Primary ovarian insufficiency is also known as early ovarian failure. Ovarian insufficiency occurs when a woman’s ovaries stop functioning normally before the age of 40.
Early Ovarian Insufficiency: Causes, Symptoms, and Treatment
When this occurs, your ovaries do not produce normal levels of estrogen or release eggs regularly. This condition often leads to infertility.
1. What is primary ovarian insufficiency?
Many women experience a natural decline in fertility around the age of 40. They may begin to have irregular periods as they transition into menopause.
For women with ovarian insufficiency, irregular periods and reduced fertility begin before the age of 40. Sometimes, this can start as early as their teenage years.
Women with ovarian insufficiency, irregular periods, and reduced fertility.
Primary ovarian insufficiency is sometimes confused with early menopause, but these conditions are not the same; ovarian insufficiency is different from early menopause.
- In early menopause, a woman’s periods stop before age 40, making it impossible to conceive.
- With ovarian insufficiency, some women may still have irregular or infrequent periods for many years and may even conceive.
Typically, a woman will begin to experience menopause between the ages of 42 and 56. Ovarian insufficiency occurs in 1 in 1,000 women aged 15 to 29 and 1 in 100 women aged 30 to 39. The average age of early onset is 27 years.
2. Signs of primary ovarian insufficiency
The first sign of ovarian insufficiency is often irregular or missed periods. The signs and symptoms of primary ovarian insufficiency are similar to those experienced during natural menopause or estrogen deficiency. Symptoms include:
- Irregular or missed periods, which may persist for many years or develop after pregnancy or stopping birth control.
- Difficulty conceiving.
- Hot flashes.
- Night sweats.
- Vaginal dryness.
- Dry eyes.
- Irritability or difficulty concentrating.
- Decreased libido.
3. Causes of early ovarian insufficiency
Primary ovarian insufficiency can be caused by:
Chromosomal defects
Some genetic disorders are associated with primary ovarian insufficiency. These include Turner syndrome, where a woman has only one normal X chromosome and a second altered X chromosome, and Fragile X syndrome, where the X chromosomes are fragile and prone to breakage.
Toxins
Chemotherapy and radiation therapy are common causes of ovarian insufficiency due to toxins. These treatments can damage the genetic material in cells. Other toxins, such as tobacco smoke, chemicals, pesticides, and viruses, can accelerate ovarian insufficiency.
An immune response to ovarian tissue (autoimmune disease)
Many studies have shown that ovarian insufficiency is related to issues with ovarian follicles. Follicles are small sacs in the ovaries where eggs develop and mature. A woman’s immune system produces antibodies against ovarian tissue, harming the follicles and damaging the eggs. The cause of this immune response is unclear, but exposure to viruses is a possibility.
Other pathogenic factors
Factors that increase the risk of developing primary ovarian insufficiency include:
- Age: The risk increases between the ages of 35 and 40. Although rare before age 30, primary ovarian insufficiency can still occur in younger women and even in teenagers.
- Family history: In some cases, women with a family history of primary ovarian insufficiency, such as mothers or sisters with the condition, are more likely to develop it themselves. About 4% of women experience this condition.
- Ovarian surgery: Surgeries related to the ovaries increase the risk of primary ovarian insufficiency.
- Genetic factors: Certain genetic changes and conditions increase a woman’s risk of developing POI.
- Individuals with certain diseases: Autoimmune diseases and viral infections, such as herpes simplex virus (HSV) and mumps virus.
- Excessive weight loss can also lead to early ovarian insufficiency, as rapid weight loss significantly reduces body fat, affecting estrogen levels and disrupting menstrual cycles.
- Women who abuse stimulants such as caffeine, tobacco, and alcohol may impact hormone production.
- Multiple abortions can severely affect the ovaries, disrupting hormone levels.
4. Complications of early ovarian insufficiency
Complications of early ovarian insufficiency include:
- Infertility: This can be a complication of early ovarian insufficiency. In rare cases, pregnancy may occur until ovulation stops. Low thyroid hormone levels can affect your metabolism and may cause very low energy, sluggishness, and other symptoms.
- Dry eye syndrome and ocular surface disease: Some women with ovarian insufficiency experience one of these eye conditions. Both can cause discomfort and may lead to blurred vision. If untreated, these conditions can cause permanent eye damage.
- Osteoporosis: Estrogen helps maintain strong bones. Without sufficient estrogen, women with ovarian insufficiency often develop osteoporosis, a bone disease that results in weak, brittle bones that are prone to fractures.
- Depression or anxiety: The risk of infertility and other complications arising from low estrogen levels may lead some women to experience depression or anxiety.
- Heart disease: Lower levels of estrogen can affect the lining of blood vessels and may increase cholesterol buildup in arteries. These factors raise the risk of atherosclerosis (hardening of the arteries).
5. How is primary ovarian insufficiency diagnosed?
To diagnose ovarian insufficiency, doctors may ask and perform the following:
Medical history, including whether you have relatives with ovarian insufficiency.
- Pregnancy test to confirm you are not pregnant.
- Physical examination to look for signs of other disorders that may cause symptoms.
- Blood tests to check certain hormone levels. Blood tests may also analyze chromosomes, which are parts of cells containing genetic information.
- Pelvic ultrasound to see if the ovaries are enlarged or have many follicles.
6. Treatment for primary ovarian insufficiency
Currently, there is no proven treatment that can restore normal ovarian function in women. However, there are treatments for some symptoms of ovarian insufficiency. Additionally, there are ways to minimize your health risks and treat conditions that ovarian insufficiency may cause:
Hormone replacement therapy is the most common treatment. It provides your body with estrogen and other hormones that the ovaries do not produce. Hormone replacement therapy improves sexual health and reduces the risk of heart disease and osteoporosis. It is typically used until around age 50, which is when menopause usually begins.
- Calcium and vitamin D supplementation. Since women with POI are at higher risk for osteoporosis, you should supplement calcium and vitamin D daily.
- In vitro fertilization (IVF). If you have ovarian insufficiency and wish to conceive, you may consider trying IVF.
In simple terms, early ovarian insufficiency is early menopause. Typically, a woman will start to experience menopause between the ages of 42 and 56.
Ovarian insufficiency occurs in 1 in 1,000 women aged 15 to 29 and 1 in 100 women aged 30 to 39. The average age of early onset is 27 years. In some cases, a family history of ovarian insufficiency is associated with about 4% of women experiencing this condition.
Regular physical activity and maintaining a healthy weight. Regular exercise and weight management can reduce the risk of osteoporosis and heart disease.
Treating related conditions. If you have a condition related to ovarian insufficiency, it is important to treat those conditions as well. Treatment may involve medications and hormones. If you have untreated hypothyroidism, your doctor will prescribe thyroid medication.
If autoimmune-related issues are found, steroid therapy may be used for some individuals.
Restoring estrogen levels in women with premature ovarian failure helps prevent certain complications that arise due to low estrogen, such as osteoporosis.
