Definition and Overview

Ovaries are a tiny pair of glands found on each side of the womb (uterus). They are a part of a woman’s reproductive and endocrine systems. Their main role is to produce eggs and female hormones. Every month, healthy ovaries release an egg that is ready for fertilisation. This stops when a woman enters menopause at around age 50.

However, certain diseases can affect the ovaries and cause them to fail in women who are of childbearing age. This means that they stop releasing eggs before age 40. The condition, which is called premature ovarian failure (POF), results in infertility.

Although they share the same symptoms, POF should not be confused with premature menopause. Unlike in menopause, women with POF still get their period although not on a monthly basis. Sometimes, they only get their period three to four times a year. Because of this, they still have a chance to get pregnant. However, their chances of conceiving are very slim when compared to women with healthy ovaries.

There is currently no cure for POF nor ways to prevent it. Available treatments are used mainly to relieve its symptoms.

The condition affects 1 in every 100 women younger than 40 years of age.

Causes of Condition

Often, doctors cannot find a reason or an explanation as to why POF occurs in some women. However, in some cases, the disorder is associated with the following:

  • Autoimmune disorder - Sometimes, the immune system attacks healthy tissue for unknown reasons. In this case, it attacks the endocrine glands and the ovaries. It also causes damage to follicles that contain the eggs. Women with an autoimmune factor are advised to undergo regular testing to check the function of their adrenal and thyroid glands. Failure of these glands can result not just in POF but also other life-threatening medical problems.

  • Genetics - Some women with POF have been found to have a Y chromosome. This is one of the reasons why ovarian tumours form. Also, they only have one normal X chromosome instead of two.

  • Radiation and chemotherapy - Women who have had childhood cancer have a higher than average risk of POF. Their risk further increases if they have undergone radiation and chemotherapy.

  • Toxins - Some researchers believe that exposure to toxins increases the risk of POF. These toxins include viruses, chemicals, and cigarette smoke.

If left untreated, the disorder can make the patient infertile. It can also lead to osteoporosis and heart disease. In many patients, it also causes severe depression and anxiety.

Key Symptoms

  • Irregular periods - 100% of patients with POF have irregular periods. Some get their period only a couple of times a year. However, it is important to note that not all women with this symptom have POF. This can occur for a number of different reasons. POF is one of the less common causes. More often, it occurs due to stress and certain disorders. These include polycystic ovary syndrome (PCOS) and gynaecological problems.

  • Difficulty getting pregnant. The majority of patients are infertile. This means they do not get pregnant even after at least one year of unprotected sex.

  • Menopause-like symptoms - Patients often complain of hot flashes, night sweats, and vaginal dryness.

  • Decreased sex drive - Some patients lose interest in sex partly because the condition also causes pain during intercourse.

Who to See and Types of Treatments Available

Any changes to a woman’s menstrual cycle must be brought to the attention of a gynaecologist. This symptom always signals problems with the ovaries. Often, its cause can be treated if diagnosed early. Common tests used to diagnose it are:

  • Pregnancy test - This is a standard test used when a woman suddenly stops getting her monthly period. If the results are negative, other tests will be used to determine the cause of the symptom.

  • Blood and urine tests - These tests are used to check the levels of follicle-stimulating hormones (FSH) and estradiol, which is a type of estrogen. In women with POF, the levels of FSH are abnormally high while the levels of estradiol are abnormally low.

  • Genetic testing - This is used to detect chromosomal defects that might explain the patient’s symptoms.

  • Review of the patient’s medical history - The doctor would want to know if the patient has a history of childhood cancer and if they received any form of cancer treatment in the past.

  • Review of the patient’s symptoms - Doctors would ask when the symptoms started and their severity.

Treatment

Treatment of POF focuses on relieving the symptoms. None of the available treatments can cure or reverse the effects of the disorder. The standard treatment for POF is hormone therapy. Patients are given hormones that their body no longer makes or produces in very small quantities. This therapy relieves hot flashes and vaginal dryness as well as night sweats. It is also believed to have long-term benefits in lowering the risk of dementia and heart diseases. Patients are also advised to take calcium and vitamin D supplements because of their increased risk of bone loss.

Patients who wish to have children may consider in vitro fertilisation (IVF). It involves extracting eggs and fertilising them with sperm in a laboratory dish. Patients and their partners may opt to use donor eggs for this procedure.

It is important to note that IVF can be very expensive in many countries. Couples must also understand that the process can be emotionally stressful and that it does not provide 100% guarantee of success. The success rates of many fertility clinics can be as high as 55%. This means that there is at least 45% chance that the procedure will fail. However, many couples have realised their dream of having children with this method.

References:

  • AskMayoExpert. Menopausal hormone therapy: What factors influence the risk to benefit ratio associated with menopausal hormone therapy? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.

  • Facts about menopausal hormone therapy. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/resources/heart/menopausal-hormone-therapy-facts.

  • The 2012 hormone therapy position statement of The North American Menopause Society. Menopause: The Journal of the North American Menopause Society. 2012;19:257.

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