Premature ovarian failure (POF) is a condition that is characterized by the ovaries ceasing to function before the age of 40. This is distinct from premature menopause as women still have an occasional period and it is possible for them to get pregnant. POF affects approximately 1 in 100 women of childbearing age younger than 40 years old.
Signs and Symptoms
The first sign of premature ovary failure is usually missed periods. Many young women experience irregular menses (oligomenorrhea) or skin periods (amenorrhea) for various reasons, one of which being POF.
Affected women will also eventually experience symptoms similar to those of menopause such as:
- Hot flushes
- Night sweats
- Mood swings and irritability
- Reduced libido
- Vaginal dryness and pain during sex
- Poor concentration
The diagnosis of premature ovarian failure is made based on reported symptoms, physical examination, and the results of laboratory and imaging diagnostic tests.
A blood test is required to check the level of hormones such as estrogen, follicle stimulating hormone (FSH), and luteinizing hormone (LH). A woman with premature ovarian failure will have elevated pituitary hormone (FSH and LH) with low levels of estrogen, which is usually produced in the ovaries.
A transvaginal ultrasound may also be used to investigate the structure and function of the ovaries. Affected women tend to have smaller than average ovaries with few visible follicles.
The cause of the condition is not clear in most women. However, it may be associated with specific events in some cases, such as a history of chemotherapy or radiation treatment. Additionally, an autoimmune response may sometimes cause the body to destroy the endocrine organs such as the ovaries, which can be detected by the presence of specific antibodies.
In some cases, premature ovarian syndrome may be caused by genetic factors. For example, there may be some Y chromosome present, which can lead to the growth of tumors in the ovaries. Other women may be affected by Turner syndrome, which involves only one normal X chromosome, rather than two. However, the cause of these genetic defects appears to be random and has not been established.
There is no cure for premature ovarian failure and there is no way known to restore the normal ovarian function.
Hormone replacement therapy is recommended for most affected women until the age of 50 to minimize symptoms of the condition and reduce loss of bone (osteopenia). There are some risks associated with hormone therapy, such as an increased risk of breast cancer, and it may be contraindicated in some women such as those with a strong family history of breast cancer. In these women, a healthy diet and regular exercise should be emphasized.
Women with POF commonly suffer from depression, anxiety, or other psychological conditions. It is important that they receive adequate support from a health professional such as a psychologist to help manage this.
Pregnancy and Fertility
Most women with premature ovarian failure are unable to conceive a child naturally, although it can happen spontaneously in rare cases.
For women who wish to have children, fertility treatments may be beneficial and helps some women to conceive. However, most women will require donor eggs and in-vitro fertilization to become pregnant. For some women, adoption may be a more appropriate option.
Reviewed by Susha Cheriyedath, MSc