What is Primary Ovarian Insufficiency

Primary ovarian insufficiency is a condition in which the ovaries stop working in women under age 40. The ovaries have a fixed number of eggs, which are stored in fluid-filled sacs (follicles).

They also produce the female sex hormones, including estrogen. After puberty, female hormones trigger the release of an egg from a follicle (ovulation) each month. If the egg does not get fertilized by a sperm, a woman will have a menstrual period.

Throughout life, the number of follicles in the ovaries slowly declines. A condition called menopause occurs when there are no follicles left. When this occurs, ovulation stops and the level of estrogen drops.

This is a natural process and occurs in all women by about age 55. If you have primary ovarian failure, the loss of follicles and ability to produce estrogen occurs at a much younger age.

What are the causes?

In most cases, the exact cause of this condition is not known. Some known causes include:

• Not having enough follicles. You are born with a certain number of follicles. You may not have enough to last 40 or more years.
• Cancer treatments that damage follicles. These include medicines (chemotherapy), high energy waves (radiation), or surgery.
• Follicles that do not respond to the brain hormone that tells follicles to release eggs (follicle-stimulating hormone or FSH).
• Having a genetic disorder that causes abnormal ovaries (Turner syndrome and fragile X syndrome).
• Having a condition in which your immune system attacks your ovaries (autoimmune disease).

What increases the risk?

You are more likely to develop this condition if:

• You smoke.
• You have diabetes.
• You have a family history of primary ovarian insufficiency.

What are the symptoms?

Symptoms of this condition include:

• Inability to get pregnant.
• Irregular or missed periods.
• Other symptoms can be caused by low levels of estrogen. They include:
  • Night sweats.
  • Hot flashes.
  • Dry vagina, which can cause pain during sex.
  • Loss of interest in sex (low libido).
  • Irritability.
  • Trouble sleeping.
  • Confusion.
  • Thinning bones (osteoporosis), which may cause bones to break easily.

In many cases, there are no symptoms for this condition.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms. Your health care provider will ask you questions about your symptoms. He or she may suspect primary ovarian insufficiency if you have trouble getting pregnant or if you have irregular or missed periods.
• A physical exam.
• Blood tests. This is done to confirm the diagnosis. The test will check for:
  • Low levels of estrogen.
  • High levels of FSH. Follicle loss and low levels of estrogen will cause your brain to release more FSH.
  • Low levels of anti-Mullerian hormone (AMH). As follicles are lost, this hormone also decreases.

If you have low estrogen associated with low AMH and high FSH, your health care provider may do more tests to look for a possible cause of your primary ovarian insufficiency. These may include genetic testing and testing for autoimmune disease.

How is this treated?

This condition is treated with hormone replacement therapy, which replaces the female hormones estrogen and progesterone. These hormones may be given as oral medicines or as a skin patch. This treatment may:

• Relieve the symptoms of estrogen deficiency.
• Prevent osteoporosis.
• Protect from heart disease.

Treatment often goes on until around age 50 when menopause usually occurs. There is no treatment that can fully restore fertility. However, a small number of women can get pregnant after being diagnosed with this condition. If you desire to get pregnant now or in the future, talk to a fertility specialist right away about your options.

Follow these instructions at home:

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Ask your health care provider about the risks and side effects of hormone replacement therapy.
• Eat foods rich in calcium and vitamin D. These include milk, other dairy products, and orange juice or breakfast cereals that have vitamin D added (fortified). These may help to prevent osteoporosis.
• Do exercise regularly. This can make your muscles and bones stronger. Ask your health care provider which activities are safe for you.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have symptoms of low estrogen.
• Your periods stop or are not regular.
• You have side effects from your medicines.

Get help right away if:

• You break (fracture) a bone.
• You have chest pain or trouble breathing.

Summary

• Primary ovarian insufficiency results when your ovaries stop working normally before age 40.
• In most cases, the exact cause of this condition is not known.
• The first sign of this disorder may be difficulty getting pregnant.
• Symptoms of this condition include irregular or missed periods and symptoms of low estrogen.
• This condition is treated with hormone replacement therapy. This reduces symptoms of low estrogen and protects from osteoporosis.