Overview

Primary ovarian insufficiency — also called premature ovarian failure — occurs when the ovaries stop functioning normally before age 40. When this happens, your ovaries don't produce normal amounts of the hormone estrogen or release eggs regularly. This condition often leads to infertility.

Primary ovarian insufficiency is sometimes confused with premature menopause, but these conditions aren't the same. Women with primary ovarian insufficiency can have irregular or occasional periods for years and might even get pregnant. But women with premature menopause stop having periods and can't become pregnant.

Restoring estrogen levels in women with primary ovarian insufficiency helps prevent some complications that occur as a result of low estrogen, such as osteoporosis.

Symptoms

Signs and symptoms of primary ovarian insufficiency are similar to those of menopause or estrogen deficiency. They include:

  • Irregular or skipped periods, which might be present for years or develop after a pregnancy or after stopping birth control pills
  • Difficulty getting pregnant
  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Dry eyes
  • Irritability or difficulty concentrating
  • Decreased sexual desire

When to see a doctor

If you've missed your period for three months or more, see your doctor to determine the cause. You can miss your period for a number of reasons — including pregnancy, stress, or a change in diet or exercise habits — but it's best to get evaluated whenever your menstrual cycle changes.

Even if you don't mind not having periods, it's advisable to see your doctor to find out what's causing the change. Low estrogen levels can lead to bone loss and an increased risk of heart disease.

Causes

Primary ovarian insufficiency may be caused by:

  • Chromosomal defects. Some genetic disorders are associated with primary ovarian insufficiency. These include mosaic Turner syndrome — in which a woman has only one normal X chromosome and an altered second X chromosome — and fragile X syndrome — in which the X chromosomes are fragile and break.
  • Toxins. Chemotherapy and radiation therapy are common causes of toxin-induced ovarian failure. These therapies can damage genetic material in cells. Other toxins such as cigarette smoke, chemicals, pesticides and viruses might hasten ovarian failure.
  • An immune system response to ovarian tissue (autoimmune disease). In this rare form, your immune system produces antibodies against your 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. The cause of primary ovarian insufficiency is often unknown (idiopathic). Your doctor might recommend further testing to find the cause, but in many cases, the cause remains unclear.

Video: Ovulation

Ovulation is the release of an egg from one of the ovaries. It often happens about midway through the menstrual cycle, although the exact timing may vary.

In preparation for ovulation, the lining of the uterus, or endometrium, thickens. The pituitary gland in the brain stimulates one of the ovaries to release an egg. The wall of the ovarian follicle ruptures at the surface of the ovary. The egg is released.

Finger-like structures called fimbriae sweep the egg into the neighboring fallopian tube. The egg travels through the fallopian tube, propelled in part by contractions in the fallopian tube walls. Here in the fallopian tube, the egg may be fertilized by a sperm.

If the egg is fertilized, the egg and sperm unite to form a one-celled entity called a zygote. As the zygote travels down the fallopian tube toward the uterus, it begins dividing rapidly to form a cluster of cells called a blastocyst, which resembles a tiny raspberry. When the blastocyst reaches the uterus, it implants in the lining of the uterus and pregnancy begins.

If the egg isn't fertilized, it's simply reabsorbed by the body — perhaps before it even reaches the uterus. About two weeks later, the lining of the uterus sheds through the vagina. This is known as menstruation.

Risk factors

Factors that increase your risk of developing primary ovarian insufficiency include:

  • Age. The risk goes up between ages 35 and 40. Although rare before age 30, primary ovarian insufficiency is possible in younger women and even in teens.
  • Family history. Having a family history of primary ovarian insufficiency increases your risk of developing this disorder.
  • Ovarian surgery. Surgeries involving the ovaries increase the risk of primary ovarian insufficiency.

Complications

Complications of primary ovarian insufficiency include:

  • Infertility. Inability to get pregnant can be a complication of primary ovarian insufficiency. In rare cases, pregnancy is possible until the eggs are depleted.
  • Osteoporosis. The hormone estrogen helps maintain strong bones. Women with low levels of estrogen have an increased risk of developing weak and brittle bones (osteoporosis), which are more likely to break than healthy bones.
  • Depression or anxiety. The risk of infertility and other complications arising from low estrogen levels causes some women to become depressed or anxious.
  • Heart disease. Early loss of estrogen might increase your risk.

Oct. 22, 2019
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  4. Moreira AM, et al. Primary ovarian insufficiency: Different approaches in three cases and a review of literature. Endocrinology, Diabetes & Metabolism Case Reports. 2016; doi:10.1530/EDM-16-0026.
  5. American College of Obstetricians and Gynecologists. Committee Opinion No. 698: Hormone therapy in primary ovarian insufficiency. Obstetrics & Gynecology. 2017; doi:10.1097/AOG.0000000000002044.
  6. Sullivan SD, et al. Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause. Fertility and Sterility. 2016; doi:10.1016/j.fertnstert.2016.09.046.
  7. Top questions about your menstrual cycle. Office on Women's Health. https://www.womenshealth.gov/menstrual-cycle/your-menstrual-cycle. Accessed July 23, 2019.
  8. Dietary reference intakes for calcium and vitamin D. National Academies of Sciences, Engineering, and Medicine. http://www.nationalacademies.org/hmd/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx. Accessed Aug. 2, 2019.
  9. Welt CK. Management of spontaneous primary ovarian insufficiency (premature ovarian failure). https://www.uptodate.com/contents/search. Accessed July 31, 2019.

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