Premature ovarian failure can happen for a number of reasons, so the causes, symptoms, and diagnosis processes may differ. Read on to learn more about the condition.
Premature ovarian failure occurs in about 1 percent of women under the age of 40. According to estimates, 1 out of 1,000 women 30 years old or younger in the United States experience this condition.
For women 35 and under, the incidence is 1 out of 250, and for women 40 and under, it’s 1 out of 100. Approximately 10 to 28 percent of women who have primary amenorrhea and 4 to 18 percent of women who have secondary amenorrhea experience primary ovarian failure.
Your ovaries contain small sacs called follicles. Inside these sacs, your eggs grow and mature each month. Premature ovarian failure occurs due to the depletion or dysfunction of these follicles.
Some causes of premature ovarian failure include:
- Chromosomal defects — Premature ovarian failure can occur due to certain chromosomal and genetic disorders. These include Fragile X syndrome, a disorder associated with a mutation in the FMR1 gene, and Mosaic Turner syndrome, when a woman has only a single normal copy of the X chromosome and the other X chromosome is either missing or structurally defective.
- Toxins — Common toxins that cause premature ovarian failure are radiation therapy and chemotherapy. These therapies can cause damage to the genetic material in the cells. Other toxins including chemicals, cigarette smoke, viruses, and pesticides may hasten premature ovarian failure.
- Autoimmune diseases — Autoimmune diseases are also one of the causes of premature ovarian failure. This is when the immune system makes antibodies against your own ovarian tissue, leading to damaged follicles and eggs.
- Viral infections — Certain viral infections can also trigger premature ovarian failure.
Some of the factors that make you more prone to developing primary ovarian insufficiency or premature ovarian failure are:
- Age — Your risk of developing the condition is increased between the ages of 35 and 40, although adolescents and younger women can also develop it.
- Family history — If you have a family history of the condition, then your risk of developing it increases.
- Multiple surgeries on the ovaries — If you have a history of ovarian endometriosis or any other condition that required you to have multiple surgeries on the ovaries, then your risk of developing premature ovarian failure increases.
Premature ovarian failure is sometimes referred to as premature menopause, but the two conditions are different. Early menopause refers to the onset of menopause before the age of 40, and with this condition, women can no longer get pregnant. With premature ovarian failure, women can still have irregular periods and may even become pregnant.
Premature ovarian failure symptoms are similar to the symptoms of menopause. These symptoms typically depict estrogen deficiency and include:
- irregular or missed periods (amenorrhea) that may be present for many years or develop post-pregnancy or after stopping oral contraceptives
- hot flashes
- difficulty getting pregnant
- night sweats
- difficulty concentrating or irritability
- vaginal dryness
- decreased desire for sex
- problems with memory
- trouble sleeping
- mood swings, depression, or anxiety
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Most women notice signs and symptoms of premature ovarian failure when they appear. Your doctor will perform a physical examination that includes a pelvic examination to diagnose the condition. They may ask questions related to your menstrual cycle, whether you had exposure to any toxins including radiation therapy or chemotherapy, and if you have a history of ovarian surgery.
Your doctor may recommend one or more of the following tests:
- Pregnancy test — A pregnancy test is done to check for an unexpected pregnancy.
- Follicle-stimulating hormone (FSH) — This is a hormone secreted by your pituitary gland that activates the growth of ovarian follicles. The levels of FSH are abnormally high in the blood of women who are experiencing premature ovarian failure.
- Estradiol test — The levels of estradiol (a kind of estrogen secreted by the ovaries) are low in women who are experiencing premature ovarian failure.
- Prolactin test — Prolactin is a hormone that stimulates the production of breast milk. High levels of prolactin may result in problems related to ovulation, including absent or irregular periods.
- Karyotype — This test investigates the 46 chromosomes for the presence of any abnormalities. It could be that only a single X chromosome is present, or other chromosomal defects may be observed.
- FMR1 gene testing — The FMR1 gene is related to Fragile X syndrome. This test investigates both of your X chromosomes for any abnormalities.
Your physician may diagnose you with primary ovarian failure if you are under 40 and you have any of these signs and symptoms:
- high levels of FSH (in the range of menopause) on two different tests performed at least a month apart
- low levels of estradiol
- irregular or no periods (less frequent than every 35 days) for three consecutive months
Your physician may also suggest a transvaginal ultrasound to examine your ovaries. Women with primary ovarian failure usually have small ovaries with fewer follicles.
The mainstay of premature ovarian failure treatment is to ease problems arising from the deficiency of estrogen. Your physician may recommend:
- Estrogen therapy — Estrogen therapy may help prevent osteoporosis and relieve hot flashes. It may also help ease other signs and symptoms of premature menopause that occur due to estrogen deficiency. Estrogen is usually given in combination with progesterone to protect the uterine lining from precancerous changes that may occur from taking estrogen alone. You should talk to your physician about the possible risks and side effects of estrogen therapy.
- Vitamin D and calcium supplements — Your physician may prescribe vitamin D and/or calcium supplements to prevent osteoporosis, which can happen due to estrogen deficiency.
- Addressing infertility — One of the common complications of premature ovarian failure is infertility, and there is no treatment to restore your ovarian function. You might want to seek counseling to understand more about this condition. You may also pursue in-vitro fertilization using donor eggs.
Premature ovarian failure support
You may find it emotionally difficult to deal with premature ovarian failure, and it is normal to grieve. But with self-care, proper treatment, and support, you can live a healthy life.
- Learn about alternative methods for having children. Talk to your physician about the various options of having children, such as adoption or in-vitro fertilization using donor eggs.
- Maintain the strength of your bones. Eat a diet rich in calcium, do regular aerobic exercises such as brisk walking, and avoid smoking. Ask your physician about vitamin D and calcium supplements.
- Seek support. Counseling may help you adjust to your situation. You can also join local or national support groups or online communities. Sharing your feelings with people who are undergoing the same issues may provide valuable understanding and insight at a time of uncertainty and confusion.
- Give yourself a lot of time. Take care of yourself by exercising regularly, eating a well-balanced and nutritious diet, and getting enough rest.
What is premature ovarian failure? Premature ovarian failure occurs when there is a loss of normal ovarian function before the age of 40. There are many causes of this condition, including chromosomal defects, exposure to toxins, and autoimmune diseases.
Its symptoms are quite similar to premature menopause symptoms and may include irregular or missed periods, hot flashes, difficulty conceiving, vaginal dryness, and night sweats. Abnormally high levels of FSH, low levels of estradiol, and absent or irregular periods in women under 40 indicate the possibility of premature ovarian failure.
It can be emotionally difficult to deal with a diagnosis of the condition. You may want to seek counseling and learn more about alternative methods for having children.