tests, to check for certain hormones. You may also have a blood test to do a chromosome analysis. A chromosome is the part of a cell that contains genetic information.
• A pelvic ultrasound, to see whether the ovaries are enlarged or have multiple follicles.

Currently, there is no proven treatment to restore normal function to the ovaries. But there are treatments for some of the symptoms of POI. There are also ways to lower your health risks and treat the conditions that POI can cause:

• Hormone therapy for menopause (sometimes called hormone replacement therapy or HRT). This is the most common treatment. It gives your body the estrogen and other hormones that your ovaries are not making. Hormone therapy for menopause improves sexual health and decreases the risks for heart disease and osteoporosis.
• Calcium and vitamin D supplements. Because women with POI are at higher risk for osteoporosis, you should take calcium and vitamin D every day.
• In vitro fertilization (IVF). If you have POI and you wish to become pregnant, you may consider trying IVF.
• Regular physical activity and a healthy body weight.Getting regular exercise and controlling your weight can lower your risk for osteoporosis and heart disease.
• Treatments for associated conditions. If you have a condition that is related to POI, it is important to treat that as well. Treatments may involve medicines and hormones.

NIH: National Institute of Child Health and Human Development

A pulmonary embolism (PE) is a sudden blockage in a lung artery. It usually happens when a blood clot breaks loose and travels through the bloodstream to the lungs. PE is a serious condition that can cause:

• Permanent damage to the lungs
• Low oxygen levels in your blood
• Damage to other organs in your body from not getting enough oxygen

PE can be life-threatening, especially if a clot is large, or if there are many clots.

The cause is usually a blood clot that breaks loose and travels through the bloodstream to the lungs. The clot is usually a deep vein thrombosis (DVT), a clot in the leg. In rare cases, material such as air bubbles, clumps of fat, or parts of a tumor can block the lung artery and cause PE.

Anyone can get a pulmonary embolism (PE), but certain things can raise your risk of PE:

• Having surgery, especially joint replacement surgery.
• Certain medical conditions, including
• Cancers
• Heart diseases
• Lung diseases
• A broken hip or leg bone or other trauma
• Hormone-based medicines, such as birth control pills or hormone therapy for menopause.
• Pregnancy and childbirth. The risk is highest for about six weeks after childbirth.
• Not moving for long periods, such as being on bed rest, having a cast, or taking a long plane flight.
• Age. Your risk increases as you get older, especially after age 40.
• Family history and genetics. Certain genetic changes that can increase your risk of blood clots and PE.
• Obesity.

Symptoms of PE include:

• Shortness of breath
• Rapid breathing
• Chest pain or discomfort, which usually gets worse when you cough or take a deep breath
• Increased heart rate
• Coughing up blood
• Very low blood pressure, lightheadedness, or fainting

Sometimes people with PE don't have any symptoms until they have serious complications, such as pulmonary hypertension (high blood pressure in the arteries to your lungs).

It can be difficult to diagnose PE. To find out if you have a PE, your health care provider will:

• Take your medical history, including asking about your symptoms and risk factors for PE
• Do a physical exam
• Likely order some tests, including various imaging and blood tests

If you have PE, you need medical treatment right away. The goal of treatment is to break up clots and help keep other clots from forming. Treatment options include medicines and procedures.

Medicines:

• Anticoagulants, or blood thinners, keep blood clots from getting larger and stop new clots from forming. You might get them as an injection, a pill, or through an I.V. (intravenous). They can cause bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin.
• Thrombolytics are medicines to dissolve blood clots. You may get them if you have large clots that cause severe symptoms or other serious complications. Thrombolytics can cause sudden bleeding, so they are used if your PE is serious and may be life-threatening.

Procedures:

• Catheter-assisted thrombus removal uses a flexible tube to reach a blood clot in your lung. Your health care provider can insert a tool in the tube to break up the clot or to deliver medicine through the tube. Usually you will get medicine to put you to sleep for this procedure.
• A vena cava filter may be used in some people who cannot take blood thinners. Your health care provider inserts a filter inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. But the filter does not stop new blood clots from forming.

Preventing new blood clots can prevent PE. Prevention may include:

• Continuing to take blood thinners. It's also important to get regular checkups with your provider, to make sure that the dosage of your medicines is working to prevent blood clots but not causing bleeding.
• Heart-healthy lifestyle changes, such as heart-healthy eating, exercise, and, if you smoke, quitting smoking.
Using compression stockings to prevent deep vein thrombosis (DVT).
• Moving your legs when sitting for long periods of time (such as on long trips).
• Moving around as soon as possible after surgery or being confined to a bed.

NIH: National Heart, Lung, and Blood Institute

Pulmonary hypertension, sometimes called PH, is a serious condition that affects the blood vessels in the lungs. It develops when the blood pressure in your lungs is higher than normal.

Your heart pumps blood to your lungs so they can add oxygen to the blood. The blood goes back to your heart. From there, it travels to the rest of your body so that your tissues can get the oxygen that they need.

The blood moves from your heart to your lungs through blood vessels called pulmonary arteries. If the pulmonary arteries become damaged, narrowed, or blocked, the blood does not flow through them as well. This can increase the blood pressure in the arteries and cause pulmonary hypertension.

There are different types of pulmonary hypertension, including pulmonary arterial hypertension (PAH). The different types are based on what caused the disease.

Pulmonary hypertension can develop on its own or be caused by another condition. Sometimes the cause is unknown or is not clear.

Some of the possible causes include:

• Heart diseases, including left-sided heart failure and congenital heart disease
• Lung diseases such as COPD (chronic obstructive pulmonary disease), interstitial lung disease, emphysema, and sleep apnea
• Other medical conditions such as:
  • Liver diseases
  • Sickle cell disease
  • Pulmonary embolism (blood clots in the lungs)
  • Connective tissue disorders like scleroderma

Certain factors can make you more likely to develop pulmonary hypertension, such as:

• Your age. The risk increases as you get older. The condition is usually diagnosed between ages 30 and 60.
• Your environment. Being exposed to asbestos or having certain infections caused by parasites can raise your risk.
• Your family history and genetics. Certain genetic disorders, such as Down syndrome, congenital heart disease, and Gaucher disease, can raise your risk of pulmonary hypertension. So can a family history of blood clots.
• Your lifestyle habits.Smoking and illegal drug use can raise your risk of developing pulmonary hypertension.
• Certain medicines. For example, some medicines used to treat cancer and depression can make you more likely to develop pulmonary hypertension.
• Your sex. Pulmonary hypertension is more common in women than in men.

The symptoms of pulmonary hypertension are sometimes hard to recognize and are similar to the symptoms of other medical conditions. So sometimes it can take years for someone to get diagnosed with pulmonary hypertension.

The symptoms of pulmonary hypertension may include:

• Shortness of breath
• Chest pain or pressure
• Dizziness that may lead to fainting
• Fatigue
• Swelling of the abdomen, legs, or feet
• Heart palpitations (the feeling that your heart is pounding or beating too fast)

Pulmonary hypertension can get worse over time and lead to serious problems, including:

• Anemia, which can cause your body to not get enough oxygen-rich blood
• Arrhythmias, problems with the rate or rhythm of your heartbeat
• Blood clots in the pulmonary arteries
• Bleeding in the lungs
• Heart failure
• Liver damage
• Pericardial effusion, a collection of fluid around the heart
• Serious pregnancy complications

To find out if you have pulmonary hypertension, your health care provider:

• Will ask about your medical history and symptoms
• Will do a physical exam, which may include checking your blood oxygen, listening to your heart and lungs, and checking your blood pressure
• Will likely order some tests, such as:
  • Blood tests to look for blood clots, stress on the heart, or anemia
  • Heart imaging tests, such as a cardiac MRI
  • Lung imaging tests, such as chest x-ray
  • An electrocardiogram (ECG or EKG)

Often there is no cure for pulmonary hypertension, but treatments can help manage your symptoms. Your provider will work with you to come up with a treatment plan. It will be based on your needs and the cause of the pulmonary hypertension. The plan may include:

• Healthy lifestyle changes, such as:
  • Healthy eating, which includes eating less salt
  • Regular physical activity, which may be done through pulmonary rehabilitation
• Medicines, such as:
  • Blood thinners
  • Medicines to control the rate blood is pumped throughout the body
  • Medicines to relax blood vessels and allow the blood to flow better
  • Medicine to reduce swelling (diuretics)
• Oxygen therapy
• Procedures to reduce pressure in the heart or pulmonary artery
• In some severe cases, a lung transplant

NIH: National Heart, Lung, and Blood Institute

The rectum is the lower part of your large intestine where your body stores stool. Problems with the rectum are common. They include hemorrhoids, abscesses, incontinence and cancer.

Many people are embarrassed to talk about rectal troubles. But seeing your doctor about problems in this area is important. This is especially true if you have pain or bleeding. Treatments vary depending on the particular problem.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Rehabilitation is care that can help you get back, keep, or improve abilities that you need for daily life. These abilities may be physical, mental, and/or cognitive (thinking and learning). You may have lost them because of a disease or injury, or as a side effect from a medical treatment. Rehabilitation can improve your daily life and functioning.

Rehabilitation is for people who have lost abilities that they need for daily life. Some of the most common causes include:

• Injuries and trauma, including burns, fractures (broken bones), traumatic brain injury, and spinal cord injuries
• Stroke
• Severe infections
• Major surgery
• Side effects from medical treatments, such as from cancer treatments
• Certain birth defects and genetic disorders
• Developmental disabilities
• Chronic pain, including back and neck pain

The overall goal of rehabilitation is to help you get your abilities back and regain independence. But the specific goals are different for each person. They depend on what caused the problem, whether the cause is ongoing or temporary, which abilities you lost, and how severe the problem is. For example,:

• A person who has had a stroke may need rehabilitation to be able to dress or bathe without help
• An active person who has had a heart attack may go through cardiac rehabilitation to try to return to exercising
• Someone with a lung disease may get pulmonary rehabilitation to be able to breathe better and improve their quality of life

When you get rehabilitation, you often have a team of different health care providers helping you. They will work with you to figure out your needs, goals, and treatment plan. The types of treatments that may be in a treatment plan include:

• Assistive devices, which are tools, equipment, and products that help people with disabilities move and function
• Cognitive rehabilitation therapy to help you relearn or improve skills such as thinking, learning, memory, planning, and decision making
• Mental health counseling
• Music or art therapy to help you express your feelings, improve your thinking, and develop social connections
• Nutritional counseling
• Occupational therapy to help you with your daily activities
• Physical therapy to help your strength, mobility, and fitness
• Recreational therapy to improve your emotional well-being through arts and crafts, games, relaxation training, and animal-assisted therapy
• Speech-language therapy to help with speaking, understanding, reading, writing and swallowing
• Treatment for pain
• Vocational rehabilitation to help you build skills for going to school or working at a job

Depending on your needs, you may have rehabilitation in the providers' offices, a hospital, or an inpatient rehabilitation center. In some cases, a provider may come to your home. If you get care in your home, you will need to have family members or friends who can come and help with your rehabilitation.