Premature ovarian failure (also known as primary ovarian insufficiency) is a loss of normal function of your ovaries before age 40. If your ovaries fail, they don’t produce normal amounts of the hormone estrogen or release eggs regularly. Infertility is a common result. Premature ovarian failure is sometimes referred to as premature menopause, but the two conditions aren’t the same. Women with premature ovarian failure can have irregular or occasional periods for years and might even become pregnant. Women with premature menopause stop having periods and can’t become pregnant. Restoring estrogen levels in women with premature ovarian failure helps prevent some complications, such as osteoporosis, that occur as a result of low estrogen.
Symptoms
Signs of premature ovarian failure are similar to those of going through menopause and are typical of estrogen deficiency. They include Irregular or skipped periods (amenorrhea), which might be present for years or develop after a pregnancy or after stopping birth control pills, difficulty in conceiving, hot flashes, night sweats, vaginal dryness, irritability or difficulty concentrating and decreased sexual desire.
If you’ve missed your period for three months or more, see your doctor to help 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.
Causes
In women with normal ovarian function, the pituitary gland releases certain hormones during the menstrual cycle, which causes a small number of egg-containing follicles in the ovaries to begin maturing. Usually one or two follicles – tiny sacs filled with fluid – reach maturity each month.
When the follicle matures, it opens, releasing an egg. The egg enters the fallopian tube where a sperm cell might fertilize it, resulting in pregnancy.
Premature ovarian failure results from the loss of eggs (oocytes). This might happen due to one of the following reasons.
Chromosomal defects: Certain genetic disorders are associated with premature ovarian failure. These include mosaic Turner’s syndrome – in which a woman has only one normal X chromosome and an altered second X chromosome – and fragile X syndrome – in which the X chromosomes are fragile and break.
Toxins: Chemotherapy and radiation therapy are the most common causes of toxin-induced ovarian failure. These therapies can damage the genetic material in cells. Other toxins such as cigarette smoke, chemicals, pesticides and viruses might hasten ovarian failure.
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: It’s possible to develop premature ovarian failure, but have no known chromosomal defects, toxin exposure or autoimmune disease. Your doctor might recommend further testing to find the cause, but in most cases, the cause remains unknown (idiopathic).
Complications
Complications of premature ovarian failure include infertility, osteoporosis, depression or anxiety, heart disease and dementia.
Treatment for premature ovarian failure usually focuses on the problems that arise from estrogen deficiency. Your doctor might recommend:
Estrogen Therapy: Estrogen therapy can help prevent osteoporosis and relieve hot flashes and other symptoms of estrogen deficiency. Your doctor typically prescribes estrogen with the hormone progesterone, especially if you still have your uterus. Adding progesterone protects the lining of your uterus (endometrium) from precancerous changes caused by taking estrogen alone. In older women, long-term estrogen plus progestin therapy has been linked to an increased risk of heart and blood vessel (cardiovascular) disease and breast cancer. In young women with premature ovarian failure, however, the benefits of hormone therapy outweigh the potential risks.
Calcium and vitamin D supplements: Both 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 bone density measurement.