Premature Ovarian Failure: Its Symptoms, Causes & Treatment

Premature Ovarian Failure is a condition that can affect a woman’s physical and mental health, so early diagnosis and management are crucial.

As we know that the ovarian reserve diminishes with age, and at an advanced age of 40 years, a woman will naturally experience reduced fertility. She might have irregular menses, which may be a sign of menopause, and eventually, the transition to menopause will occur. But for women with premature ovarian failure, irregular menses, reduced fertility starts even before they turn 40. It can also begin in her teenage years.

 

What is a premature ovarian failure (POF)?

Premature ovarian failure (POF), also known as primary ovarian insufficiency, can be described as a condition when the ovaries lose their normal function of releasing a mature egg every month. Due to this, a woman diagnosed with POF may have menopause earlier than the average age. Oestrogen hormone is a necessary part of a woman’s monthly cycle as it controls the menstrual cycle and helps to keep the woman fertile, but with age, the ovaries stop producing oestrogen, so they cannot release an egg, thus making it non-functional and this can lead to infertility.

Symptoms of premature ovarian failure

There may be no noticeable symptoms that might suggest that a woman has premature ovarian failure. She might have her periods and might get pregnant too. But if she is finding it difficult to get pregnant, and visits a doctor, then during the initial fertility workup, the diagnosis of POF can be made. The first symptom that is usually noticed is of irregular periods or missed periods. Other signs and symptoms are very similar to those of menopause:

  • Irregular or missed periods
  • Difficulty in conceiving
  • Anxiety and Depression
  • Hot flashes
  • Night Sweats
  • Low sex drive
  • Vaginal dryness
  • Painful intercourse
  • Infertility

Causes of premature ovarian failure

Premature ovarian failure is a condition in which the eggs in the ovaries are depleting fast, or the ovaries might have turned dysfunctional. It is usually a genetic condition, but there might be other reasons too for this condition to occur, they are:

  • Family history – It runs in the genes, a woman who has a history of POF in her family might acquire this condition.
  • Chromosomal defect – Some mutation in a gene or some chromosomal disorders like Turner syndrome and Fragile X syndrome can put women at high risk of having POF.
  • Infections – Some viral infections like herpes and cytomegalovirus can cause POF and even Tuberculosis of the genital tract.
  • Autoimmune disorders – in this case, the body’s immune system produces antibodies against the ovarian tissue, which in a way harms the follicles containing eggs.
  • Iatrogenic conditions – Any kind of ovarian surgery, pelvic surgery, chemotherapy and radiotherapy can cause POF.
  • Hormonal imbalance – Low levels of Oestrogen and high levels of FSH, which means the ovaries are no longer responding to the circulating FSH by producing oestrogen and releasing mature eggs. The ovaries also appear to shrink in size.
  • Environmental factors – Cigarette smoking and exposure to pesticides, industrial toxins have been seen to speed up ovarian depletion.
  • Idiopathic – In many women, unexplained POF is one of the most frequent diagnosis, that means the cause of the condition is unknown.

Note: The risk associated with premature ovarian failure - A woman suffering from POF can be at an increased risk to develop heart diseases, dementia, hypothyroidism, dry eye syndrome autoimmune disorders and osteoporosis.

 

Diagnosis of premature ovarian failure

If a woman is having missed or irregular menses, then a visit to a doctor is recommended. A doctor might suggest a blood test to rule out pregnancy, thyroid or other health conditions and give a diagnosis on the following basis:

  • A woman under the age of 40 years should have at least 4-6 months of missed period (amenorrhoea).
  • When checked for hormones, the woman should have elevated levels of gonadotrophins and low oestradiol (at least 2 tests should be performed a month apart).
  • Blood test for AMH (Anti Mullerian hormone) can ascertain the diagnosis.
  • An ultrasound scan can confirm the diagnosis if smaller ovaries with few follicles are found during the scan.

Is pregnancy possible with premature ovarian failure?

5 – 10% of women with POF can become pregnant due to the sudden resumption of ovarian function. But many women who have been diagnosed with POF have infertility issues due to hormonal deficiency. If tests and scans show very few or complete follicular depletion, then pregnancy is not possible and neither the fertility can be restored. In this case, the only option for these women to attain pregnancy would be IVF with Donor eggs.

And in cases where POF runs in the family, and early diagnosis by genetic investigations can be made, then it is advisable for early conception or fertility preservation, i.e. egg harvesting and then freezing for future use.

Treatment for premature ovarian failure

A diagnosis of POF can be depressing, and the patient should be appropriately counselled, as she and her family may not be prepared to receive the news of compromised fertility and the need for long-term hormonal therapy as a treatment. The premature ovarian failure treatment options are discussed below:

  • Hormonal treatment –In young women with POF, hormonal therapy is used as the most common treatment, to restore the loss of ovarian hormones. This therapy provides oestrogen and progesterone, which prevents osteoporosis and can relieve a woman from hot flashes and other symptoms of oestrogen deficiency. These combinations of hormones can bring in periods but wouldn’t help to restore back the ovarian function.
  • Calcium & Vitamin supplements – A drop in the oestrogen hormone can lead to osteoporosis, so intake of calcium and vitamin D supplements will prevent bone loss.
  • Physical exercise – To curb out the risk associated with POF like cholesterol, heart diseases, one must maintain a healthy weight, and do regular exercise to keep the bones healthy.
  • Infertility – In this case, ovarian function cannot be restored, so IVF with Donor eggs is recommended to attain pregnancy. Where a donor with matching profile of the woman is selected, egg retrieved from her, and then the egg is fertilised with sperm of the male partner in a lab. The fertilised egg now called an embryo is transferred in the uterus of the woman.

 

Frequently Asked Questions

How can premature ovarian failure be controlled?

Premature ovarian failure can indicate a low level of oestrogen and high levels of FSH, which means that the ovaries are not responding to the high levels of gonadotrophins. So, in this case, if the woman is young, oestrogen hormone is given exogenously in the form of oral contraceptive pills and which has shown to make the ovaries responsive.

Is premature ovarian failure genetic?

Yes, one of the causes of POF is a genetic factor where some gene mutations can lead to X chromosome defects (Turner syndrome, Fragile X syndrome), thus causing POF.

Why does early menopause occur?

One of the early causes of menopause may be due to premature ovarian failure. Other reasons can include damage to the ovaries by chemotherapy/radiotherapy/surgeries/or removal of ovaries.