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Premature ovarian failure

The term premature ovarian failure describes a stop in the normal functioning of the ovaries in a woman younger than age 40. Some people also use the term primary ovarian insufficiency to describe this condition. It is also known as hypergonadotropic hypogonadism.

Health care providers used to call this condition premature menopause, but premature ovarian failure is actually much different than menopause:

  • In menopause, a woman will likely never have another menstrual period again; women with premature ovarian failure are much more likely to get periods, even if they come irregularly.
  • A woman in menopause has virtually no chance of getting pregnant; a woman with premature ovarian failure has a greatly reduced chance of getting pregnant, but pregnancy is still possible.

Premature ovarian failure – symptoms

Woman with premature ovarian failure

Woman with premature ovarian failure

The most common first symptom of premature ovarian failure is skipping or having irregular periods (oligomenorrhea or more often amenorrhea).

Some women with premature ovarian failure also have other symptoms, similar to those of women going through natural menopause:

  • Hot flashes and night sweats;
  • Irritability, poor concentration;
  • Decreased interest in sex or pain during sex;
  • Drying of the vagina;
  • Infertility.

Premature ovarian failure also puts women at risk for some other health conditions, some of them serious, including:

  • Osteoporosis – loss of bone strength and bone density. Getting enough calcium, vitamin D, and weight-bearing physical activity can help reduce this risk.
  • Low thyroid function – affects metabolism and can cause very low energy. Replacing the thyroid hormone can treat the problem.
  • Addison’s disease – an autoimmune disorder in which the body has trouble handling physical stress, such an injury or illness, because of problems with the adrenal glands. About 3.2 percent of women with premature ovarian failure also have Addison’s disease. Addison’s can be dangerous for women who don’t know they have it. This condition can’t be prevented, but can be managed with help from your health care provider.
  • Heart disease – estrogen replacement therapy, along with keeping a healthy body weight and getting regular, moderate, physical activity can help reduce this risk.

Also, it is important to know that people who are carriers for the gene for Fragile X syndrome, or who have the premutation for the condition, are more likely than other people to get premature ovarian failure. If you are a Fragile X carrier or have a premutation, it is important to get tested for premature ovarian failure.

Premature ovarian failure – treatment

There is no proven treatment to make a woman’s ovaries work normally again. However, there are treatments that can help some of the symptoms of premature ovarian failure.

  • Estrogen replacement therapy (ERT), also called hormone replacement therapy (HRT) gives women the estrogen and other hormones their bodies are not making. HRT can help women have regular periods and lower their risk for osteoporosis.
  • Current research is looking into giving women the hormone testosterone to help prevent bone loss in women with premature ovarian failure.

Premature ovarian failure – diagnosed

Because one of the most common signs of premature ovarian failure is irregular periods, women should pay close attention to their menstrual cycles and tell their health care provider about any changes.

If your health care provider thinks you may have premature ovarian failure, he or she may do a blood test to measure the level of a hormone called follicle stimulating hormone (FSH) that is normally present in the body. This test will help determine whether the ovaries are working properly or not.

Premature ovarian failure – causes

Researchers know that in women in premature ovarian failure something happens to stop the normal functioning of the ovaries; but in most cases, the exact cause is not clear.

Most research focuses on a problem with the follicles in the ovaries. Follicles in the ovaries start out as microscopic seeds. These seeds mature into eggs, which travel to the uterus for fertilization. Follicles also release the hormone estrogen, which is important for a woman’s overall health and bone health.

Most women have enough follicles to last until menopause. However, this may not be the case in women with premature ovarian failure.

Women with premature ovarian failure may fall into one of two groups:

  • A woman with follicle depletion has no follicles left in her ovaries and there is no way to make more.
  • A woman with follicle dysfunction may have follicles in her ovaries, but they are not working properly.

About 10 percent to 20 percent of women with premature ovarian failure have a family history of the condition. This finding suggests that some cases of premature ovarian failure can be genetic. However, genetics is not the only cause of premature ovarian failure.

Premature ovarian failure and fertility

Women with premature ovarian failure are unlikely to get pregnant because their ovaries do not work correctly. At this time there is no proven treatment to improve a woman’s ability to have a baby naturally if she has premature ovarian failure.

However, between 5 percent and 10 percent of women with premature ovarian failure become pregnant without fertility treatment. There is also a type of fertility treatment, known as egg donation, which may be an option for women with premature ovarian failure.

(info from NICND – http://www.nichd.nih.gov/health/topics/premature_ovarian_failure.cfm)

Some scientists suggest that Premature ovarian failure can be natural or caused by surgery, chemotherapy or radiation. Missed periods are usually the first sign of POF. Later symptoms may be similar to those of natural menopause.

Women ovaries hold thousands of immature follicles, which contain eggs. At the beginning of each menstrual cycle, pituitary gland — which secretes a variety of hormones regulating processes throughout female body — secretes follicle-stimulating hormone (FSH). This hormone causes a small number of the egg-containing follicles in the ovaries to begin maturing, although usually only one follicle actually reaches maturity. Maturing follicles make estrogen. In turn, rising estrogen levels “notify” the pituitary gland that FSH is no longer needed.

If the follicles don’t mature properly — and don’t release adequate amounts of estrogen — the level of follicle-stimulating hormone continues to increase and remains elevated. This is why women with premature ovarian failure often have high levels of FSH circulating in their blood.

In women with normal ovarian function, the pituitary gland releases another hormone, called luteinizing hormone (LH). This hormone causes the mature follicle to open, releasing the egg (ovulation). The egg then enters the fallopian tube where it might be fertilized by sperm — resulting in pregnancy. Without the increased estrogen levels released by maturing follicles and subsequent spike of luteinizing hormone, ovulation doesn’t occur.

FSH causes a small number of the egg-containing follicles in the ovaries to begin maturing, although usually only one follicle actually reaches maturity. Maturing follicles make estrogen. In turn, rising estrogen levels “notify” the pituitary gland that FSH is no longer needed.
If the follicles don’t mature properly — and don’t release adequate amounts of estrogen — the level of follicle-stimulating hormone continues to increase and remains elevated. This is why women with premature ovarian failure often have high levels of FSH circulating in their blood.

Premature ovarian failure arises when there are few or no “responsive” follicles left in your ovaries (follicle depletion) or when the follicles aren’t responding properly (follicle dysfunction).

Causes of follicle depletion resulting in premature ovarian failure include:

  • Chromosomal defects. Certain genetic disorders are associated with premature ovarian failure. These include Turner’s syndrome, a condition in which a woman has only one X chromosome instead of the usual two, and fragile X syndrome, a major cause of mental retardation.
  • Toxins. Chemotherapy and radiation therapy treatments are the most common causes of toxin-induced ovarian failure. These therapies may damage the genetic material in cells. Other toxins such as cigarette smoke, chemicals, pesticides and viruses may hasten ovarian failure.

(info from MayoClinic.com – http://www.mayoclinic.com/health/premature-ovarian-failure/DS00843)


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