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Primary ovarian insufficiency occurs when the ovaries stop working properly before the age of 40. When this happens, your ovaries stop producing the hormone estrogen and stop releasing eggs on a regular basis. This disorder, also known as premature ovarian failure, frequently results in infertility.
Primary ovarian insufficiency is frequently confused with premature menopause, however the two are not the same. Women suffering from primary ovarian insufficiency may have irregular or infrequent periods for years and may even become pregnant. Women who experience premature menopause, on the other hand, stop having periods and are unable to become pregnant.
Restoring estrogen levels in women with primary ovarian insufficiency aids in the prevention of several problems caused by low estrogen, such as osteoporosis.
WHAT ARE THE SYMPTOMS OF PRIMARY OVARIAN INSUFFICIENCY?
Primary ovarian insufficiency has symptoms that are similar to menopause or estrogen deprivation. They are as follows:
- Irregular or skipped periods that might last for years or begin after a pregnancy or after discontinuing birth control pills
- Obstacles to pregnancy
- Flashes of heat
- Sweating at night
- Dryness of the vagina
- Dry eyes
- Irritability or inability to concentrate
- decreased sexual desire
WHAT ARE THE CAUSES OF PRIMARY OVARIAN INSUFFICIENCY?
The following conditions can cause primary ovarian insufficiency:
- Changes in chromosomes: Some hereditary conditions are linked to primary ovarian insufficiency. These diseases include mosaic Turner syndrome, in which you have one typical X chromosome and one mutant X chromosome, and in which X chromosomes are fragile and break (fragile X syndrome).
- Toxins: Toxin-induced ovarian failure is commonly caused by chemotherapy and radiation therapy. These treatments have the potential to harm cells' genetic material. Toxins like cigarette smoke, chemicals, pesticides, and viruses may also hasten ovarian failure.
- An immune system response to ovarian tissue (autoimmune disease): In this uncommon condition, your immune system creates antibodies against your ovarian tissue, causing damage to the egg-containing follicles and the egg. It is unknown what causes the immunological response, but viral exposure is one potential.
- Unknown factors: The exact cause of primary ovarian insufficiency is frequently unknown (idiopathic). Your doctor may recommend additional tests to determine the cause, although in many situations, the cause is unknown.
WHAT ARE THE RISK FACTORS FOR PRIMARY OVARIAN INSUFFICIENCY?
The following factors enhance your chances of getting primary ovarian insufficiency:
- Age: Between the ages of 35 and 40, the risk increases. Although uncommon before the age of 30, primary ovarian insufficiency can occur in younger women and even teenagers.
- Family history: A family history of primary ovarian insufficiency increases your chances of having it.
- Ovarian surgery: Ovarian surgery increases the likelihood of developing primary ovarian insufficiency.
WHAT ARE THE COMPLICATIONS OF PRIMARY OVARIAN INSUFFICIENCY?
Primary ovarian insufficiency complications include:
- Infertility: Inability to conceive is a complication of primary ovarian insufficiency. Pregnancy is possible in rare situations until the eggs are depleted.
- Osteoporosis: The hormone estrogen contributes to bone strength. Women with low estrogen levels are more likely to have weak and brittle bones (osteoporosis), which are more likely to break than healthy bones.
- Anxiety or depression: Some women get melancholy or nervous as a result of the risk of infertility and other issues caused by low estrogen levels.
- Heart disease: Early estrogen loss may raise your risk.
HOW IS PRIMARY OVARIAN INSUFFICIENCY DIAGNOSED?
Most women show few symptoms of primary ovarian insufficiency, but your doctor may suspect the disease if you have irregular periods or are having difficulty conceiving. A physical exam, including a pelvic exam, is frequently used to make a diagnosis. Your clinician may inquire about your menstrual cycle, previous ovarian surgery, and exposure to toxins such as chemotherapy or radiation therapy.
Your doctor may suggest one or more tests to look for:
- Pregnancy: If you're of childbearing age and have missed a period, a pregnancy test will screen for an unexpected pregnancy.
- Hormone levels: A number of hormones in your blood may be tested by your provider, including follicle-stimulating hormone (FSH), estradiol, a kind of estrogen, and the hormone that increases breast milk production (prolactin).
- Changes in chromosomes or specific genes: A karyotype analysis is a blood test that looks for unique variations in your chromosomes. Your doctor may also examine you to discover if you have the FMR1 gene, which is linked to fragile X syndrome.
WHAT ARE THE TREATMENTS FOR PRIMARY OVARIAN INSUFFICIENCY?
Treatment for primary ovarian insufficiency often focuses on the issues caused by estrogen shortage. Your doctor may advise you to do the following:
- Estrogen therapy: Estrogen therapy can help prevent osteoporosis and reduce hot flashes and other symptoms of estrogen insufficiency. If you still have your uterus, your practitioner may administer estrogen in conjunction with the hormone progesterone. Adding progesterone protects your uterine lining (endometrium) from precancerous alterations induced by estrogen alone.
The combination of hormones may restore your period, but it will not restore ovarian function. Depending on your health and preferences, you may continue to utilize hormone treatment until the age of 50 or 51, which is the average age for natural menopause.
Long-term estrogen plus progestin therapy in older women has been related to an increased risk of heart and blood vessel problems, as well as breast cancer. However, in young women with primary ovarian insufficiency, the benefits of hormone therapy exceed the hazards.
- Calcium and vitamin D supplements: Both nutrients are vital for preventing osteoporosis, but you may not get enough through your food or from sun exposure. Before beginning supplements, your practitioner may recommend bone density testing to establish a baseline value.
Experts normally recommend 1,000 milligrams (mg) of calcium per day through diet or supplements for women aged 19 to 50, increasing to 1,200 mg per day for women aged 51 and beyond.
The recommended daily intake of vitamin D is unknown. Adults should consume 600 to 800 international units (IU) per day, either through food or supplements. If your vitamin D levels are low, your doctor may advise you to take larger amounts.
Addressing infertility
There is no proven treatment to restore fertility. Some women and their partners try to conceive with donated eggs through in vitro fertilization. The process entails extracting eggs from a donor and fertilizing them with sperm. After then, a fertilized egg (embryo) is implanted in your uterus.
HOME REMEDIES FOR PRIMARY OVARIAN INSUFFICIENCY
It can be upsetting to learn that you have primary ovarian insufficiency. However, with proper therapy and self-care, you can live a healthy life.
- Find more about other options for having children: If you want to start a family, talk to your doctor about possibilities including in vitro fertilization with donor eggs or adoption.
- Discuss your contraceptive options with your provider: A small fraction of women with primary ovarian insufficiency conceive on their own. Consider utilizing birth control if you don't want to become pregnant.
- Maintain the strength of your bones: Eat a calcium-rich diet, engage in weight-bearing exercises such as walking and upper-body strength training exercises, and avoid smoking. Check with your doctor to see if you need calcium and vitamin D pills.
- Maintain a record of your menstrual cycle: Get a pregnancy test if you miss a period while taking hormone therapy that causes you to have a monthly cycle.