Premature ovarian failure
DEFINITION
Premature ovarian failure — also known as primary ovarian insufficiency — refers to 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 exactly the same. Women with premature ovarian failure may have irregular or occasional periods for years and may 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, but infertility is harder to treat.
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, only one follicle — a sac that’s filled with fluid — reaches maturity each month.
When the follicle is mature, it bursts open, releasing the egg. The egg then enters the fallopian tube where a sperm cell might fertilize it, resulting in pregnancy.
Premature ovarian failure results from one of two processes — follicle depletion or follicle disruption.
Follicle depletion
Causes of follicle depletion 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 intellectual disability (intellectual development disorder), formerly called mental retardation.
- Toxins. Chemotherapy and radiation therapy 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.
Follicle dysfunction
Follicle dysfunction may be the result of:
- An immune system response to ovarian tissue (autoimmune disease). Your immune system may produce antibodies against your own 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. If you develop premature ovarian failure through follicular dysfunction and your tests indicate that you don’t have an autoimmune disease, further diagnostic studies may be necessary. An exact underlying cause often remains unknown.
SYMPTOMS
Signs and symptoms of premature ovarian failure are similar to those experienced by a woman going through menopause and are typical of estrogen deficiency. They include:
- Irregular or skipped periods (amenorrhea), which may be present for years or may develop after a pregnancy or after stopping birth control pills
- Hot flashes
- Night sweats
- Vaginal dryness
- Irritability or difficulty concentrating
- Decreased sexual desire
When to see a doctor
If you notice that you’ve skipped your period for three months or more, see your doctor to help determine what may be the cause. You may 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 that your periods have stopped, it’s still wise to see your doctor and try to find out what’s causing the problem. If your estrogen levels are low, bone loss can occur.
