Premature Ovarian Failure: Symptoms, Causes, Treatments
Primary ovarian insufficiency (POI), sometimes called premature ovarian failure (POF) or premature menopause, is a reproductive disease in which the ovaries stop producing eggs before age 40. When the ovaries stop working, they don’t ovulate and produce a reduced amount of oestrogen. Women with POI are at risk of severe conditions such as osteoporosis, heart disease or infertility.
Precise symptoms of premature ovarian failure might be hard to identify, especially during the early stages of the condition. Women with POF may have regular periods, and, in some cases, still have the ability to conceive. However, if challenges related to fertility arise, consulting a doctor might lead to a diagnosis of the condition. You should consider to contact your health care provider if you experience one or multiple of the following symptoms:
- Irregular periods: the hormonal changes caused by premature ovarian failure can lead to disruptions in the menstrual cycle, which in turn might result in irregular or missed periods.
- Problems with conceiving: POF often causes a decline in fertility, meaning that women with the condition often have problems with conceiving.
- Depression and Anxiety: the hormonal fluctuations can significantly impact the mood, which in some cases can result in depression and anxiety.
- Hot flashes and Night sweats: these are also symptoms associated with hormonal changes, and are similar to those experienced during natural menopause.
- Low sex drive: hormonal imbalances can lead to decreased interest in sexual activity.
- Vaginal dryness and Painful intercourse: reduced oestrogen levels can lead to changes in the vaginal tissues, which in turn might cause dryness and discomfort during intercourse.
- Memory problem: the hormonal fluctuations might diminish cognitive function, resulting in memory issues or difficulties related to concentration.
- Trouble sleeping: changes in the hormone levels can lead to sleep disturbances, such as problems falling asleep or staying asleep.
While the causes of premature ovarian failure can be diverse, there are certain factors that may contribute. Origins of POF include;
- Hormonal imbalance: Reduced oestrogen levels and increased levels of FSH (follicle-stimulating hormone indicate a disruption in the ovarian response. As a result, oestrogen production is reduced.
- Family history: if there is a family history of POF, descendants are at increased risk of acquiring this condition.
- Infections: Herpes, cytomegalovirus, and tuberculosis of the genital tract can cause primary ovarian insufficiency.
- Genetic disorders: premature ovarian failure can be associated with genetic disorders such as turner syndrome or fragile X syndrome.
- Chromosomal defect: some viral infections are known to cause POF, and some less common infections can cause Tuberculosis of the genital tract.
- Autoimmune diseases: the body produces antibodies against ovarian tissue that can harm the follicles containing eggs, which in turn can cause premature ovarian failure.
- Lifestyle factors: Cigarette smoking and exposure to pesticides or industrial toxins have been proven to decrease the chances of conception and an increased risk of POF.
Premature Ovarian Insufficiency Diagnosis and Tests
Diagnosing premature ovarian failure usually involves a combination of various components, including;
- Medical History: understanding the woman's medical history, including information regarding irregular periods or missed cycles. Assessing the family history for any instances of early menopause or fertility issues may also be relevant.
- Physical Examination: a thorough physical examination to uncover any signs or symptoms related to hormonal imbalances.
- Blood Tests: measuring hormone levels, in particular follicle-stimulating hormone (FSH) and estradiol, help to evaluate the ovarian function. Thyroid function tests are also done to rule out other potential causes of menstrual irregularities.
- Genetic Testing: checking for genetic conditions such as Turner syndrome or Fragile X syndrome is a common procedure, as these conditions may be associated with POI.
- Imaging Studies: doctors often use ultrasound imaging to examine the ovaries and detect any abnormalities.
- Bone Density Testing: dual-energy X-ray absorptiometry (DEXA) scans are conducted in order to assess bone density, considering the increased risk of osteoporosis.
Premature Ovarian Failure Treatments
While premature ovarian failure can be a difficult diagnosis to receive, it is important to discuss treatment options with a doctor. The healthcare provider should also explain that while the prospect of seeking professional medical care and initiating hormone replacement therapy may seem overwhelming, it is the most common treatment to restore lost ovarian hormones. The combination of the hormones oestrogen and progesterone restore the affected woman's hormone levels to a state similar to those prior to early menopause. The therapy stops hot flashes and other symptoms of hormone deficiency, while also inducing menstrual periods. However, it does not restore ovarian function. In addition to hormonal treatment, there are other alternative options. These include:
- Vitamin supplements: to counter undesired consequences of oestrogen deficiency, calcium and vitamin D supplements may be recommended.
- Fertility treatments: for those wanting to conceive, assisted reproductive technologies (ART) such as in vitro fertilisation (IVF) or egg donation can be alternative routes.
- Psychological support: upon being diagnosed with POF, dealing with fertility issues and hormonal fluctuations can be emotionally demanding. Thus, counselling or support groups can provide valuable psychological assistance.
- Lifestyle changes: adopting a healthier lifestyle, especially in regards to physical exercise and a balanced diet, can contribute to an overall well being.
- Regular check-ups: after getting the diagnosis, women with POF benefit from regular check-ups to monitor bone health, cardiovascular risks, and overall hormonal balance.
Risks Associated with Premature Ovarian Failure
These are some of the health conditions that are common in women with POF:
- Infertility: About nearly 90% of women with premature ovarian failure can’t get pregnant. About 10% who have tried to conceive without medical help have succeeded, and had pregnancies without the need for fertility drugs.
- Heart disease: Not enough oestrogen can elevate the risk of a heart attack in women with POF
- Osteoporosis: In case of low oestrogen level, a woman might have a higher risk of developing brittle bones due to bone loss, which in turn puts her at an increased risk for fractures.
- Depression: There is a risk of lingering sadness after ovarian failure. Women with POF may want to talk to a therapist or may benefit from medication for depression.
References
- Goswami, D., & Conway, G. S. (2005). Premature ovarian failure. Human reproduction update, 11(4), 391-410. Retrieved from https://academic.oup.com/humupd/article/11/4/391/874983.
- Beck-Peccoz, P., & Persani, L. (2006). Premature ovarian failure. Orphanet journal of rare diseases, 1, 1-5. Retrieved from https://link.springer.com/article/10.1186/1750-1172-1-9.
- Kalantaridou, S. N., Davis, S. R., & Nelson, L. M. (1998). Premature ovarian failure. Endocrinology and metabolism clinics of North America, 27(4), 989-1006. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0889852905700517.
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