Although there are no specific causes of primary ovarian insufficiency (POI), the majority of instances are idiopathic. However, POI could result from genetic and autoimmune factors and certain medical interventions such as chemotherapy, radiation therapy (for cancer), or surgical removal of the ovaries.
In addition, some of the known potential causes of and risk factors for POI include:
- Genetic
- Genetic mutations in the female sex chromosome or other genes that control sex hormones
- Turner syndrome
- Fragile X syndrome
- Galactosemia
- Autoimmune diseases
- Ovaries are damaged by the body's immune system
- Hypothyroidism
- Rheumatoid arthritis
- Type I diabetes
- Addison’s disease
- Family history of POI
- Women with a family history of POI are more vulnerable to developing the condition.
- Approximately 10 to 20 percent of women with POI have an affected biological parent or family member (mother, sister, or grandmother).
- Infection
- Although rarely, POI may appear after diseases such as mumps, tuberculosis, HIV, and malaria.
- Surgery
- Surgical removal of the ovaries or uterus (hysterectomy) before the age of 40 years for conditions such as ovarian cancer, ovarian cysts, endometriosis, or severe premenstrual syndrome may lead to POI.
- Cancer treatment
- Treatments such as chemotherapy and radiotherapy can harm the ovaries permanently, leading to POI.
- Certain toxins
What is primary ovarian insufficiency?
Primary ovarian insufficiency (POI) is an irreversible condition, in which the ovaries cease to function normally before the age of 40 years.
POI is also known as:
- Premature ovarian insufficiency
- Premature ovarian failure
- Premature ovarian insufficiency syndrome
The average age of menopause ranges from 45 to 52 years. However, women with POI may experience menopause before the age of 40 years.
POI leads to loss of eggs in the ovaries or abnormal ovarian function. Although rare, there are still chances of ovulation and spontaneous pregnancy (about 5 to 10 percent) without any medical intervention.
What are the signs and symptoms of primary ovarian insufficiency?
The most common symptom for the majority of women with primary ovarian insufficiency (POI) is a gradual cessation of menstruation.
Although some women do not experience any POI symptoms, others may notice a change in their menstrual cycle or duration.
Some of the common symptoms of POI include:
- Irregular or missed periods
- Hot flushes (especially on the chest, neck, and face)
- Sweating
- Dizziness
- Light-headedness
- Palpitations
- Night sweats
- Mood swings
- Tiredness/feeling exhausted
- Poor sleep
- Difficulty conceiving
- Decreased or complete lack of libido
- Poor concentration
- Joint pain (due to decreased joint lubrication resulting from reduced estrogen levels)
- Hair and skin changes
- Depression
- Anxiety
- Panic attacks
- Irritability
- Poor memory
- Vaginal dryness
- Painful intercourse
- Urinary problems (frequent urination or recurrent urinary infection)
Symptoms often come and go on their own, making the woman feel completely normal for some months and have unpleasant symptoms for other months, negatively affecting her quality of life.
QUESTION
What is pelvic inflammatory disease (PID)? See AnswerHow to diagnose primary ovarian insufficiency
Apart from a thorough history and physical examination, the doctor may recommend certain tests to confirm the diagnosis or rule out any other potential causes.
- Hormonal assessments
- Follicle-stimulating hormone
- Prolactin
- Thyroid-stimulating hormone
- Anti-Mullerian hormone
- General health tests
- Diabetes
- Cholesterol
- Adrenal antibodies
- Thyroid antibodies
- Imaging tests
- Bone densitometry
- Pelvic ultrasound
- Genetic tests
- Karyotype testing
How to treat primary ovarian insufficiency
Primary ovarian insufficiency can be managed by the following:
- Hormone replacement therapy, which is a mix of natural estrogen and synthetic progestin, intrauterine progestin, or natural progesterone
- Androgen replacement to treat sexual dysfunction
- Psychological support
- Nonhormonal treatment
- Selective serotonin reuptake inhibitors
- Serotonin-norepinephrine reuptake inhibitors
- Antiepileptics and centrally-acting medications
- Supplements (vitamin D and calcium)
- Adequate physical activity
Medically Reviewed on 12/30/2022
References
Image Source: iStock image
What is Premature Ovarian Insufficiency (Also Called Premature Ovarian Failure)? American Society for Reproductive Medicine: https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-premature-ovarian-insufficiency-also-called-premature-ovarian-failure/
Primary Ovarian Insufficiency in Adolescents and Young Women The American College of Obstetricians and Gynecologists: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/07/primary-ovarian-insufficiency-in-adolescents-and-young-women
Primary Ovarian Insufficiency Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/17963-primary-ovarian-insufficiency
What is Premature Ovarian Insufficiency (Also Called Premature Ovarian Failure)? American Society for Reproductive Medicine: https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-premature-ovarian-insufficiency-also-called-premature-ovarian-failure/
Primary Ovarian Insufficiency in Adolescents and Young Women The American College of Obstetricians and Gynecologists: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/07/primary-ovarian-insufficiency-in-adolescents-and-young-women
Primary Ovarian Insufficiency Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/17963-primary-ovarian-insufficiency
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