Premature Ovarian Failure

Unlike men, who produce sperm throughout their lives, women are born with about 1 million eggs in their ovaries and do not generate new eggs.

Approximately, 80 percent of women exhaust their ovarian reserve at 45 or 50 years of age, which leads to menopause. However, in some cases, a woman’s ovaries stop working before she reaches the 40.

This condition is known as premature ovarian failure (POF), premature ovarian insufficiency or early menopause. Women who suffer this condition are likely to have fertility problems.

Premature ovarian failure affects one in every hundred fertile age women and beyond causing an ovulatory cessation, it also reduces blood estrogen levels, which can greatly increase osteoporosis risks.

There are two types of premature ovarian failure:

  1. The permanent interruption of ovarian function due to egg depletion.
  2. An ovulatory dysfunction in which a woman’s eggs do not respond to the body’s normal hormonal stimuli (which happens in 50 percent of POF cases)

Premature ovarian failure main symptoms

Premature ovarian failure symptoms are often similar to those of menopause:

  • Irregular and increasingly scattered menstrual periods
  • Amenorrhea or menstrual period absence
  • Hot flashes
  • Night sweats
  • Insomnia
  • Vaginal dryness
  • Decreased libido
  • Painful intercourse
  • Fatigue
  • Irritability and frequent mood swings
  • Concentration difficulty
  • Infertility

Since women with premature ovarian failure have low estrogen levels, it is important to note that they are also more likely to develop osteoporosis and cardiovascular disease.

Premature ovarian failure causes

Although the specific origin cannot be determined in many cases, most common causes of premature ovarian failure are:

  • Genetic disorders such as Turner syndrome and fragile X syndrome
  • Immune system disorders such as lupus and Addison’s disease
  • Enzymatic or metabolic disorders like galactosemia and hemochromatosis
  • Thyroid disorders with antibody presence
  • Diseases like diabetes and anorexia nervosa
  • Infections
  • Pelvic inflammatory disease
  • Cancer treatments such as chemotherapy and radiotherapy
  • Pelvic surgery comprising complete ovary removal
  • Smoking
  • Pesticide exposure

Premature ovarian failure (POF) can also be hereditary. Consequently, women with mothers or sisters who suffer this condition are more likely to develop it.

How is premature ovarian failure diagnosed?

If you are under 40 but suffer menstrual disorders or any of the previously mentioned premature ovarian failure symptoms it is necessary to perform a blood test between the third and fifth day of your menstrual cycle (if your menstrual periods are absent this can be performed any day ) to determine if your ovaries are functioning properly.

A high level of follicle stimulating hormone (FSH) and a low level of estradiol are good evidences of premature ovarian failure.

Once the results are in, your specialist will likely repeat this test to confirm the diagnosis and perform some additional tests to determine the causes of premature ovarian failure. He will also perform a transvaginal ultrasound (or pelvic vaginal ultrasound), during which the doctor inserts an ultrasound probe into the patient’s vagina to examine her ovaries.

Transvaginal ultrasound is simple, painless and can determine the remaining follicle number in a woman’s ovaries.

Treatments to achieve pregnancy when you have premature ovarian failure

Although there is no fertility treatment to restore normal ovarian function, In vitro fertilization, coupled with egg donation offers success rates of up to 85 percent for women wishing to be mothers.

It is essential for couples considering egg donation to feel comfortable with the decision. At Ingenes’ emotional support unit we will work with you throughout the process, and all our qualified specialists will answer any questions you may have.

In some cases though, a patient still has a small ovarian reserve. In this case it is still possible to carry out an ovulation induction treatment, followed by an In-Vitro Fertilization cycle. However, it is important to understand that ovarian reaction is often insufficient, so you and your specialist should carefully evaluate this possibility before starting any treatment.

If the patient is under 40 and there is no contraindication, any chosen treatment should be coupled to hormone therapy with estrogen and progesterone. This alleviates menopausal symptoms of premature ovarian failure and helps prevent complications such as osteoporosis.

Your doctor will ask you to take a low dose and gradually increase it until your hormone levels back to normal. Generally, hormone therapy can be safely discontinued when the premature ovarian failure patient reaches a natural menopausal age.

Premature ovarian failure treatment should always be accompanied by healthy lifestyle tips to help reduce osteoporosis and heart disease risks.