19 May 2023

Premature Ovarian Failure: Understanding the Role of Ovarian Follicles

premature ovarian failure
By the Editorial Comitee IVI Blog

Premature ovarian failure, also called primary ovarian insufficiency, occurs when the ovaries stop functioning normally before the age of 40. When this happens, the ovaries do not produce normal amounts of estrogen or ovulate regularly. This condition affects 1% of women under 40 in Europe and is often a cause of infertility.

Today on our blog, we are discussing this condition, what causes it, its symptoms, and how it differs from menopause and premature menopause. We will also explain how assisted reproduction can help women who want to become mothers and have been diagnosed with this condition.

What causes premature ovarian failure?

There are several factors that can cause premature ovarian failure. Below, we explain the main causes:

  • Chromosomal changes: Some genetic disorders may be associated with premature ovarian failure, such as Turner syndrome and fragile X syndrome.
  • Toxins: Chemotherapy and radiation therapy can damage the genetic material in cells. Other substances like tobacco smoke, pesticides, and viruses can accelerate ovarian insufficiency due to the toxic substances they contain.
  • Autoimmune disease: In this case, the immune response to ovarian tissue produces antibodies that damage the follicles and the oocyte. The factors that trigger this immune response have not been precisely determined, but exposure to a virus is a possibility.
  • Unknown factors: The cause of primary ovarian insufficiency is often unknown. Specialists conduct additional tests, but in many cases, the reasons remain unknown.

On the other hand, there are factors that can increase the risk of developing premature ovarian failure:

  • Age: The highest risk age range is between 35 and 40 years old. Although it is rare for it to manifest before the age of 30, primary ovarian insufficiency is possible in young women and even in adolescents.
  • Family history: Family history of premature ovarian failure increases the risk of developing this disorder.
  • Ovarian surgery: Surgeries involving the ovaries increase the likelihood of experiencing primary ovarian insufficiency.

Premature ovarian failure symptoms

Premature ovarian failure is sometimes confused with menopause, mainly because the symptoms are similar. However, they are not the same and therefore do not have the same effects, as we will explain later. These are some of the symptoms of premature ovarian failure:

  • Irregular or intermittent cycles. They can be like this for years or develop after a pregnancy or after stopping the use of oral contraceptives.
  • Difficulty getting pregnant
  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Dry eyes
  • Instability or difficulty concentrating
  • Decreased libido

If you have not had your period for more than three months, you should consult your doctor. The loss of periods can be due to various causes, including pregnancy. It can also be caused by stress or changes in diet or exercise habits. It is always advisable to undergo a check-up to evaluate the reason for changes in your menstrual cycle. In addition, low levels of estrogen are a cause of osteoporosis and increase the risk of heart disease, so it is important to monitor them.

Can you get pregnant if you suffer from premature ovarian failure?

Women suffering from premature ovarian failure may have irregular cycles for years and still be able to get pregnant. However, their chances are reduced because the number and quality of eggs decrease.

Pregnancy is not possible in the case of premature menopause, as this does result in amenorrhea, making it incompatible with the possibility of achieving a pregnancy. That’s why it’s important to undergo the necessary tests to determine if the irregularities are due to premature ovarian failure. While most women present few symptoms, a specialist may suspect it due to irregular cycles and/or difficulties in achieving pregnancy.

The diagnosis usually involves a physical examination, including a pelvic evaluation. Additionally, to verify the diagnosis of premature ovarian failure, the following tests may be requested:

  • Pregnancy test
  • Hormonal analysis, to monitor levels of FSH, estradiol, and prolactin.
  • Karyotype, to look for unusual chromosomal changes and search for mutations in the FMR1 gene, associated with fragile X syndrome.

Treatment of premature ovarian insufficiency

The treatment of primary ovarian insufficiency is focused on managing complications resulting from estrogen deficiency. Restoring estrogen levels can help prevent some complications such as osteoporosis.

Here are some ways to compensate for the hormonal deficit caused by POI:

  • Treatment with estrogens. In addition to preventing osteoporosis, it also helps relieve hot flashes and other symptoms. Adding progesterone to this treatment protects the endometrium from pre-cancerous changes that may occur from taking only estrogens. The combination of estrogens and progesterone can restore menstrual regularity but not restore ovarian function. In women of advanced maternal age, long-term estrogen therapy has been associated with an increased risk of cardiovascular disease. However, in young women, the benefits of hormone therapy outweigh the potential risks.
  • Calcium and vitamin D supplements. Both nutrients are important for preventing osteoporosis. A bone density test may be necessary before starting to take these supplements. For women aged 19-50, experts recommend a calcium dose of 1000 mg/day, increasing to 1200 mg/day when over 50 years old. As for the optimal dose of vitamin D, it is still unclear. A starting point for adult women is 600-800 IU per day through food or supplements.

Fertility treatment for premature ovarian failure

There is no treatment that guarantees restoring fertility, but pregnancy can be achieved through assisted reproduction. Women or couples who wish to have a child can make their dream come true by in vitro fertilization with their own eggs or donated eggs.

At IVI, we can study your case and determine the best option for you to fulfill your dream of having a child. If you do not become pregnant and experience any of the symptoms we have described, you can arrange a first appointment in which we will analyze your situation. Call us or leave your information on our web form, and our team will contact you.

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