Primary ovarian insufficiency

Overview

Primary ovarian insufficiency, also known as premature ovarian failure, is a condition where the ovaries fail to function normally before a woman reaches the age of 40. The ovaries produce inadequate amount of estrogen which affects a woman’s ovulation, menstruation, pregnancy, and other bodily functions.

Normally, a woman will reach a certain age where egg production stops. In most people, it is around the age of 51 years old that menopause occurs. With primary ovarian insufficiency, a woman’s ovaries do not stop producing eggs like menopause, but rather significantly decrease its production at an early age.

Although it is commonly mistaken as premature menopause, women suffering from primary ovarian insufficiency might experience irregular or infrequent periods for years but may still become pregnant. With premature menopause, it is not possible. Most patients with primary ovarian insufficiency will need hormone replacement to reduce symptoms of estrogen deficiency such as osteoporosis and heart disease.

Symptoms

In some people, primary ovarian insufficiency may not have any symptoms. But in most cases, it includes:

• Missed or irregular periods
• Difficulties conceiving
• Reduced sexual desire
• Irritability
• Dry eyes
• Severe hot flashes
• Vaginal dryness, which can lead to painful intercourse
• Trouble concentrating

It is recommended to visit a doctor if women experience these signs and symptoms. Specifically, if a woman younger than 40 and have not had her period in three months consecutively or longer. Missed period can be caused by changes on exercise or diet, pregnancy, or stress. Persistent low estrogen levels can cause bone loss as well as an increased risk of heart problems. The doctor will need to establish the cause of the problem to provide the best treatment.

Causes

Primary ovarian insufficiency has no one exact caused. Commonly, it may be due to:

• Chromosome changes: Hereditary diseases such as Turners syndrome and Fragile X syndrome can affect women’s normal reproductive development. These conditions occur when a person has one of the X chromosomes missing, either partially or completely, or portion of the X chromosome looks broken or fragile.
• Autoimmune diseases.  Studies show that primary ovarian insufficiency is linked to having an autoimmune disorder, such as Addison disease, rheumatoid arthritis, or thyroid disease.

Normally, the immune system creates antibodies to protect the body from bacteria and viruses. In autoimmune diseases, particularly in the case of primary ovarian insufficiency, the antibodies target the ovarian tissue causing damage to the egg-containing follicles and the egg. Viral exposure is one explanation for this immunological response, but in most cases, the cause is unknown.

• Toxins: Powerful cancer treatments and prolonged exposure to certain toxins can potentially harm genetic material and may result to ovarian failure. Common toxins are chemicals, pesticides, viruses, and cigarette smoke. Chemotherapy and radiation therapy are also known to negatively affect a woman’s ovarian function.
• Unknown factors: The healthcare provider may recommend additional tests to determine the cause of primary ovarian insufficiency. Although in most cases, the cause may still be unknown (idiopathic).

Risk factors

The following factors gives women a higher risk of having primary ovarian insufficiency:

• Age: Primary ovarian insufficiency can occur in younger women and even teenagers. However, those between the ages of 35 and 40 have higher risk.
• Family history: A woman is most likely to develop this condition if she has an immediate family or biological parent who had a primary ovarian insufficiency before.
• Genetic disorder: A person with an autoimmune disorder or genetic condition such as Turners syndrome and Fragile X syndrome has an increased risk of having primary ovarian insufficiency.
• Ovarian surgery: Pelvic or ovarian surgery increases the likelihood of developing primary ovarian insufficiency.