What is premature ovarian failure?

The term premature ovarian failure describes a stop in the normal functioning of the ovaries in a woman younger than age 40. Some people also use the term primary ovarian insufficiency to describe this condition. It is also known as hypergonadotropic hypogonadism.

Health care providers used to call this condition premature menopause, but premature ovarian failure is actually much different than menopause.

• In menopause, a woman will likely never have another menstrual period again; women with premature ovarian failure are much more likely to get periods, even if they come irregularly.
• A woman in menopause has virtually no chance of getting pregnant; a woman with premature ovarian failure has a greatly reduced chance of getting pregnant, but pregnancy is still possible.

What are the symptoms of premature ovarian failure?

The most common first symptom of premature ovarian failure is skipping or having irregular periods.

Some women with premature ovarian failure also have other symptoms, similar to those of women going through natural menopause. These may include:

• Hot flashes and night sweats
• Irritability, poor concentration
• Decreased interest in sex or pain during sex
• Drying of the vagina
• Infertility

Premature ovarian failure also puts women at risk for some other health conditions, some of them serious, including:

• Osteoporosis – loss of bone strength and bone density. Getting enough calcium, vitamin D, and weight-bearing physical activity can help reduce this risk.
• Low thyroid function – affects metabolism and can cause very low energy. Replacing the thyroid hormone can treat the problem.
• Addison’s disease – an autoimmune disorder in which the body has trouble handling physical stress, such an injury or illness, because of problems with the adrenal glands. About 3.2 percent of women with premature ovarian failure also have Addison’s disease. Addison’s can be dangerous for women who don’t know they have it. This condition can’t be prevented, but can be managed with help from your health care provider.
• Heart disease – estrogen replacement therapy, along with keeping a healthy body weight and getting regular, moderate, physical activity, can help reduce this risk.

Also, it is important to know that people who are carriers for the gene for Fragile X syndrome, or who have the premutation for the condition, are more likely than other people to get premature ovarian failure. If you are a Fragile X carrier or have a premutation, it is important to get tested for premature ovarian failure.

Are there treatments for the symptoms of premature ovarian failure?

There is no proven treatment to make a woman’s ovaries work normally again. However, there are treatments that can help some of the symptoms of premature ovarian failure.

• Estrogen replacement therapy (ERT), also called hormone replacement therapy (HRT) gives women the estrogen and other hormones their bodies are not making. HRT can help women have regular periods and lower their risk for osteoporosis.
• Current research is looking into giving women the hormone testosterone to help prevent bone loss in women with premature ovarian failure.

How is premature ovarian failure diagnosed?

Because one of the most common signs of premature ovarian failure is irregular periods, women should pay close attention to their menstrual cycles and tell their health care provider about any changes.

If your health care provider thinks you may have premature ovarian failure, he or she may do a blood test to measure the level of a hormone called follicle stimulating hormone that is normally present in the body. This test will help determine whether the ovaries are working properly or not.

What causes premature ovarian failure?

Researchers know that in women in premature ovarian failure something happens to stop the normal functioning of the ovaries; but in most cases, the exact cause is not clear.

Most research focuses on a problem with the follicles in the ovaries. Follicles in the ovaries start out as microscopic seeds. These seeds mature into eggs, which travel to the uterus for fertilization. Follicles also release the hormone estrogen, which is important for a woman’s overall health and bone health.

Most women have enough follicles to last until menopause. However, this may not be the case in women with premature ovarian failure.

Women with premature ovarian failure may fall into one of two groups:

• A woman with follicle depletion has no follicles left in her ovaries and there is no way to make more.
• A woman with follicle dysfunction may have follicles in her ovaries, but they are not working properly.

About 10 percent to 20 percent of women with premature ovarian failure have a family history of the condition. This finding suggests that some cases of premature ovarian failure can be genetic. However, genetics is not the only cause of premature ovarian failure.

How does premature ovarian failure affect fertility?

Women with premature ovarian failure are unlikely to get pregnant because their ovaries do not work correctly. At this time there is no proven treatment to improve a woman’s ability to have a baby naturally if she has premature ovarian failure.

However, between 5 percent and 10 percent of women with premature ovarian failure become pregnant without fertility treatment. There is also a type of fertility treatment, known as egg donation, which may be an option for women with premature ovarian failure.