Primary Ovarian Insufficiency
Primary ovarian insufficiency — also called premature ovarian failure — occurs when the ovaries stop functioning normally before age 40. When this happens, your ovaries don’t produce normal amounts of the Hormone Estrogen or release eggs regularly. This condition often leads to infertility.
Primary ovarian insufficiency is sometimes confused with premature menopause, but these conditions aren’t the same. Women with primary ovarian insufficiency can have irregular or occasional periods for years and might even get pregnant. But women with premature menopause stop having periods and can’t become pregnant.
Restoring estrogen levels in women with primary ovarian insufficiency helps prevent some complications that occur as a result of low estrogen, such as osteoporosis
Symptoms
Signs and symptoms of primary ovarian insufficiency are similar to those of menopause or estrogen deficiency. They include:
Irregular or skipped periods, which might be present for years or develop after a pregnancy or after stopping birth control pills
Difficulty getting pregnant
Hot flashes
Night sweats
Vaginal dryness
Dry eyes
Irritability or difficulty concentrating
Decreased sexual desire
When to see a doctor?
If you’ve missed your period for three months or more, see your doctor to determine the cause. You can miss your period for a number of reasons — including pregnancy, stress, or a change in diet or exercise habits — but it’s best to get evaluated whenever your menstrual cycle changes.
Even if you don’t mind not having periods, it’s advisable to see your doctor to find out what’s causing the change. Low estrogen levels can lead to bone loss and an increased risk of heart disease.
Causes
Primary ovarian insufficiency may be caused by:
Chromosomal defects. Some genetic disorders are associated with primary ovarian insufficiency.
Toxins. Chemotherapy and radiation therapy are common causes of toxin-induced ovarian failure. These therapies can damage genetic material in cells. Other toxins such as cigarette smoke, chemicals, pesticides and viruses might hasten ovarian failure.
An immune system response to ovarian tissue (autoimmune disease). In this rare form, your immune system produces antibodies against your ovarian tissue, harming the egg-containing follicles and damaging the egg. What triggers the immune response is unclear, but exposure to a virus is one possibility.
Unknown factors. The cause of primary ovarian insufficiency is often unknown (idiopathic). Your doctor might recommend further testing to find the cause, but in many cases, the cause remains unclear.
Risk factors
Factors that increase your risk of developing primary ovarian insufficiency include:
Age. The risk goes up between ages 35 and 40. Although rare before age 30, primary ovarian insufficiency is possible in younger women and even in teens.
Family history. Having a family history of primary ovarian insufficiency increases your risk of developing this disorder.
Ovarian surgery. Surgeries involving the ovaries increase the risk of primary ovarian insufficiency.
Complications
Complications of primary ovarian insufficiency include:
Infertility. Inability to get pregnant can be a complication of primary ovarian insufficiency. In rare cases, pregnancy is possible until the eggs are depleted.
Osteoporosis. The hormone estrogen helps maintain strong bones. Women with low levels of estrogen have an increased risk of developing weak and brittle bones (osteoporosis), which are more likely to break than healthy bones.
Depression or anxiety. The risk of infertility and other complications arising from low estrogen levels causes some women to become depressed or anxious.
Heart disease. Early loss of estrogen might increase your risk.
Diagnosis
Most women have few signs of primary ovarian insufficiency, but your doctor may suspect the condition if you have irregular periods or are having trouble conceiving. Diagnosis usually involves a physical exam, including a pelvic exam. Your doctor might ask questions about your menstrual cycle, exposure to toxins, such as chemotherapy or radiation therapy, and previous ovarian surgery.
Your doctor might recommend one or more tests to check for:
Pregnancy. A pregnancy test checks for an unexpected pregnancy if you’re of childbearing age and missed a period.
Hormone levels. Your doctor may check the levels of a number of hormones in your blood, including follicle-stimulating hormone (FSH), a type of estrogen called estradiol, and the hormone that stimulates breast milk production (prolactin).
Certain genes or genetic defects. You may have a karyotype test to look for abnormalities in your chromosomes.
Treatment
Treatment for primary ovarian insufficiency usually focuses on the problems that arise from estrogen deficiency. Your doctor might recommend:
Estrogen therapy. Estrogen therapy can help prevent osteoporosis as well as relieve hot flashes and other symptoms of estrogen deficiency.
Calcium and vitamin D supplements. Both nutrients are important for preventing osteoporosis, and you might not get enough in your diet or from exposure to sunlight. Your doctor might suggest bone density testing before starting supplements to get a baseline measurement.
Addressing infertility
There’s no treatment proved to restore fertility. Some women and their partners pursue pregnancy through in vitro fertilization .