Premature Ovarian Failure – Symptoms and Causes
Overview
Primary ovarian insufficiency happens when the ovaries don’t function properly before age 40. The ovaries produce less estrogen and don’t release eggs regularly, which often results in fertility problems.
This condition was previously called premature ovarian failure, but that term is no longer used.
It’s important to understand that primary ovarian insufficiency differs from premature menopause. People with primary ovarian insufficiency may still have irregular periods and could potentially become pregnant. In contrast, those with premature menopause have no periods and cannot conceive.
Treatment options focus on restoring estrogen levels, which helps prevent health complications like:
- Heart disease
- Osteoporosis (weak bones)
- Other conditions linked to low estrogen
With proper medical care, many symptoms can be managed effectively. Healthcare providers typically develop personalized treatment plans based on individual needs and health goals.
Signs and Symptoms
Primary ovarian insufficiency causes symptoms similar to menopause or low estrogen levels. People may experience irregular or skipped periods, which might occur for years or start after pregnancy or stopping birth control.
Fertility problems are common, making it difficult to conceive.
Physical symptoms often include hot flashes, night sweats, and vaginal dryness. Emotional changes may appear as anger, depression, or anxiety. Some people notice problems with concentration or memory. A decrease in sexual interest is also typical.
When to Consult a Healthcare Provider
If your period has been absent for three months or longer, it’s important to see a healthcare provider. Missing periods can happen for many reasons, including pregnancy, stress, or changes in diet and exercise, but professional evaluation is necessary.
Even if irregular periods don’t bother you, medical attention is still important. The underlying cause needs proper diagnosis. Low estrogen can lead to osteoporosis (weakened bones) and increase your risk of heart disease.
These serious health concerns make timely medical consultation essential.
Causes
Primary ovarian insufficiency happens when the ovaries stop working properly before age 40. Several factors can lead to this condition:
Genetic Factors
Changes in the X chromosome often play a role in primary ovarian insufficiency. People born female typically have two X chromosomes. Some with this condition have one normal X chromosome and one altered X chromosome.
This can indicate genetic conditions like mosaic Turner syndrome. Others have X chromosomes that break easily, known as fragile X syndrome.
Harmful Substances
Cancer treatments like chemotherapy and radiation therapy commonly damage ovarian tissue. These treatments can harm the genetic material in cells. Other substances may speed up ovarian decline, including:
- Cigarette smoke
- Industrial chemicals
- Pesticides
- Viral infections
Autoimmune Reactions
In rare cases, the body’s immune system attacks ovarian tissue by mistake. This autoimmune response creates proteins that damage follicles (the small sacs containing eggs) and the eggs themselves.
Doctors aren’t sure what triggers this immune response, but exposure to viruses might contribute.
Unknown Causes
Most often, doctors can’t identify why primary ovarian insufficiency happens. This is called idiopathic primary ovarian insufficiency. Additional testing may help find the underlying cause.
The ovaries normally release eggs during ovulation, which occurs midway through the menstrual cycle. When a person has primary ovarian insufficiency, this process doesn’t work properly.
During typical ovulation, several things happen:
- The uterine lining thickens
- The brain’s pituitary gland signals an ovary to release an egg
- The egg travels through the fallopian tube
- If sperm fertilizes the egg, pregnancy may begin
- If no fertilization occurs, menstruation follows about two weeks later
In primary ovarian insufficiency, this cycle becomes irregular or stops completely. The ovaries don’t release eggs regularly, which affects hormone levels and fertility.
What Increases Your Risk
Several factors can raise your chances of getting primary ovarian insufficiency:
Age: Most cases occur in women between 35 and 40 years old, though it can happen earlier, even in teenagers.
Family History: If your relatives have had this condition, you may face a higher risk yourself.
Ovarian Surgery: Surgical procedures involving the ovaries can increase your risk of developing this condition.
These risk factors don’t guarantee you’ll develop the condition, but they may increase your chances compared to others without these factors.
Complications
Primary ovarian insufficiency may cause several health problems. These issues can impact a person’s physical and mental well-being.
Fertility Problems
Women with this condition often struggle to get pregnant. The body’s egg supply becomes limited. In rare cases, pregnancy might still be possible until all eggs are depleted.
Bone Health Concerns
Reduced estrogen levels increase the risk of osteoporosis. This condition makes bones weak and prone to fractures. Estrogen plays an important role in maintaining bone strength.
Mental Health Effects
Depression and anxiety are common in people with primary ovarian insufficiency. These mental health issues often relate to concerns about infertility, the emotional impact of hormone changes, and worry about other health complications.
Cardiovascular Risks
The early loss of estrogen may increase the risk of heart disease, blood vessel problems, and stroke.
Neurological Conditions
Some research suggests connections between ovarian insufficiency and brain health issues. These include dementia (especially in women who have both ovaries removed before age 43 without receiving hormone therapy) and Parkinson’s disease (particularly following ovarian removal surgery).
