A loss of normal ovary function prior to turning 40 is called premature ovarian failure. Because failing ovaries do not produce normal amounts of hormones such as estrogen, or release eggs regularly, infertility can be a common result.
While premature ovarian failure is sometimes referred to as premature menopause, the two conditions are different. Women in premature ovarian failure may have irregular or occasional periods for years and can achieve pregnancy. In premature menopause, women stop having periods altogether and cannot become pregnant.
If a woman is experiencing premature ovarian failure balancing estrogen levels may help prevent some complications, such as osteoporosis, but an infertility specialist such as Dr. Opsahl at Poma Fertility, may be needed to walk through potential treatments for infertility.
Symptoms of Premature Ovarian Failure
The symptoms of premature ovarian failure can be similar to those experienced by women going through menopause. They include:
- Irregular or skipped periods (amenorrhea). This may be present for years, or can develop after a pregnancy, or stopping birth control pills
- Hot flashes
- Night sweats
- Vaginal dryness
- Irritability or difficulty concentrating
- Decreased sexual desire
Causes of Premature Ovarian Failure
Premature ovarian failure is the result of one of two disruptions to this process: follicle depletion or follicle disruption.
- Chromosomal defects. Certain genetic disorders are associated with premature ovarian failure, including Turner’s syndrome. Turner’s syndrome is a condition in which a woman has only one X chromosome instead of two.
- Toxins. Cancer treatments such as chemotherapy and radiation therapy treatments are the most common causes of toxin-induced ovarian failure. These therapies can potentially damage the genetic material in cells which is why it is important to talk to your doctor about fertility prior to beginning cancer treatments.
- An immune-system response to ovarian tissue (autoimmune disease). Your immune system may produce antibodies against your own ovarian tissue, harming the egg-containing follicles and damaging the egg. What triggers the immune response is unclear, but exposure to a virus is one possibility.
- Unknown factors. If you develop premature ovarian failure through follicular dysfunction and your tests indicate that you don’t have an autoimmune disease, further diagnostic studies may be unnecessary. An exact underlying cause often remains unknown.
- Infertility. Infertility is the inability to get pregnant and is often the most troubling complication of premature ovarian failure.
- Osteoporosis. Because the hormone estrogen helps maintain strong bones, women with low levels of estrogen are at an increased risk of developing weak and brittle bones (osteoporosis).
- Depression or anxiety. Anxiety or depression can sometimes result from the risk of infertility and other complications arising from low estrogen levels.
Several blood tests are important in making a diagnosis. These include:
- Pregnancy test. Pregnancy tests are often performed to rule out the possibility of an unexpected pregnancy in women of childbearing age who have missed a period.
- Follicle-stimulating hormone (FSH) test. FSH is a hormone released by the pituitary gland that stimulates the growth of follicles in your ovaries. Women with premature ovarian failure can show abnormally high levels of FSH in the blood.
- Luteinizing hormone (LH) test. Luteinizing hormone causes a mature follicle within the ovary to release an egg. In women with premature ovarian failure, the level of LH is usually lower than the level of FSH.
- Serum estradiol test. The blood level of estradiol, a type of estrogen, usually shows to be low in women with premature ovarian failure.
- Karyotype. This test examines all 46 of your chromosomes for abnormalities. Some women with premature ovarian failure may have only one X chromosome instead of two or may show other chromosomal defects.
Estrogen therapy. It is important to replace the estrogen the ovaries have stopped producing to help prevent osteoporosis, and relieve other symptoms of estrogen deficiency. Estrogen is typically prescribed with another hormone, progesterone. Adding progesterone protects the lining of the uterus (endometrium) from precancerous changes that can be caused by taking estrogen alone. The combination of hormones may cause monthly periods, but it won’t restore ovarian function. Estrogen can be taken as a pill, a gel or patch applied to the skin, or a vaginal ring, which is replaced every three months. Hormonal therapy will likely be continued until about the age of 50 or 51 — the average age of natural menopause.
Calcium and vitamin D supplements. Taken together, calcium and vitamin D are important for preventing osteoporosis. Many doctors advise patients to have bone density testing done before starting supplements so that there is some idea of the baseline bone density measurement.
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