Dr. Angelo Smith M.DWHPL

DefinitionPremature ovarian failure is also

known as primary ovarian insufficiency It refers to a loss of normal function

of ovaries before age 40Affects 1% of womenDepending on the cause, premature

ovarian failure may develop as early as the teen years, or the problem may have been present from birth.

Primary ovarian insufficiency (POI) is characterized by amenorrhea, hypoestrogenism, and elevated serum gonadotropin

levels in women younger than 40 years.

Anatomy

The ovary is a ductless reproductive gland in which the female reproductive cells are produced.

Although about 1 million oocytes are present at birth in the human ovary, only about 500 of these ovulate, and the rest are wasted.

If the ovaries fail, they won’t produce normal amounts of the hormone estrogen or release eggs regularly which will result into Infertility.

Causes

Genetic disordersAutoimmune diseasesTuberculosis of the genital tractSmokingRadiation and/or chemotherapyOvarian failure following hysterectomyProlonged GnRH (Gonadatrophin Releasing Hormone)

therapyEnzyme defectsResistant ovaryInduction of multiple ovulation in infertility

Chromosomal defects. • Certain genetic disorders are associated which

include Turner's syndrome, a condition in which a woman has only one X chromosome instead of the usual two, and fragile X syndrome.

Toxins. • Chemotherapy and radiation therapy 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.

Autoimmune: Immune system may produce

antibodies against own ovarian tissue, harming the egg-containing follicles and damaging the egg. What triggers the immune response is unclear, but exposure to a virus is one possibility.

Risk Factors

Age : The risk of ovarian failure rises sharply between age 35 and age 40.

Family history : Having a family history of premature ovarian failure increases your risk of developing this disorder.

Symptoms

Irregular or skipped periods (amenorrhea)Hot flashesNight sweatsVaginal drynessIrritability Poor concentrationDecreased sexual desire

Complications

Infertility. Inability to get pregnant may be the most troubling complication of premature ovarian failure, although in rare cases, pregnancy is possible.

Osteoporosis. The hormone estrogen helps maintain strong bones. Women with low levels of estrogen have an increased risk of developing weak and brittle bones (osteoporosis), which are more likely to break than healthy bones.

Depression or anxiety. The risk of infertility and other complications arising from low estrogen levels may cause some women to become depressed or anxious.

Tests & DiagnosisFollicle-stimulating hormone (FSH) test.

FSH is a hormone released by the pituitary gland that stimulates the growth of follicles in the ovaries. Women with premature ovarian failure often have abnormally high levels of FSH in the blood.

POF patients is over 40 mlU/ml (post-menopausal range).

Estradiol test. The blood level of estradiol, a type of estrogen, is

usually low in women with premature ovarian failure.Prolactin test

High levels of prolactin the hormone that stimulates breast milk production in the blood can lead to problems with ovulation.

Tests & DiagnosisKaryotype.

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.

FMR1 gene testing. The FMR1 gene is the gene associated with fragile X

syndrome an inherited disorder that causes intellectual problems. The FMR1 test looks at both of your X chromosomes to make sure they appear to be normal

Treatmenten therapy. To help prevent osteoporosis and relieve hot flashes

and other symptoms of estrogen deficiency, Estrogen is typically prescribed with another hormone called progesterone.

Adding progesterone protects the lining of your uterus (endometrium) from precancerous changes caused by taking estrogen alone.

In older women, long-term estrogen plus progestin therapy has been linked to an increased risk of heart and blood vessel (cardiovascular) disease and breast cancer.

In young women with premature ovarian failure, however, the benefits of hormone replacement therapy for heart health may outweigh the potential risks.

TreatmentCalcium and vitamin D supplements. Both calcium and vitamin D are important for

preventing osteoporosis. A bone density test shall be suggested before

starting supplements to get a baseline bone density measurement.

For women ages 19 through 50, the Institute of Medicine recommends 1,000 milligrams (mg) of calcium a day through food or supplements, increasing to 1,200 mg a day for women age 51 or older.