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Premature Ovarian Failure

Definition:
Premature ovarian failure refers to a loss of normal function of your ovaries before the age of 40. If your ovaries fail, they don't produce normal amounts of the hormone estrogen — which can lead to infertility and other problems. Premature ovarian failure affects about 1 percent of U.S. women.

Premature ovarian failure is sometimes referred to as premature menopause, but the two conditions are not exactly the same: Women with premature menopause stop having periods, while women with premature ovarian failure may have sporadic periods for years — and may even become pregnant.

Restoring estrogen levels in women with premature ovarian failure helps prevent some complications, such as osteoporosis, but infertility is difficult to treat. Women having problems conceiving a child may choose to explore other means of expanding their families.

Causes:
Your ovaries hold thousands of immature follicles, which contain eggs. At the beginning of each menstrual cycle, your pituitary gland — which secretes a variety of hormones regulating processes throughout your body — secretes follicle-stimulating hormone. This hormone causes a small number of the egg-containing follicles to begin maturing, although usually only one follicle actually reaches maturity. Maturing follicles make estrogen. In turn, rising estrogen levels "notify" the pituitary gland that
follicle-stimulating hormone is no longer needed.

If the follicles don't mature properly — and don't release critical amounts of estrogen — the level of follicle-stimulating hormone continues to increase and remains elevated. This is why women with premature ovarian failure often have high levels of follicle-stimulating hormone circulating in their blood.

In women with normal ovarian function, the pituitary gland releases another hormone, called luteinizing hormone. This hormone causes the mature follicle to burst open, releasing the egg (ovulation). The egg then enters the fallopian tube where it might be fertilized by sperm — resulting in pregnancy. Without the increased estrogen levels released by maturing follicles and subsequent spike of luteinizing hormone, ovulation doesn't occur.

Premature ovarian failure arises when there are few or no "responsive" follicles left in your ovaries (follicle depletion) or when the follicles aren't responding properly (follicle dysfunction).

What causes follicle depletion
Causes of follicle depletion resulting in premature ovarian failure include :

  • Chromosomal defects. Certain genetic disorders are associated with premature ovarian failure. These include Turner's syndrome, a condition in which a woman has only one X chromosome instead of the usual two, and fragile X syndrome, a major cause of mental retardation.
  • Toxins. Chemotherapy and radiation therapy treatments are the most common causes of toxin-induced ovarian failure. These therapies may damage the genetic material in cells. Other toxins such as cigarette smoke, chemicals, pesticides and viruses may hasten ovarian failure.

What causes follicle dysfunction
A cause of follicle dysfunction is damage arising from autoimmune diseases. Infrequently, a woman's body may produce antibodies against her own ovarian tissue, which may harm the egg-containing follicles. It's not certain why this occurs, but the process may be initiated by exposure to a virus.

Often, it's difficult to pinpoint an exact cause of premature ovarian failure. In most cases, the cause is unknown.

Risk Factor :
Several factors may increase your risk of developing premature ovarian failure :

  • Age. The risk of ovarian failure rises as you age. The incidence of developing premature ovarian failure is about one in 250 by age 35 and one in 100 by age 40.
  • Family history. Having a family history of premature ovarian failure increases your risk of developing this disorder. About 10 percent of cases are familial.

When to seek medical advice :
If you notice that you've skipped your period for three months or more, see your doctor to help determine what may be the cause. You may 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 checked out whenever your menstrual cycle changes.

A diagnosis of premature ovarian failure can be difficult to cope with, especially if you had plans to conceive a child. If you're feeling particularly depressed or anxious, consider seeking counseling with a mental health professional to help you sort through the emotional consequences of premature ovarian failure.

Symptoms:
The most common sign of premature ovarian failure is irregular or skipped periods (amenorrhea). Sometimes women with premature ovarian failure experience erratic periods for years, while others first notice skipped periods after a pregnancy or after discontinuing birth control pills.

Other signs and symptoms of premature ovarian failure are similar to those experienced by a woman going through menopause. These signs and symptoms may include :

  • Hot flashes or night sweats
  • Vaginal dryness
  • Irritability or difficulty concentrating

These are typical signs and symptoms of estrogen deficiency.

Diagnosis:
To help make a diagnosis of premature ovarian failure, your doctor may ask about your signs and symptoms, your menstrual cycle, and a history of exposure to any toxins, such as chemotherapy or radiation therapy. Most women have few signs of premature ovarian failure, but you'll likely have a physical examination, including a pelvic exam.

Several blood tests are important in making a diagnosis. These include :

  • Pregnancy test. Pregnancy tests are often performed on women of childbearing age who have missed a period to rule out the possibility of an unexpected pregnancy.
  • Follicle-stimulating hormone (FSH) test. FSH is a hormone released by the pituitary gland that stimulates the growth of follicles in your ovaries. Women with premature ovarian failure often have abnormally high levels of FSH in the blood.
  • Luteinizing hormone (LH) test. Luteinizing hormone prompts a mature follicle within the ovary to release an egg. In women with premature ovarian failure, the level of LH is usually lower than the level of FSH.
  • Serum estradiol test. The blood level of estradiol, a type of estrogen, is usually low in women with premature ovarian failure.
  • Karyotype. This is a test that examines all 46 of your chromosomes for abnormalities. Some women with premature ovarian failure may have only one X chromosome instead of two or may have other chromosomal defects.

Complications :
Several conditions may result from premature ovarian failure :

  • Infertility. Infertility is a troubling challenge for many women with premature ovarian failure. Yet, a very small percentage of women with the condition may become pregnant and deliver healthy babies, so natural conception remains a small possibility.
  • Osteoporosis. The hormone estrogen helps maintain strong bones. Women with low levels of estrogen are at an increased risk of developing weak and brittle bones (osteoporosis), which are more likely to break than are healthy bones.
  • Addison's disease. This disorder results when adrenal glands, small hormone-producing glands located just above each of your kidneys, don't produce sufficient amounts of certain hormones that regulate body functions. Addison's disease can be fatal if it's not treated. Some types of premature ovarian failure may be associated with an increased risk of developing Addison's disease.
  • Depression or anxiety. The risk of infertility and other complications arising from low estrogen levels may cause some women to become anxious or depressed.

Treatment:
Treatment for premature ovarian failure is usually tailored to address the problems that arise from estrogen deficiency :

  • Estrogen therapy. Replacing the estrogen that is normally produced by functioning ovaries is important to help prevent osteoporosis and relieve symptoms of estrogen deficiency, such as vaginal dryness and hot flashes. Prescription estrogen may be paired with another sex hormone, progesterone, to mimic the natural balance of hormones in your body. Hormone replacement therapy may be taken as a pill or applied to your skin as a gel or a patch. You'll likely continue taking hormonal therapy until about the age of 50 or 51 — the average age of natural menopause.

    Some women express concern about taking hormone replacement therapy because of reported associations between long-term estrogen therapy and cardiovascular disease and breast cancer incidence in older women. However, in young women with premature ovarian failure, the benefits of hormone replacement therapy usually outweigh the potential risks.

  • Calcium and vitamin D supplements. Taken together, these supplements are important for bone health and help reduce the development of osteoporosis.

Addressing infertility
Infertility is a common complication of premature ovarian failure. There's no treatment proved to restore fertility in women with this condition. However, some women and their partners choose to pursue an alternative means of conception called in vitro fertilization. This is a procedure in which a woman's eggs are removed, fertilized with her partner's sperm in a laboratory and then returned to the woman's uterus. If the woman's eggs are no longer viable, in vitro fertilization using donor eggs provides the best possibility of carrying a pregnancy.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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