Premature ovarian failure

Premature ovarian failure is a complicated health condition in young females that gives rise to menopausal symptoms like mood swings, hot flashes and night sweats. If you have been lately wondering why you are experiencing such problems at such a tender age as yours, read and find out all about the symptoms, causes, diagnosis and treatment of this disorder.

Premature ovarian failure Definition

When defined simply, it is a condition that leads to physiological shutting down of the reproductive system. It actually refers to a loss of the normal function of the ovaries in women before the age of 40. This may often lead to infertility.

The disorder is generally abbreviated as POF.

What Happens in Premature ovarian failure?

In this disorder, production of estrogen is completely stopped, inducing early menopause in younger women. Unlike premature menopause, individuals suffering from POF may have periods or menstrual cycles but on a very rare basis. Follicle stimulating hormone (FSH), an essential hormone produced by the pituitary gland for follicle development within the ovary, is abnormally high during this condition. Follicles are the basic units of female reproductive system that contain immature egg for fertilization. However, there is a decreased level of luteinizing hormone (LH) that mainly regulates ovulation and menstruation.

Premature ovarian failure Synonyms

This particular condition of the ovaries is also known by several names such as:

Picture of Premature ovarian failure

Picture 1 – Premature ovarian failure

  • Primary ovarian insufficiency
  • Premature ovarian insufficiency
  • Hypergonadotropic hypogonadism

This disorder was previously known as “Premature Menopause”. It is also referred to as “Ovarian hypofunction”.

Premature ovarian failure Incidence

1 in every 1000 women between the ages of 15-29 and 1 out of every 100 women between 30-39 years of age are estimated to be affected by POF.

Premature ovarian failure History

In 1942, Fuller Albright et al. reported this particular disorder in many young women who had high levels of follicle stimulating hormone (FSH), low estrogen levels as well as irregular periods. The condition was initially named as “Primary ovarian insufficiency” in order to differentiate it from secondary ovarian insufficiency, which is a failure of the pituitary gland that normally secretes FSH.

Premature ovarian failure Symptoms

Some of the common symptoms of this condition are:

  • Thinning and drying of vagina
  • Decreased sexual drive
  • Hot flashes
  • Night sweats
  • Irritability
  • Decreased concentration
  • Insomnia

Amenorrhea or irregular menstrual cycles is a primary symptom of this condition. In some cases, women may have regular periods when FSH levels come back to the normal range. Affected patients experience a varied range of symptoms that are nearly similar to those undergoing natural menopause. Generally, the average age of women going through menopause is around 51 years. This is unlike premature ovarian failure which occurs at any age before 40. Although follicle production continues to take place, the ovaries begin to malfunction due to some unknown reason.

Premature ovarian failure Causes

Medical experts have not yet been able to identify the exact cause that prevents the ovaries from functioning normally. FSH levels may remain normal despite failure of the ovaries to produce large amount of estrogen. Follicles in the ovaries are usually produced in large numbers in the form of microscopic seeds called primordial follicles that are still immature. Approximately two million primordial follicles are present in every woman since birth. In this condition, however, these follicles are not able to function normally. There are two main processes through which this abnormal ovarian condition occurs.

Follicle depletion

Deficiency of follicles may occur due to causes like:

Chromosomal defects

Some genetic disorders like Turner’s syndrome and Fragile X syndrome could be associated with this condition. In case of the former condition, there is a partial or complete loss of either X chromosome that may lead to decreased production of primordial follicles. In the latter condition, a part of X chromosome undergoes modification leading to mental retardation.

Chemotherapy/Radiation therapy

These treatment procedures are often used on cancer patients and can have various toxic effects on the production of follicles. The after-effects of these therapeutic techniques inhibit the normal function of the ovaries.

Surgery

Individuals with an abnormal growth or cyst in the ovary, and pelvic muscle dysfunction, may require early ovarian or pelvic surgery. However, several complications such as early loss of ovarian function may arise after surgery. Hysterectomy, a surgical removal of the entire uterus including fundus and cervix, performed at an early age can give rise to all the major symptoms of POF.

Follicle dysfunction

It normally involves only one specific cause:

Autoimmune response

Mature follicles may get damaged due to certain autoimmune reaction in the body that directly attacks the ovarian tissue. Primordial follicles remain unaffected and are continuously produced by the ovaries. However, these remain inactive even after reaching the mature stage.

Other than the above mentioned causes, there are few additional causative factors that may initiate the degeneration of the ovaries. These include:

  • Tuberculosis of the genital tract
  • Smoking
  • Accidental inhalation/ingestion of chemicals or pesticides
  • Gonadotropin-releasing hormone (GNRH) therapy
  • Defective enzymes in the body
  • Viral/Bacterial infection
  • Thyroid disorders
  • Abnormal eating habits

Premature ovarian failure Diagnosis

Complete analysis of the medical history of a patient is very important for diagnosis of this disorder. Pelvic examination is essentially performed to evaluate any abnormality within the pelvis. An array of blood tests is generally conducted to confirm the presence of the exact condition.

Follicle-stimulating hormone (FSH) test

Elevated levels of FSH in the blood clearly indicate possibility of POF.

Luteinizing hormone (LH) test

LH is another hormone of the pituitary gland that triggers mature follicles produced within the ovaries to release an egg. Individuals suffering from POF always exhibit a decreased level of LH in the body.

Karyotype test

Blood cells are a good source for evaluating the size, shape and the number of X chromosomes in this condition. Turner or Fragile X syndrome can be easily detected by using this diagnostic method that distinctly shows the chromosomal abnormalities.

Pregnancy test

Blood pregnancy test usually detects human chorionic gonadotropin that is completely normal during this condition, thus ruling out the possibility of pregnancy.

Serum estradiol test

Estradiol is the most important form of estrogen in the body. It is released in large amounts from the ovaries, adrenal cortex, and the placenta during pregnancy. It is also responsible for development of external female genital organs. Patients with POF have low levels of this particular estrogen that prevents the normal discharge of the eggs from the matured follicles.

Premature ovarian failure Treatment

Currently, there are no proven treatment options available for reversing the hypofunctioning of the ovaries. However, some of the menopausal symptoms could be treated with the help of the following methods:

Image of Premature ovarian failure

Picture 2 – Premature ovarian failure Image

Estrogen replacement therapy (ERT)

Women with POF are at a greater risk of developing disorders of the bone including osteoporosis and osteopenia. Vaginal dryness and hot flashes are generally the outcomes of estrogen deficiency. ERT is basically the administration of low doses of estrogen along with synthetic progesterones. This combination of hormones may aid in restoring the normal menstrual cycle and providing relief from the unpleasant symptoms. Estrogen can be administered in form of a pill, gel, cream, patch or vaginal ring. Potential risks, such as cardiovascular disorders and breast cancer, are most likely to occur due to this form of treatment.

Vitamin D and calcium supplements

Patients who are suspected of having osteoporosis are often advised to undergo bone marrow testing. On the basis of the obtained results the right amount of these supplements are administered to the affected patients.

Premature ovarian failure pregnancy

Nearly 5 to 10% of women suffering from POF have higher chances of conceiving. Presently, there are no fertility treatments available to restore fertility in such patients, apart from in-vitro fertilization. Fertility researchers in New York are presently working on a male hormone called Dehydroepiandrosterone (DHEA). This particular hormone may speed up the pace of pregnancy in these affected patients.

Ovarian tissue cryopreservation is normally performed on some young girls who are at a greater risk of developing POF. This surgical procedure is very safe in comparison to other operative techniques, especially in children.

Women who are having infrequent menstrual cycles and longer periods should immediately consult a good healthcare professional. Timely diagnosis is very essential before the condition turns severe. Visit a general physician or a gynecologist who can detect your condition and prescribe appropriate treatment options to you.