If you’ve recently been diagnosed with premature ovarian failure or premature ovarian insufficiency, we’re here to help you better understand the causes, symptoms, and treatment options.
What is ovarian failure?
The ovaries, two organs on either side of the uterus, store the eggs (ova) and produce hormones like estrogen and progesterone.
During ovulation, one ovary releases a mature egg into the fallopian tube, where it has the potential to be fertilized. If fertilization occurs, an embryo is formed, which travels back down the fallopian tube to the uterus for implantation. If fertilization doesn’t occur, the lining of the uterus sheds, resulting in menstruation.
Ovarian failure, or premature ovarian insufficiency (POI), occurs when the ovaries stop working “normally” before the age of 40.
Understanding Primary Ovarian Insufficiency (POI)
There are two types of ovarian failure: primary and secondary.
Primary ovarian failure occurs when issues within the ovaries themselves disrupt their normal function. Examples include:
- Genetic conditions or chromosomal abnormalities like Turner syndrome or Fragile X syndrome
- Autoimmune diseases, infections, and metabolic disorders
- Surgeries involving the ovaries or surrounding pelvic structures
- Radiation or chemotherapy
Secondary ovarian failure happens when a problem with the hypothalamus or pituitary glands in the brain (both of which are responsible for regulating hormone production) disrupts the ovaries’ ability to function.
Recognizing the Signs of Premature Ovarian Decline
Ovarian function declines naturally with age, leading to a transitional period known as perimenopause before eventually reaching menopause (which occurs at the average age of 51).
Premature and Early Menopause
Premature menopause happens before age 40, while early menopause happens between 40 and 45. Both conditions are similar to natural menopause, except they occur earlier in life. Night sweats, hot flashes, and vaginal dryness are common symptoms.
Menopause, regardless of when it occurs, is diagnosed after going 12 consecutive months without a menstrual period.
Early Menopause vs. Premature Ovarian Failure
With menopause, ovulation and menstruation stop completely. Women with POI, however, still have a chance of ovulating, menstruating, or becoming pregnant.
Symptoms and Diagnosis
The symptoms of POI are similar to natural menopause but occur earlier in life.
Menstrual Irregularities
Women with POI may have menstrual irregularities, including changes in the timing and flow of their cycle or periods stopping altogether (amenorrhea).
Menstrual irregularities are often the first sign of POI but can also indicate underlying conditions, such as endometriosis or thyroid problems. If you notice any changes in your menstrual cycle, it’s always best to talk to a healthcare professional to rule out other potential causes.
Estrogen Deficiency
Estrogen deficiency is another sign of POI. Low estrogen levels can cause uncomfortable symptoms like hot flashes, mood swings, a decrease in sex drive, night sweats, and vaginal dryness.
Reduced estrogen also increases the risk of osteoporosis and cardiovascular disease later in life.
Infertility
It’s not uncommon for women with POI to experience issues with fertility and conceiving a child, but this doesn’t mean it’s impossible. Many struggling with infertility can still become pregnant with the help of assisted reproductive technologies (ART), like in vitro fertilization (IVF).
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Diagnosing Premature Ovarian Insufficiency
Diagnosing POI involves a comprehensive approach, including a thorough physical exam and medical history. Blood tests, genetic testing, and imaging may also be necessary.
Blood Tests for FSH Levels and Estrogen
Blood tests to measure follicle-stimulating hormone (FSH) and estrogen levels are the most common tests for diagnosing POI.
If FSH levels are abnormally high (> 20-30 mIU/mL) and estradiol (a form of estrogen) levels are lower than normal (< 20 pg/mL), POI could be the culprit.
Genetic Testing and Imaging
Healthcare professionals might recommend genetic testing, like karyotyping, to check for unusual chromosome changes. They might also want to look at a specific gene called FMR1, which is linked to fragile X syndrome, a common risk factor of POI.
Imaging tests, like transvaginal ultrasound, may also be used to view the size and structure of the ovaries, in addition to the antral follicle count (a measurement of ovarian reserve).
Causes and Risk Factors
The cause of POI is often unknown, but about one-third of cases may be linked to genes or family history.
Other potential causes of POI include autoimmune disorders, cancer treatments, infections, metabolic conditions, and lifestyle factors like smoking.
Autoimmune Disorders and Thyroid Disease
Approximately 4-30% of POI cases are caused by autoimmune disorders, where the body’s immune system mistakenly attacks its own tissues.
Addison’s disease, rheumatoid arthritis, and thyroid disorders, such as hypothyroidism, Hashimoto thyroiditis, and Grave’s disease, can be associated with POI.
Other autoimmune conditions like Chron’s disease, multiple sclerosis, myasthenia gravis (a neuromuscular disorder that causes weakness in the eyes, face, and throat), and systemic lupus erythematosus have also been linked to POI.
Turner Syndrome and Fragile X
Turner syndrome, a condition in which a woman is missing an X chromosome, is one of the most common genetic conditions leading to POI. It’s estimated that approximately one in 2,000 to one in 2,500 female infants are born with Turner syndrome.
A mutation in the FMR1 gene, which causes Fragile X syndrome, is another known cause of POI. Studies suggest that up to 20% of those with POI carry the FMR1 premutation.
Lifestyle and Environmental Factors
Certain environmental exposures and lifestyle choices may increase the risk of developing POI, including:
- Smoking
- Exposure to toxins (e.g., pesticides, heavy metals, and industrial chemicals)
- Chemotherapy and radiation therapy
- Oophorectomy (surgical removal of the ovaries)
Other potential risk factors include being between 35 and 40 and having a family history of POI.
Managing Ovarian Failure
POI is typically managed by treating the symptoms and focusing on long-term health and well-being, mainly with hormonal treatment.
Can ovarian failure be cured?
No, POI cannot be cured, but there are treatment options that can help manage symptoms and reduce health risks.
Possible treatment options for POI include:
- Hormone replacement therapy (HRT): HRT (a combination of estrogen and progestin) is the most common treatment for POI. It comes in several forms, including creams, skin patches, gels, pills, and intrauterine devices. HRT can help relieve hot flashes and night sweats and in addition to reducing the risk of cardiovascular disease and osteoporosis.
- Calcium and vitamin D supplements: Women with POI are at a higher risk of decreased bone density and osteoporosis. Experts recommend getting 1,000 milligrams (mg) of calcium and 800 to 1,000 international units (IU) of vitamin D daily.
Living with Ovarian Failure
Even though there are ways to treat the symptoms of POI, living with the condition can be emotionally challenging. This is especially true for those who are hoping to have children.
In addition to making dietary adjustments and monitoring heart and bone health, women with POI may want to:
- Join a support group like the Daisy Network.
- See a therapist or counselor to address feelings of grief or loss.
- Explore alternative reproductive options like donor eggs, surrogacy, or adoption.
Fertility and Pregnancy
Some studies suggest that between 5-10% of women with POI can become pregnant without fertility treatments.
For those who need additional help, ART methods like IVF may improve their chances of conceiving. However, success rates vary and depend on age and ovarian reserve (number and quality of remaining eggs in the ovaries).
In Vitro Fertilization (IVF) and Donor Eggs
IVF using a woman’s own eggs can be a successful treatment for POI, but only if she has enough eggs left that can respond to fertility drugs. It might also take multiple cycles to work.
A more successful approach is to use donor eggs; about half of embryo transfers result in a live birth.
Success Rates and Considerations
Several factors can affect a woman’s chances of success with fertility treatments, including her age, how many eggs she has left, the underlying cause of her POI, and any other health problems.
Here are a few more things to keep in mind:
- Emotional and financial considerations: Getting a POI diagnosis can be difficult emotionally. It’s normal to feel sad, lost, or even anxious or depressed. These feelings can be made worse by the hormonal changes associated with POI. Adding fertility treatments on top of all this might exacerbate these feelings even further.
- Potential rinks: Fertility treatments come with potential risks, like ovarian hyperstimulation syndrome (OHSS), multiple pregnancies, and ectopic pregnancy.
- Alternative options: Adoption, surrogacy, egg donor, or choosing to remain child-free are also options.
The Prevalence of POI
POI affects about 1-2% of women under 40 and even fewer (around 0.1%) under 30.
Natural menopause typically occurs around age 51 for most women, and only 5% experience early menopause.
Takeaway
Premature ovarian insufficiency is a complex condition without a single cause or cure. The symptoms (hot flashes, night sweats, mood swings, etc.) are similar to menopause and can be difficult to manage both emotionally and physically.
Connecting with others via a support group or by speaking to a therapist in addition to taking steps to protect your long-term health can make living with POI easier.
A Word from RMA
At RMA, we’re committed to supporting you no matter where you are in your reproductive health journey. We know how hard it is to learn about a POI diagnosis, especially if starting a family is something you’ve always hoped for.
If you’re ready to take the next step, give us a call. We’re here to here to listen without judgment and offer support.
