What is primary ovarian insufficiency?
Primary ovarian insufficiency usually occurs when the ovaries stop working before age 40. When this happens, the ovaries do not produce the normal amount 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 are not the same. Women with primary ovarian failure can have irregular or intermittent periods of years and can become pregnant. But women with premature menopause do not have periods and become pregnant.
Restoring estrogen levels in women with primary ovarian failure can help prevent some of the complications that can result from low estrogen levels, such as osteoporosis. The term health care provider POI is used when the female ovaries stop working before age 40.
Most women experience fertility naturally in their 40s. This age indicates the onset of irregular periods that indicate the onset of menopause. For women with primary ovarian insufficiency (POI), irregular periods and decreased fertility occur before age 40, sometimes even in adolescence.
Previously, primary ovarian insufficiency (POI) was called “premature menopause” or “premature ovarian failure,” but those terms did not accurately describe what happens in a woman with primary ovarian insufficiency (POI). A woman who has gone through menopause will not have another normal period and will not be able to conceive. If a woman with primary ovarian insufficiency (POI) does not become regular, she may still be pregnant.
Symptoms of primary ovarian insufficiency
You may not know that your ovaries are working normally. Some women with premature ovarian failure still have periods and may become pregnant. But many people with this condition have trouble getting pregnant. This usually prompts you to visit a doctor.
Common symptoms of premature ovarian failure are rare or missing periods. Periods that start as they expect, then stop and start again. Other symptoms can resemble menopause and can include:
- Hot flushes; Hot vapours
- Night sweats
- Anxiety, depression, or mood swings
- Concentration or memory problems.
- Your sex drive is not what it used to be
- Trouble sleeping
- Vaginal dryness, which makes sex uncomfortable.
Primary ovarian insufficiency causes
Inside the ovaries are small sacs called follicles. The eggs are captured as they grow. Girls are generally born with 2 million “seeds” that develop into these follicles, which go through menopause.
If you have a primary ovarian defect, your follicles may swell (as your doctor calls this degeneration) or not function properly (also known as dysfunction). Doctors do not know why this happens.
This condition is more likely to occur if you have a mother or sister. Other things that make it more:
- Autoimmune disorders
- Chemotherapy and radiotherapy.
- Genetic and chromosomal disorders, including Fragile X syndrome and Turner syndrome
- Viral infections
Primary ovarian insufficiency risk factors
Factors that can increase your risk of developing primary ovarian failure:
- Years: The risk increases between the ages of 35 and 40. Although rare before age 30, primary ovarian failure is also possible in young women and adolescents.
- Family history: Having a family history of primary ovarian failure increases the risk of developing this disorder.
- Ovarian surgery: Surgeries that involve the ovaries increase the risk of primary ovarian failure.
Complications of primary ovarian insufficiency
Complications of primary ovarian failure:
- Sterility: The inability to get pregnant is a problem of primary ovarian failure. In rare cases, pregnancy is possible until the eggs hatch.
- Osteoporosis: A hormone called estrogen helps maintain strong bones. Women with low estrogen levels are at higher 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 problems caused by low estrogen levels can make some women feel depressed or anxious.
Heart disease Early loss of estrogen increases your risk.
How is primary ovarian insufficiency diagnosed?
Primary ovarian insufficiency (POI) key codes:
- Missing or irregular 4-month periods, usually after spending some time regularly
- High levels of follicle-stimulating hormone (FSH)
- Low estrogen levels 4,6,13
- If a woman is under 40 and starts having irregular periods or stops for 4 months or more, her healthcare provider can take these steps to diagnose the problem:
- Take a pregnancy test: This test ruled out an unexpected pregnancy as the cause of missed periods
- Do a physical exam: During the physical exam, the doctor will see signs of other disorders. In some cases, the presence of these other disorders overrides the POI. Or, if there are other disorders associated with POI, such as Addison’s disease, the healthcare provider may know that there is POI.
- Collect blood: The healthcare provider collects your blood and sends it to a lab where the technician performs several tests:
- Follicle-stimulating hormone (FSH) test: FSH refers to the ovaries for estrogen production, sometimes called the “female hormone” because women need high levels for fertility and general health. When the ovaries are not working properly, the level of FSH in the blood rises, as in POI. The doctor can perform two FSH tests at least once a month. If the FSH level in both tests is as high as in women who have gone through menopause, then the probability of having a POI.
- Luteinizing hormone test: LH refers to the mature follicle that releases an egg. Women with POI have higher LH levels, further evidence that follicles are not working normally
- Estrogen test: In women with POI, estrogen levels are generally lower because the ovaries do not function properly in the role of estrogen producers.1,6
- Karyotype test: This test looks for abnormalities in your 46 chromosomes. Karyotype tests reveal genetic changes in the structure of chromosomes associated with POI and other health problems.
- Do a pelvic ultrasound: In this test, the doctor uses a sound wave machine (ultrasound) to create and view images within the female pelvic area. Ultrasound shows whether the ovaries are dilated or have multiple follicles 4,11
The healthcare provider also asks questions about a gynaecological history. He or she may ask:
- A blood relative with POI or its symptoms
- A blood relative with Fragile X syndrome or undiagnosed intellectual or developmental disability
- Ovarian surgery
- Radiation or chemotherapy treatment
- Pelvic inflammatory disease or other sexually transmitted infections.
- An endocrine disorder such as diabetes 4
If they don’t perform tests to rule out POI, some healthcare providers may find missing periods stressful. However, this approach is problematic because it delays diagnosis; Further evaluation is required.
Treatments of primary ovarian insufficiency
Treatment for primary ovarian failure usually focuses on problems caused by estrogen deficiency. Your doctor may recommend:
Estrogen therapy can help prevent osteoporosis, as well as eliminate hot flashes and other symptoms of estrogen deficiency. Your doctor will usually prescribe estrogen with a hormone called progesterone, especially if your uterus is still there. Adding progesterone protects the lining of the uterus (endometrium) from premature changes caused by estrogen alone.
The combination of hormones will rejuvenate your period, but will not restore ovarian function. Depending on your health and preferences, you can take hormone therapy until age 50 or 51, the average age of natural menopause.
In older women, chronic estrogen plus progestin therapy increases the risk of cardiovascular (cardiovascular) disease and breast cancer. In young women with primary ovarian failure, the benefits of hormone therapy outweigh the potential risks.
Calcium and vitamin D supplements
Both of these nutrients are important in preventing osteoporosis, and you may or may not be exposed to sunlight in your diet. Your doctor may prescribe a bone density test before starting supplements to get a baseline measurement.
For women ages 19 to 50, experts generally recommend 1,000 milligrams (mg) of calcium per day through diet or supplements, increasing to 1,200 mg per day for women 51 and older. The exact daily dose of vitamin D is not yet clear. A good starting point for adults is 600 to 800 international units (IU) per day, per diet or medication. If your blood D levels are low, your doctor may prescribe higher doses.
Treatment to restore fertility has not been proven. Some women and their partners continue to conceive through in vitro fertilization using donor eggs. In this process, the eggs are collected from the donor and fertilized in the laboratory with your partner’s sperm. The fertilized egg (embryo) is placed in your uterus.