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Primary ovarian insufficiency — also called premature ovarian failure — occurs when the ovaries stop functioning normally before age 40. When this happens, your ovaries don't produce normal amounts 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 aren't the same. Women with primary ovarian insufficiency can have irregular or occasional periods for years and might even get pregnant. But women with premature menopause stop having periods and can't become pregnant.
Restoring estrogen levels in women with primary ovarian insufficiency helps prevent some complications that occur as a result of low estrogen, such as osteoporosis.
Symptoms
Signs and symptoms of primary ovarian insufficiency are similar to those of menopause or estrogen deficiency. They include:
- • Irregular or skipped periods, which might be present for years or develop after a pregnancy or after stopping birth control pills
- • Difficulty getting pregnant
- • Hot flashes
- • Night sweats
- • Vaginal dryness
- • Dry eyes
- • Irritability or difficulty concentrating
- • Decreased sexual desire
When to see a doctor
If you've missed your period for three months or more, see your doctor to determine the cause. You can 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 not having periods, it's advisable to see your doctor to find out what's causing the change. Low estrogen levels can lead to bone loss and an increased risk of heart disease.
Causes
Primary ovarian insufficiency may be caused by:
- Chromosomal defects. Some genetic disorders are associated with primary ovarian insufficiency. These include mosaic Turner syndrome — in which a woman has only one normal X chromosome and an altered second X chromosome — and fragile X syndrome — in which the X chromosomes are fragile and break.
- Toxins. Chemotherapy and radiation therapy are common causes of toxin-induced ovarian failure. These therapies can damage genetic material in cells. Other toxins such as cigarette smoke, chemicals, pesticides and viruses might hasten ovarian failure.
- An immune system response to ovarian tissue (autoimmune disease). In this rare form, your immune system produces antibodies against your 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. The cause of primary ovarian insufficiency is often unknown (idiopathic). Your doctor might recommend further testing to find the cause, but in many cases, the cause remains unclear.
Risk factors
Factors that increase your risk of developing primary ovarian insufficiency include:
- Age. The risk goes up between ages 35 and 40. Although rare before age 30, primary ovarian insufficiency is possible in younger women and even in teens.
- Family history. Having a family history of primary ovarian insufficiency increases your risk of developing this disorder.
- Ovarian surgery. Surgeries involving the ovaries increase the risk of primary ovarian insufficiency.
Complications
Complications of primary ovarian insufficiency include:
- Infertility. Inability to get pregnant can be a complication of primary ovarian insufficiency. In rare cases, pregnancy is possible until the eggs are depleted.
- Osteoporosis. The hormone estrogen helps maintain strong bones. Women with low levels of estrogen have an increased 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 complications arising from low estrogen levels causes some women to become depressed or anxious.
- Heart disease. Early loss of estrogen might increase your risk.
Diagnosis
Most women have few signs of primary ovarian insufficiency, but your doctor may suspect the condition if you have irregular periods or are having trouble conceiving. Diagnosis usually involves a physical exam, including a pelvic exam. Your doctor might ask questions about your menstrual cycle, exposure to toxins, such as chemotherapy or radiation therapy, and previous ovarian surgery.
Your doctor might recommend one or more tests to check for:
- Pregnancy. A pregnancy test checks for an unexpected pregnancy if you're of childbearing age and missed a period.
- Hormone levels. Your doctor may check the levels of a number of hormones in your blood, including follicle-stimulating hormone (FSH), a type of estrogen called estradiol, and the hormone that stimulates breast milk production (prolactin).
- Certain genes or genetic defects. You may have a karyotype test to look for abnormalities in your chromosomes. Your doctor may also check to see if you have a gene associated with fragile X syndrome called FMR1.
Treatment
Treatment for primary ovarian insufficiency usually focuses on the problems that arise from estrogen deficiency. Your doctor might recommend:
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Estrogen therapy. Estrogen therapy can help prevent osteoporosis as well as relieve hot flashes and other symptoms of estrogen deficiency. Your doctor typically prescribes estrogen with the hormone progesterone, especially if you still have your uterus. Adding progesterone protects the lining of your uterus (endometrium) from precancerous changes that may be caused by taking estrogen alone.
The combination of hormones may make your period come back, but it won't restore ovarian function. Depending on your health and preference, you might take hormone therapy until around age 50 or 51 — the average age of natural menopause.
In older women, long-term estrogen plus progestin therapy has been linked to an increased risk of heart and blood vessel (cardiovascular) disease and breast cancer. In young women with primary ovarian insufficiency, however, the benefits of hormone therapy outweigh the potential risks.
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Calcium and vitamin D supplements. Both nutrients are important for preventing osteoporosis, and you might not get enough in your diet or from exposure to sunlight. Your doctor might suggest bone density testing before starting supplements to get a baseline measurement.
For women ages 19 through 50, experts generally recommend 1,000 milligrams (mg) of calcium a day through food or supplements, increasing to 1,200 mg a day for women age 51 and older.
The optimal daily dose of vitamin D isn't yet clear. A good starting point for adults is 600 to 800 international units (IU) a day, through food or supplements. If your blood levels of vitamin D are low, your doctor might suggest higher doses.
Addressing infertility
There's no treatment proved to restore fertility. Some women and their partners pursue pregnancy through in vitro fertilization using donor eggs. The procedure involves removing eggs from a donor and fertilizing them with your partner's sperm in a lab. The fertilized egg (embryo) is then placed in your uterus.