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 eggs or normal amounts of the hormone estrogen - which can lead to infertility and other problems.
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.
When premature ovarian failure does cause infertility, however, fertility treatment is unlikely to be successful. Restoring estrogen levels helps prevent other complications of premature ovarian failure, such as osteoporosis.
Signs and symptoms of premature ovarian failure include:
- Irregular or skipped periods (amenorrhea)
- Hot flashes or night sweats
- Vaginal dryness
- Irritability or difficulty concentrating
- Decreased sexual desire
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. The signs and symptoms of premature ovarian failure are similar to those experienced by a woman going through menopause and are typical of estrogen deficiency.
When to see a doctor
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, a change in diet or exercise habits or, rarely, cancer of the uterus - but it's best to get evaluated 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 provider to help you sort through the emotional consequences of premature ovarian failure.
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 (FSH). This hormone causes a small number of the egg-containing follicles in the ovaries 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 FSH is no longer needed.
If the follicles don't mature properly - and don't release adequate 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 FSH circulating in their blood.
In women with normal ovarian function, the pituitary gland releases another hormone, called luteinizing hormone (LH). This hormone causes the mature follicle to 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.
Factors that increase your risk of developing premature ovarian failure include:
- 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.