What Causes Premature Ovarian Failure?

Premature ovarian failure, also known as primary ovarian insufficiency, is a condition where the ovaries fail to produce estrogen hormone and prematurely stop ovulation for four to six months before a woman reaches the age of 40 years. The estrogen hormone plays a vital role in women’s health and well-being.

Premature ovarian failure can result in infertility, psychological issues, and many other major health complications such as the increased risk of cardiovascular issues and gynecological malignancies which increases mortality. 

Although premature ovarian failure is commonly confused with premature menopause, the two disorders are not the same.

• An average woman attains menopause at 52 years (it is when she will stop having periods entirely), whereas premature menopause means attaining early menopause. 
• Women going through menopause will no longer have follicles to create eggs.

Premature ovarian failure occurs in women at a younger age. They usually have depleted or malfunctioning follicles, but they may still have irregular or infrequent periods. This implies that ovarian function may change over time and result in periods, ovulation, or even pregnancy years after diagnosis of premature ovarian failure.

Nearly 5 to 10 percent of women can get pregnant even after being diagnosed with premature ovarian failure.

Menstrual irregularities or missing periods are the most common symptoms of premature ovarian failure. Periods may occur irregularly or continue several years after premature ovarian failure is identified. 

Because of the decrease in estrogen levels, women with premature ovarian failure may have menopause-like symptoms, such as:

• Hot flashes 
• Night sweats
• Heart diseases
• Dryness of the vagina
• Infertility
• Osteoporosis (reduction in bone density)
• Depression
• Anxiety
• Irritability
• Sleeping issues
• Difficulty paying attention 
• Memory loss

Diagnosis starts with a detailed medical history and a physical exam, including a pelvic exam. Premature ovarian failure can be diagnosed through the following:

• Blood tests
  • Blood work is done to check for various hormones.
    • Follicle-stimulating hormone is excessively high in premature ovarian failure, whereas estrogen is very low or nil. 
    • Anti-Mullerian hormone levels are sometimes undetectable. 
• Ultrasound scan
  • A transvaginal ultrasound identifies ovaries that are small with only a few follicles.
  • One to two percent of women with premature ovarian failure can still produce healthy eggs between missed menstrual cycles and still conceive and give birth spontaneously.

There is no permanent cure, and no treatment can reverse the functions of a depleted or malfunctioning ovary.

The diagnosis of premature ovarian failure can be depressing to women due to reduced fertility and the necessity for long-term hormone treatment. Support through proper counseling of affected women and their families will help bring good results following treatment.

Treatment options for premature ovarian failure include:

• Hormonal therapy
  • This is the most frequently used treatment for young women with premature ovarian failure to replace the loss of ovarian hormones.
  • This treatment includes the administration of estrogen and progesterone, which protect against osteoporosis and help alleviate hot flashes and other symptoms caused by the depletion of estrogen. 
  • These hormone combinations can induce menstruation but will not assist in restoring ovarian function.
• Calcium and vitamin D supplements
  • With the decrease in levels of estrogen hormone, osteoporosis occurs, and the bones become weak and brittle.
  • Taking calcium and vitamin D supplements can help prevent bone loss.
• Physical activity
  • To reduce the risk of premature ovarian failure and associated diseases such as increased cholesterol and heart disease, you must maintain a healthy weight and engage in regular exercise.
  • This not only helps maintain a healthy weight and reduce cholesterol levels, but it also makes the bones strong.
• Infertility treatment
  • Because the depleted ovarian function cannot be restored, a woman with premature ovarian failure can conceive through in vitro fertilization techniques using donor eggs.
  • Eggs are retrieved from a donor who has a similar profile to that of the woman with premature ovarian failure. The egg is then fertilized in a lab with the male partner's sperm.
  • The fertilized egg, now known as an embryo, is implanted into the uterus.
  • The chance of becoming pregnant increases to 50 percent with a donor’s egg.